Association between psychiatric disorders and iron deficiency anemia

“Association between psychiatric disorders and iron deficiency anemia among children and adolescents: a nationwide population-based study” Presented by: Lindsey Sumpman Chen, Mu-Hong, et al. "Association between psychiatric disorders and iron deficiency anemia among children and adolescents: a nationwide population-based study. " BMC Psychiatry. Bio. Med Central, 4 June 2013. Web. 14 May 2015. <http: //www. biomedcentral. com/1471 -244 X/13/161>.

Introduction ● Iron deficiency anemia is the most common nutritional deficiency worldwide ● Iron deficiency: two or more abnormal measurements ○ Serum ferritin ○ transferrin saturation ○ erythrocyte protoporphyrin

Introduction ● Anemia occurs when the deficiency is so extreme that is affects the ability of hemoglobin to transport oxygen ● This team studied the association between iron deficiency anemia and psychiatric disorders

Review of Literature 1985: Iron deficiency is the most prevalent nutritional deficiency De. Maeyer E, Adiels-Tegman M: The prevalence of anaemia in the world. World Health Stat Q 38(3): 302– 316 1985, 1991: Iron plays a crucial role in the development of the central nervous system Pollitt E: Effects of a diet deficient in iron on the growth and development of preschool and school-age children. Food Nutr Bull 1991, 13: 110– 118 2001: Abnormal measurements for iron deficiency are defined and it is difficult to self-detect this disorder World Health Organization, Dept. of Nutrition for Health and Development: Iron deficiency anaemia: assessment, prevention and control: a guide for programme managers. Geneva: World Health Organization; 2001. 2003: Iron is key in the development and functioning of different neurotransmitters (dopamine, norepinephrine, serotonin) Beard J: Iron deficiency alters brain development and functioning. J Nutr 2003, 133(5 Suppl 1): 1468 S– 1472 S.

Review of Literature 2008: Ferritin level is related to behavioral problems in children with ADHD Oner O, Alkar OY, Oner P: Relation of ferritin levels with symptom ratings and cognitive performance in children with attention deficit hyperactivity disorder. Pediatr Int 2008, 50(1): 40– 44. 2011: People with lower serum ferritin concentration levels had a higher prevalence of depressive symptoms Yi S, Nanri A, Poudel-Tandukar K, Nonaka D, Matsushita Y, Hori A, Mizoue T: Association between serum ferritin concentrations and depressive symptoms in Japanese municipal employees. Psychiatry Res 2011, 189(3): 368– 372. 2012: A high prevalence (30%) of IDA was observed in children with autism spectrum disorder Herguner S, Kelesoglu FM, Tanidir C, Copur M: Ferritin and iron levels in children with autistic disorder. Eur J Pediatr 2012, 171(1): 143– 146. 2012: Infants with IDA showed significantly lower scores on language, environmental sound perception, and motor measures when compared with infants with normal iron status Beltran-Navarro B, Matute E, Vasquez-Garibay E, Zarabozo D: Effect of chronic iron deficiency on neuropsychological domains in infants. J Child Neurol 2012, 27(3): 297– 303

Hypothesis -Clarify the association between IDA and various psychiatric disorders among children and adolescents SPECIFICALLY “We hypothesized that children and adolescents with ADHD exhibited higher risk of having psychiatric disorder. ”

Methodology ● 1, 000 randomly chosen subjects in Taiwan by National Health Insurance program ● Children and adolescents (under age 18) ● Found those diagnosed with iron deficiency anemia (IDA) between January 1996 and December 2008 ● Those found to have an overlap of IDA and psychiatric disorders became the subjects of the study

Methodology ● The following disorders were investigated: o schizophrenia o unipolar depressive disorder o major depressive disorder o dysthymic depressive disorder o o o o obsessive-compulsive disorder anxiety disorder tic disorder autistic spectrum disorder attention-deficit hyperactivity disorder delayed developmental retardation

Methodology ● Any subject who had a health condition affecting iron levels was not included ● Control group- 4 control for every 1 patient o Had no health issues or condition ● A two-tailed T-test was conducted ● P-values less than. 05

Discussion ● Supported previous evidence that IDA is significantly associated with increased risk of o o o unipolar depressive disorder bipolar disorder autism spectrum disorder ADHD delayed developmental retardation

Discussion ● Increased risk of ADHD was noted among those with IDA in this study o disturbs norepinephrine and dopamine neurotransmitters ● Increased risk of ASD with IDA o o possible reciprocal effect children with ASD are typically picky eaters which may lead to IDA

Discussion ● Bipolar disorder associated with IDA was found to be more common in females o This information may be needed in future studies ● Iron deficiency whether in childhood or adolescence has psychiatric effects ● Iron depletion in childhood has immediate and chronic effects on brain development

Conclusion ● Patients with IDA display a higher risk of psychiatric disorders ● Iron supplementation should be prompted to prevent possible psychiatric disorders ● Physicians should check the iron levels of patients displaying psychiatric disorders ● Further studies are needed to determine the causality between IDA and psychiatric disorders