Comorbidity of Scurvy and Psychotic-Spectrum Disorders: Psychiatric Pathways to Vitamin C Deficiency, A Systematic...

Scurvy is a nutritional deficiency disorder caused by sustained vitamin C depletion and is historically associated with dietary deprivation.

To review published cases of scurvy co-occurring with psychotic-spectrum disorders, characterize the recurrent illness-related contexts linked to low ascorbate intake, and summarize the clinical features relevant to recognition in consultation-liaison settings.

We searched four databases for reports of scurvy with a psychotic-spectrum diagnosis, from inception to May, 2025.

Eighteen reports describing nineteen patients met the criteria. Patients were typically middle-aged (median age, 54.0 years, [interquartile range 42-64]) and predominantly male (n = 13/19). Across the descriptions, mental state and functional narratives repeatedly converged in 2 contexts that plausibly reduced vitamin C intake: (i) psychosis that directly constrained eating (e.g., delusional contamination or rigid rules restricting fresh foods) and (ii) negative symptoms associated with self-neglect, impaired meal preparation, and irregular intake. Diets were often severely monotonous and lacked fresh produce. Psychiatric or behavioral deterioration was the presenting complaint in 5/19 patients (26%). Vitamin C repletion was followed by clinical improvement within days to weeks, mainly in the physical manifestations of scurvy; one patient died from refeeding syndrome. However, smoking status was rarely reported.

These case descriptions are consistent with a conceptual framework that suggests 2 potential pathways linking psychotic-spectrum disorders to vitamin C deficiency: psychosis-driven restrictive intake and executive-dysfunction mediated self-neglect. Clinicians should consider vitamin C deficiency when compatible mucocutaneous, musculoskeletal, or hematological features are accompanied by impaired self-care or marked dietary monotony.