September 06, 2004

Folate, homocysteine, and negative symptoms in schizophrenia

Goff DC, Bottiglieri T, Arning E, Shih V, Freudenreich O, Evins AE, Henderson DC, Baer L, Coyle J. Folate, homocysteine, and negative symptoms in schizophrenia. Am J Psychiatry. 2004 Sep;161(9):1705-8.

This is an article that tries to look for an explanation for why patients with schizophrenia have negative symptoms. Negative symptoms are considered the symptoms of schizophrenia that can be very debilitating but are often inaccurately not thought of as the primary symptoms of the disorder. Examples of negative symptoms are a flat or blunted affect (affect is the way someone demonstrates their emotions externally), lack of motivation, poor personal hygiene, decreased cognition (ability to problem solve, etc.), difficulty with interpersonal relations, etc. The authors in this study propose that vitamins in our blood, folate (folic acid) and homocysteine, might have a role in the development of these symptoms.

Folate and homocysteine are vitamins that help with particular reactions in the body and brain. Low levels of folate can be associated with problems with nerves (neuropathy) and in newly pregnant women, low levels of folate are associated with birth defects like spina bifida. Homocysteine is a molecule that helps with various reactions in the body that impact how amino acids are processed. Elevated homocysteine is associated with increased blood clots and strokes.

In patients with schizophrenia, the authors noted that they had a lower average level of folate compared to a population of people without schizophrenia. One possible explanation for the difference may be that people with schizophrenia smoke cigarettes more than the general population and cigarettes may lower folate levels. Also, people with schizophrenia, and particularly those with prominent negative symptoms, may have difficulty eating the green leafy vegetables where one might get folate into their diet. Thus, decreased folate could actually be a symptom of the negative symptoms rather than a possible cause. With homocysteine, the authors did not find that it played a role in negative symptoms.

This was a small study and the results do not give a clear picture for the role of folate in schizophrenia. However, it is possible that in the future more research could be done of the role of folate and clinical changes could be determined at that point. At this point, taking supplemental folate has not been shown to improve negative symptoms, however it is a relatively safe vitamin (it is in every woman's multivitamin) and so it would be a safe intervention to try with your doctor's permission.

Supported by NIMH grants MH-02025 (Dr. Goff) and MH-60450 (Dr.
Coyle) and by an Independent Investigator Award from the National
Alliance for Research on Schizophrenia and Depression (Dr. Goff).

Here is a link to the article on Pubmed

Author: Jacob Ballon


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