B12 acts as a cofactor in synthesis of neurotransmitters such as serotonin and dopamine, thus B12 deficiency affects mood, emotions and sleeping and can lead to psychiatric disorders. Psychiatric manifestations of B12 deficiency are varied. They seldom precede anemia. We want to present a case of B12 deficiency which was presented with obsessive compulsive disorder.
B12 deficiency has hematological and neuropsychiatric manifestations. Neuropsychiatric manifestations are included : p0 eripheral neuropathy, myeloneuropathy, cerebellar ataxia, optic atrophy, mood disorders, psychosis, personality changes, loss of memory, depression, dementia, confusion and more rarely reversible manic and schizoferniform status and obsessive compulsive disorder (OCD).[1–8] Psychiatric manifestations of B12 deficiency seldom precede anemia.[6–8] We present a case of B12 deficiency in which OCD precedes anemia.
A 29-year-old female came with anxiety and history of OCD since 11 years ago. She had a history of menorrhagia. Drug history was positive for irregular consumption of ferrous sulfate, Inderal and Fluoxetine. History taking revealed anxiety, changes in mood and OCD. In physical examination she had only pallor. Neurological exam was normal. General blood chemistries including thyroid function tests, liver function tests, renal function tests, CBC diff, hemoglobin level and iron profile had been performed 5 months ago and all were in normal ranges [Table 1], but further investigations in recent visit showed mild anemia (Hb=11.8 g/dl, MCV=89 fl) and markedly diminished serum cobalamine level to <30 pg/ml and also iron deficiency with significant decreased ferritin level to 1.28 ng/ml [Table 2].