College of Psychiatric and Neurologic Pharmacists

It is well know that folate is essential for the development and normal function of the central nervous system (CNS).  This is illustrated by the many cases of in-born errors of folate metabolism which lead to profound deleterious effects in the CNS.  The neuropsychiatric complications of folate deficiency from various causes are remarkably similar to those described for vitamin B12 deficiency, but the former is particularly associated with depression and dementia especially in the elderly. Inherited and acquired disorders of folate and B vitamin metabolism are often associated with neurological and psychiatric complications.

Clinical features, which may vary depending on the severity of the defect and age at presentation, may include; lethargy, hypotonia, mental retardation, seizures, encephalopathy, myelopathy, behavioral disturbance, depression and cognitive impairment.  It is clear from clinical studies that the central nervous system is sensitive to disturbances in the metabolism of folate, and that maintaining adequate amounts of folate is essential for normal brain function.  There is substantial evidence that the mechanisms by which folate and B vitamin deficiency causes neurological and psychiatric deficits are multifactoral and various pathways have been implicated including; methylation of DNA and gene expression, key CNS proteins, neurotransmitters, phospholipid metabolism, excitoitoxicity, and oxidative stress. This presentation will focus on the causes and detection of folate and B vitamin deficiency, neurotoxic mechanisms involved and therapeutic options for the treatment of depression and dementia.

1. Describe the metabolism of folate and what factors impact folate activity.
2. Identify tests that diagnose folate deficiency in humans.
3. Recognize the biochemical mechanisms of folate deficiency that can lead to depression and dementia.
4. Develop a pharmacotherapy plan and monitoring parameters for a patient with folate deficiency.

Activity Dates: 04/19/2010 - 04/19/2013
ACPE Contact Hours: 1.0
ACPE Number: 0284-0000-10-010-H04-P (Knowledge)
Nursing Credit Reminder: Note that ACPE and ACCME credit is accepted for certification renewal.

This course is provided online at cpnp.org and consists of the speaker audio and slides. A PDF file of the slides is also provided and access is available to participants indefinitely although ACPE credit is available only through the course expiration date.

Participants in this course must complete an examination and achieve a score of 60% or greater. Successful completion of the course also requires the completion of a course evaluation. ACPE statements of credit can be retrieved by participants online at cpnp.org immediately upon successful completion of the course.

If you are a pharmacist, nurse practitioner or other healthcare professional involved in the medication therapy management of psychiatric and/or neurological patients, we invite you to participate in this online course.

This programming was supported in part by grants from Bristol-Myers Squibb, Otsuka America Pharmaceutical, Inc., Lilly USA, LLC, AstraZeneca and Cyberonics.