TITLE:
Vitamin B12 Deficiency Associated with Depression, Psychosis, and Violent Suicidality in an Older Woman
AUTHORS:
Emily Yablonsky, Ethan Higginbotham, Daniel Chrzanowski, Suzanne Holroyd
KEYWORDS:
Vitamin B12 Deficiency, Psychosis, Major Depressive Disorder, Aggression
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.14 No.12,
December
18,
2025
ABSTRACT: Background: Vitamin B12 deficiency is prevalent among the elderly population and can present with a range of neurologic and psychiatric symptoms, including cognitive decline, mood disturbances, psychosis, and behavioral changes. Case Presentation: In this report, we describe a female in her sixties who was hospitalized in a psychiatric unit following a violent suicide attempt in which she forcefully slashed multiple appendages, parts of the torso, and the neck with a steak knife, causing severe superficial and deep tissue damage. History revealed a recent development of paranoid psychosis where she felt she was being controlled by others and surveilled in her apartment and on her phone. Examination revealed severe depressive symptoms with constant suicidal ideation, paranoid psychosis, and significant psychomotor retardation. Laboratory results were only remarkable for a low vitamin B12 level of 170 pg/mL (reference range 232 pg/mL - 1245 pg/mL). MRI demonstrated significant cerebral cortical and cerebellar atrophy, not typical for her age. She received a five-day course of intramuscular B12 1000 units, along with venlafaxine 75 mg extended release for the depressive symptoms. The patient’s mood and psychomotor retardation drastically improved during the first several days of B12 replacement, with full resolution of suicidal ideation. Some paranoia continued, and aripiprazole 5 mg was then added. Conclusion: This case adds to the literature and suggests a constellation of symptoms, including paranoid psychosis, severe depression, and violent behavior associated with vitamin B12 deficiency. It also emphasizes the importance of obtaining vitamin B12 levels in psychiatric patients, especially those with new-onset depression, psychosis, or violent behavior.