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pensive to provide universal health Laboratory tests showed that Ms. speech, motivation, and social initia-
care coverage. Ifhealth care reform is L had a hemoglobin level of7 .3 g/dL, tive. After three and a half weeks on
to occur in the United States, Amen- a white blood cell count of 10.4/cu the inpatient service, she was dis-
cans will have to let their govern- mm, and normal levels of electno- charged on halopenidol decanoate 75
ment representatives at both state lytes, creatinine, and glucose. Chest mg per month and was able to live
and federal levels know that universal x-ray revealed progressive pneumo- independently and attend day treat-
health care is important and worth nia of the right lower lobe with pos- ment.
paying for. sible cavitation and increased effu- As Ms. L’s case illustrates, serious
TERRY ZIBIN, B.S.W., R.S.W. sion. An electrocardiogram was sig- self-neglect is a common behavioral
DARLENE BRowN, S.W. DIPL nificant for sinus tachycardia. The sequela of schizophrenia. Typically,
DwIGHT HuNKs, B.S.W., R.S.W. admission diagnosis was subacute symptoms ofself-neglect lead to the
bacterial endocarditis; differential patient’s obtaining psychiatric care.
Theauthors aresocialworkers atAlberta
diagnosis included infectious, vascu- However, because of factors related
Hospital Ponoka in Ponoka, Alberta. litic, cardiovascular, and collagen to economics, access to the health
vascular diseases as well as malig- care system, and the illness itself,
Reference nancy and nutritional deficiencies. many patients with schizophrenia are
An extensive work-up led to a pre- living in poverty and have limited
1. Frank RG, Goldman HH, McGuire TG:
sumptive diagnosis of scurvy, con- medical care (5). Accordingly, they
Who will pay for health reftrm conse-
quences of redistribution of funding for firmed by a vitamin C level of .1 are at risk for infectious and metabo-
mental healthcare. Hospitaland Commu- mg/dl (the normal range is .2 to 2 lic illnesses. Although Ms. L made
nity Psychiatry 45:906-910, 1994 mg/cU). five emergency room visits, her psy-
After vitamin C therapy was initi- chiatric symptoms were neither
ated, Ms. L was able to provide a identified nor treated, and her mcdi-
Scurvy in Schizophrenia
psychiatric history of fleeting past cal deterioration continued.
To the Editor: Scurvy, a disorder contact with her community mental As health service delivery changes
caused by severe vitamin C defi- health center. Medication had been to an emphasis on prevention and
ciency, has protean clinical manifes- prescribed, but she took it unpre- primary care, early identification of
tations. At-risk populations include dictably. Instead, she was “blessed” comorbid medical or psychiatric dis-
single elderly men, infants, the urban and absolved of her sins. She heard orders will help conserve limited re-
poor, pregnant and lactating women, voices ofthe “authorities” informing sources and lead to better treatment
food faddists, and alcoholics (1). her of a complex set of rules she was of patients with chronic mental ill-
Scurvy has also been reported in required to follow, including strict ness.
psychiatric patients with alcoholism dietary restrictions. Consequently, DERRI L. SHTASEL, M.D.
and depression (2,3). Psychiatric she had been eating only rice and HEATHER KRELL, M.D., M.P.H.
symptoms described in patients with beans for months.
scurvy include hypochondriasis, de- Historical information obtained Dr. Sbtasel is dinical associate professor
pression, and hysteria (4). Despite from primary sources was reasonably in the department ofpsychiatry at the
the high incidence ofparanoid delu- consistent with that provided by the University of Pennsylvania School of
sions and negative symptoms in patient: she had been diagnosed as Medicine in Philadelphia, where Dr.
schizophrenia, both of which mdc- having schizophrenia, had been pre- Krell is a second-year resident. Dr.
pendently contribute to abnormal scnibed antipsychotic medication Shtasel is also a senior attending psychia-
dietary patterns, little is written with dubious compliance, and was trist at Friends Hospital.
about scurvy in schizophrenia. We subsequently discharged from com-
report such a case. munity care. In the year preceding
Ms. L, a 37-year-old African- admission to the medical unit, the References
American woman, was admitted to a patient had made five emergency
medical unit of a teaching hospital room visits for medical complaints; 1. Onorato j, Lynfield Y: Scurvy. Cutis
with complaints offever, chills, leth- although medical treatment was nec- 49:321-322, 1992
argy, shortness of breath, and knee ommended, Ms. L never followed up. 2. Jillella 1W, Finan ET, Butt ZW, et a!:
Case report: adultscurvy. Maryland Medi-
and anide pain. Her temperature was The patient was transferred to the
caijournal 39:577-578, 1990
102.5#{176}F. Physical examination re- inpatient psychiatry service after two
3. DeSantis J: Scurvy and psychiatric symp-
vealed poor dentition, shorty lym- weeks on the medical unit, and phar- toms. Perspectives in Psychiatric Care
pbadenopathy,decreasedbreath sounds, macologic and psychosocial treat- 29:18-22, 1993
focal erythema with warm tender hy- ments were initiated. She showed 4. Kinsman BA,Hood J: Some behavioral
perpigmented areas on her knee and gradual improvement in positive as effects ofascorbic acid deficiency. Amen-
ankle, and palpable purpura over bi- well as negative symptoms as re- canjourna! ofClinica! Nutrition 24:455-
anterior shins and forearms. 464, 1971
lateral flected by diminution in the ftc-
Cardiac and neurological examina- quency and punitive content of audi- 5. Health care reform for Americans with
severe mental illnesses: report of the Na-
tions were unremarkable. A mental tory hallucinations, decreased behav- tional Advisory Mental Health Council.
status examination showed confu- ioral “restrictions” related to diet and American Journal of Psychiatry 150:
sion and poverty of speech. activities, and increased spontaneous 1447-1465, 1993
Psychiatric Services March 1995 Vol.46 No.3 293
