Effect of vitamin D supplementation on outcomes in people with early psychosis

Journal article


Fiona Gaughran, Dominic Stringer, Gabriella Wojewodka, Sabine Landau, Shubulade Smith, Poonam Gardner-Sood, David Taylor, Harriet Jordan, Eromona Whiskey, Amir Krivoy, Simone Ciufolini, Brendon Stubbs, Cecilia Casetta, Julie Williams, Susan Moore, Lauren Allen, Shanaya Rathod, Andrew Boardman, Rehab Khalifa, Mudasir Firdosi, Philip McGuire, Michael Berk and John McGrath 2021. Effect of vitamin D supplementation on outcomes in people with early psychosis. JAMA Network Open. 4 (12), p. e2140858. https://doi.org/10.1001/jamanetworkopen.2021.40858
AuthorsFiona Gaughran, Dominic Stringer, Gabriella Wojewodka, Sabine Landau, Shubulade Smith, Poonam Gardner-Sood, David Taylor, Harriet Jordan, Eromona Whiskey, Amir Krivoy, Simone Ciufolini, Brendon Stubbs, Cecilia Casetta, Julie Williams, Susan Moore, Lauren Allen, Shanaya Rathod, Andrew Boardman, Rehab Khalifa, Mudasir Firdosi, Philip McGuire, Michael Berk and John McGrath
Abstract

Importance People with psychotic disorders have an increased risk of vitamin D deficiency, which is evident during first-episode psychosis (FEP) and associated with unfavorable mental and physical health outcomes.

Objective To examine whether vitamin D supplementation contributes to improved clinical outcomes in FEP.

Design, Setting, and Participants This multisite, double-blind, placebo-controlled, parallel-group randomized clinical trial from the UK examined adults 18 to 65 years of age within 3 years of a first presentation with a functional psychotic disorder who had no contraindication to vitamin D supplementation. A total of 2136 patients were assessed for eligibility, 835 were approached, 686 declined participation or were excluded, 149 were randomized, and 104 were followed up at 6 months. The study recruited participants from January 19, 2016, to June 14, 2019, with the final follow-up (after the last dose) completed on December 20, 2019.

Interventions Monthly augmentation with 120 000 IU of cholecalciferol or placebo.

Main Outcomes and Measures The primary outcome measure was total Positive and Negative Syndrome Scale (PANSS) score at 6 months. Secondary outcomes included total PANSS score at 3 months; PANSS positive, negative, and general psychopathology subscale scores at 3 and 6 months; Global Assessment of Function scores (for symptoms and disability); Calgary Depression Scale score, waist circumference, body mass index, and glycated hemoglobin, total cholesterol, C-reactive protein, and vitamin D concentrations at 6 months; and a planned sensitivity analysis in those with insufficient vitamin D levels at baseline.

Results A total of 149 participants (mean [SD] age, 28.1 (8.5) years; 89 [59.7%] male; 65 [43.6%] Black or of other minoritized racial and ethnic group; 84 [56.4%] White [British, Irish, or of other White ethnicity]) were randomized. No differences were observed in the intention-to-treat analysis in the primary outcome, total PANSS score at 6 months (mean difference, 3.57; 95% CI, −1.11 to 8.25; P = .13), or the secondary outcomes at 3 and 6 months (PANSS positive subscore: mean difference, −0.98; 95% CI, −2.23 to 0.27 at 3 months; mean difference, 0.68; 95% CI, −0.69 to 1.99 at 6 months; PANSS negative subscore: mean difference, 0.68; 95% CI, −1.39 to 2.76 at 3 months; mean difference, 1.56; 95% CI, −0.31 to 3.44 at 6 months; and general psychopathology subscore: mean difference, −2.09; 95% CI, −4.36 to 0.18 at 3 months; mean difference, 1.31; 95% CI, −1.42 to 4.05 at 6 months). There also were no significant differences in the Global Assessment of Function symptom score (mean difference, 0.02; 95% CI, −4.60 to 4.94); Global Assessment of Function disability score (mean difference, −0.01; 95% CI, −5.25 to 5.23), or Calgary Depression Scale score (mean difference, −0.39; 95% CI, −2.05 to 1.26) at 6 months. Vitamin D levels were very low in the study group, especially in Black participants and those who identified as another minoritized racial and ethnic group, 57 of 61 (93.4%) of whom had insufficient vitamin D. The treatment was safe and led to a significant increase in 25-hydroxyvitamin D concentrations.

Conclusions and Relevance In this randomized clinical trial, no association was found between vitamin D supplementation and mental health or metabolic outcomes at 6 months. Because so few patients with FEP were vitamin D replete, the results of this study suggest that this group would benefit from active consideration in future population health strategies.

Trial Registration isrctn.org Identifier: ISRCTN12424842

KeywordsVitamin D; Early psychosis
Year2021
JournalJAMA Network Open
Journal citation4 (12), p. e2140858
PublisherAmerican Medical Association
ISSN2574-3805
Digital Object Identifier (DOI)https://doi.org/10.1001/jamanetworkopen.2021.40858
Official URLhttps://jamanetwork.com/journals/jamanetworkopen/fullarticle/2787456
Publication dates
Online28 Dec 2021
Publication process dates
Accepted27 Oct 2021
Deposited24 May 2023
Publisher's version
License
Output statusPublished
Permalink -

https://repository.canterbury.ac.uk/item/94qqq/effect-of-vitamin-d-supplementation-on-outcomes-in-people-with-early-psychosis

Download files


Publisher's version
  • 50
    total views
  • 21
    total downloads
  • 1
    views this month
  • 1
    downloads this month

Export as

Related outputs

Effective and safe use of intramuscular clozapine in a patient presenting with catatonia and thrombocytopenia.
Thapaliya, Suresh, Whiskey, Eromona and Firdosi, Mudasir 2024. Effective and safe use of intramuscular clozapine in a patient presenting with catatonia and thrombocytopenia. BMJ Case Reports. 17 (8), p. e260197. https://doi.org/10.1136/bcr-2024-260197
Editorial: Prolonged grief disorder: vulnerability and resilience
Margoob, Mushtaq, Firdosi, Mudasir and Katshu, Mohammad Zia Ul Haq 2024. Editorial: Prolonged grief disorder: vulnerability and resilience. Frontiers in Psychiatry. 15, p. 1387937. https://doi.org/10.3389/fpsyt.2024.1387937
Neuroleptic malignant syndrome: a guide for psychiatrists
Wadoo, O., Ouanes, S. and Firdosi, M. 2021. Neuroleptic malignant syndrome: a guide for psychiatrists. BJPsych Advances. 27 (6), pp. 373-382. https://doi.org/10.1192/bja.2020.71