{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T10:03:03Z","timestamp":1771927383214,"version":"3.50.1"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:p>Scurvy, although rare in developed countries, can notably occur in individuals with extreme dietary selectivity, particularly those with neurodevelopmental disorders. We describe the case of an 18-year-old woman with autism spectrum disorder and severe intellectual disability who presented with severe behavioral dysregulation and limited response to multiple psychotropic regimens. Despite progressive lithium dose escalation, serum levels remained subtherapeutic. The turning point came with the diagnosis of profound vitamin C deficiency (ascorbic acid &amp;lt;1 \u00b5mol\/L), prompting high-dose supplementation. Within days, the patient showed rapid behavioral improvement and a marked rise in serum lithium concentrations, necessitating dose reduction. First, nutritional deficiencies\u2014particularly scurvy\u2014can manifest primarily through psychiatric and behavioral symptoms in vulnerable populations, often resulting in misdiagnosis and polypharmacy. Second, although still speculative, we hypothesize that vitamin C status may affect lithium pharmacokinetics. This case underscores the importance of nutritional screening in refractory psychiatric presentations, particularly in individuals with restrictive diets, and highlights a potentially underrecognized interaction between vitamin C and lithium that warrants further investigation.<\/jats:p>","DOI":"10.3389\/fpsyt.2025.1741734","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T12:47:42Z","timestamp":1769172462000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Scurvy\u2014a modifiable cause of psychiatric refractoriness and lithium pharmacokinetic abnormalities in autism"],"prefix":"10.3389","volume":"16","author":[{"given":"Marie","family":"Geiser","sequence":"first","affiliation":[{"name":"D\u00e9partement de Psychiatrie, Centre Hospitalier Universitaire Vaudois (CHUV)","place":["Lausanne, Switzerland"]},{"name":"Ecole de m\u00e9decine, Universit\u00e9 de Lausanne","place":["Lausanne, Vaud, Switzerland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicolas","family":"Guggisberg","sequence":"additional","affiliation":[{"name":"D\u00e9partement de M\u00e9decine interne, Centre Hospitalier Universitaire Vaudois (CHUV)","place":["Lausanne, Switzerland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josephine","family":"Convertini","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Psychiatrie, Centre Hospitalier Universitaire Vaudois (CHUV)","place":["Lausanne, Switzerland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Severine","family":"Crettol","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Psychiatrie, Centre Hospitalier Universitaire Vaudois (CHUV)","place":["Lausanne, Switzerland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicolas","family":"Ansermot","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Psychiatrie, Centre Hospitalier Universitaire Vaudois (CHUV)","place":["Lausanne, Switzerland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent","family":"Guinchat","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Psychiatrie, Centre Hospitalier Universitaire Vaudois (CHUV)","place":["Lausanne, Switzerland"]},{"name":"Ecole de m\u00e9decine, Universit\u00e9 de Lausanne","place":["Lausanne, Vaud, Switzerland"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1108\/RR-10-2013-0256","article-title":"Diagnostic and statistical manual of mental disorders: DSM-5 (5th edition)","volume":"28","author":"Guha","year":"2014","journal-title":"Reference Rev"},{"key":"B2","article-title":"Chapter 22 - Multidisciplinary treatment plan for challenging behaviors in neurodevelopmental disorders","volume-title":"Handbook of clinical neurology","author":"Guinchat","year":"2020"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2015-309575","article-title":"Challenging behaviour and learning disabilities: prevention and interventions for children with learning disabilities whose behaviour challenges: NICE guideline 2015","volume":"102","author":"Tanwar","year":"2017","journal-title":"Arch Dis Child Educ Pract Ed"},{"key":"B4","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/s13229-019-0307-z","article-title":"Persistence and predictors of self-injurious behaviour in autism: a ten-year prospective cohort study","volume":"11","author":"Laverty","year":"2020","journal-title":"Mol Autism"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.ridd.2014.12.020","article-title":"Acute behavioral crises in psychiatric inpatients with autism spectrum disorder (ASD): recognition of concomitant medical or non-ASD psychiatric conditions predicts enhanced improvement","volume":"38","author":"Guinchat","year":"2015","journal-title":"Res Dev Disabil"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.nurt.2010.06.001","article-title":"Medical comorbidities in autism: challenges to diagnosis and treatment","volume":"7","author":"Bauman","year":"2010","journal-title":"Neurotherapeutics"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2024.1502773\/full","article-title":"Pregabalin treatment in a 30-year-old patient with Bainbridge-Ropers syndrome: a case-report","volume":"15","author":"Geiser","year":"2024","journal-title":"Front Psychiatry [Internet]"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1007\/s10803-016-2946-7","article-title":"Psychotropic medication use among insured children with autism spectrum disorder","volume":"47","author":"Madden","year":"2017","journal-title":"J Autism Dev Disord"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/S0005-7916(01)00007-6","article-title":"Pharmacotherapy for severe aggression in a child with autism: \u2018open label\u2019 evaluation of multiple medications on response frequency and intensity of behavioral intervention","volume":"31","author":"Luiselli","year":"2000","journal-title":"J Behav Ther Exp Psychiatry"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2020.09.036","article-title":"Scurvy in a pediatric patient with autism and limp: A case report","volume":"60","author":"Luckow","year":"2021","journal-title":"J Emergency Med"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1080\/20469047.2021.1901406","article-title":"Reversible right-sided heart failure and pulmonary hypertension caused by scurvy in a 7-year-old boy with autism spectrum disorder and a review of the literature","volume":"43","author":"Abe","year":"2023","journal-title":"Paediatrics Int Child Health"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.5546\/aap.2025-10643.eng","article-title":"Pulmonary hypertension secondary to vitamin C deficiency: A case report","volume":"123","author":"Silberkasten","year":"2025","journal-title":"Arch Argent Pediatr"},{"key":"B13","doi-asserted-by":"publisher","first-page":"59","DOI":"10.14740\/ijcp321","article-title":"Scurvy: A case report on a child with autism","volume":"7","author":"Lim","year":"2018","journal-title":"Int J Clin Pediatrics"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e24.00162","DOI":"10.5435\/JAAOSGlobal-D-24-00162","article-title":"The troubling rise of scurvy: A review and national analysis of incidence, associated risk factors, and clinical manifestations","volume":"8","author":"Reikersdorfer","year":"2024","journal-title":"J Am Acad Orthop Surg Glob Res Rev"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1111\/jpc.16594","article-title":"Scurvy and vitamin C deficiency in an Australian tertiary children\u2019s hospital","volume":"60","author":"van Heerden","year":"2024","journal-title":"J Paediatr Child Health"},{"key":"B16","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1186\/s12888-020-02730-w","article-title":"The neuropsychiatric effects of vitamin C deficiency: a systematic review","volume":"20","author":"Plevin","year":"2020","journal-title":"BMC Psychiatry"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.freeradbiomed.2008.12.018","article-title":"Vitamin C function in the brain: vital role of the ascorbate transporter (SVCT2)","volume":"46","author":"Harrison","year":"2009","journal-title":"Free Radic Biol Med"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.2014.83","article-title":"Geneva cocktail for cytochrome P450 and P-glycoprotein activity assessment using dried blood spots","volume":"96","author":"Bosilkovska","year":"2014","journal-title":"Clin Pharmacol Ther"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1985.01790340093010","article-title":"The aberrant behavior checklist: a behavior rating scale for the assessment of treatment effects","volume":"89","author":"Aman","year":"1985","journal-title":"Am J Ment Defic"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1212\/CPJ.0000000000000158","article-title":"Scurvy in the 21st century","volume":"5","author":"Meisel","year":"2015","journal-title":"Neurol Clin Pract"},{"key":"B21","article-title":"Vitamin C deficiency","volume-title":"StatPearls","author":"Maxfield","year":"2025"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1007\/s40262-016-0370-y","article-title":"Drug interactions with lithium: an update","volume":"55","author":"Finley","year":"2016","journal-title":"Clin Pharmacokinet"},{"key":"B23","unstructured":"Center for drug evaluation and research (CDER)\n          \n          2024"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.5152\/tud.2017.02700","article-title":"Is it safe to prescribe ascorbic acid for urinary acidification in stone-forming patients with alkaline urine","volume":"43","author":"Noureldin","year":"2017","journal-title":"Turk J Urol"},{"key":"B25","unstructured":"epocrates web multiCheck"},{"key":"B26","unstructured":"Journal of the american society of nephrology"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.3349\/ymj.2007.48.5.847","article-title":"Blockade of oxidative stress by vitamin C ameliorates albuminuria and renal sclerosis in experimental diabetic rats","volume":"48","author":"Lee","year":"2007","journal-title":"Yonsei Med J"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1055\/a-2263\u20111388","article-title":"Perspectives about ascorbic acid to treat inflammatory bowel diseases","volume":"74","author":"Andriolo","year":"2024","journal-title":"Drug Res"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2025.1741734\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T09:10:50Z","timestamp":1771924250000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2025.1741734\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,23]]},"references-count":28,"alternative-id":["10.3389\/fpsyt.2025.1741734"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2025.1741734","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,23]]},"article-number":"1741734"}}