Chronic psychosis associated with vitamin B12 deficiency

B12 deficiency is widely prevalent and usually presents with haematologic and neuropsychiatric manifestations. Psychiatric symptoms seldom precede anaemia and present as the principal manifestation of B12 deficiency. A report an unusual presentation of long standing psychotic symptoms without anaemia in a 31 year old male, who presented to a tertiary care psychiatric facility. His physical examination revealed hyper pigmentation of extremities and posterior column involvement. Laboratory investigations confirmed normal haemoglobin and low serum B12 levels. He recovered dramatically with short term anti psychotic medication and intramuscular cobalamin supplementation. He remained asymptomatic and functionally independent at two years follow up.