Misplaced Pages

This is an old revision of this page, as edited by 24.208.43.154 (talk) at 15:01, 22 February 2010 (→Causes). The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.

This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. Find sources: "Pica" disorder – news · newspapers · books · scholar · JSTOR (July 2007) (Learn how and when to remove this message)

Pica (disorder)
Specialty	Psychiatry, psychology

Pica is a medical disorder characterized by an appetite for substances largely non-nutritive (e.g. metal (coins, etc), clay, coal, soil, feces, chalk, paper, soap, mucus, ash, gum, etc.) or an abnormal appetite for some things that may be considered foods, such as food ingredients (e.g., flour, raw potato, raw rice, starch, ice cubes, salt). In order for these actions to be considered pica, they must persist for more than one month at an age where eating such objects is considered developmentally inappropriate. The condition's name comes from the Latin word for magpie, a bird which is reputed to eat almost anything. Pica is seen in all ages, particularly in pregnant women, small children, and those with developmental disabilities.

Pica in children, while common, can be dangerous. Children eating painted plaster containing lead may suffer brain damage from lead poisoning. There is a similar risk from eating dirt near roads that existed prior to the phaseout of tetra-ethyl lead in gasoline (in some countries) or prior to the cessation of the use of contaminated oil (either used, or containing toxic PCBs or dioxin) to settle dust. In addition to poisoning, there is also a much greater risk of gastro-intestinal obstruction or tearing in the stomach. This is also true in animals. Another risk of dirt eating is the possible ingestion of animal feces and the accompanying parasites. Pica can also be found in animals, and is most commonly found in dogs.

Causes

The scant research that has been done on the causes of pica suggests that the disorder is caused by mineral deficiency in many cases, typically iron deficiency which is sometimes a result of celiac disease. Often the substance eaten by someone with pica contains the mineral in which that individual is deficient. More recently, cases of pica have been tied to the obsessive–compulsive spectrum, and there is a move to consider OCD in the etiology of pica; however, pica is not currently recognized by the widely used Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as being a mental disorder. Sensory, physiological, cultural, and psychosocial perspectives have also been used by some to explain the causation of pica.

Mental health conditions, such as obsessive-compulsive disorder (OCD) and schizophrenia can sometimes cause pica.

Pica may also be a symptom of iron deficiency anemia secondary to hookworm infection. Symptoms may also include a bluish hue to the skin, particularly around the mouth.

Few studies have been conducted to measure the prevalence of pica in various populations. Two prevalence studies conducted on pregnant women in the 1990s found rates of 8.1% for pregnant African American women in the U.S. and 8.8% for pregnant women in Saudi Arabia. Rates of pica among pregnant women in developing countries can be much higher, however, with estimates of 63.7% and 74.0% reported for two different African populations. This is due to different cultural norms as well as greater levels of malnutrition. Two studies of mentally retarded adults living in institutions found that 21.8% and 25.8% of these groups suffered from pica. Prevalence rates for children with and without developmental disabilities are unknown.

It was suggested that stress associated with traumatic events is linked to pica disorder. Some of the traumatic events common in individuals with pica include maternal deprivation, parental separation or neglect, child abuse, disorganized family structure and poor parent-child interaction.

Unlike in humans, in dogs or cats, pica may be a sign of immune-mediated hemolytic anemia, especially when it involves eating substances such as tile grout, concrete dust, and sand. Dogs exhibiting this form of pica should be tested for anemia with a CBC or at least hematocrit levels.

Treatment

Treatment for pica will vary based on the patient's category (child, developmentally disabled, pregnant, or psychopathic) and may emphasize psychosocial, environmental, and family guidance approaches. An initial approach often involves screening for and, if necessary, treating any mineral deficiencies or other comorbid conditions. For pica that appears to be of psychotic etiology, therapy and medication such as SSRIs have been used successfully. However, previous reports have cautioned against the use of medication until all non-psychotic etiologies have been ruled out.

Some medications may be helpful in reducing the abnormal eating behavior if pica occurs in the course of a developmental disorder, such as mental retardation or pervasive developmental disorder. These medications enhance dopaminergic functioning, which is believed to be associated with the occurrence of pica.

Behavior-based treatment options can be useful for developmentally disabled or mentally retarded individuals with pica. These may involve associating negative consequences with eating non-food items or good consequences with normal behavior, and may be contingent on pica being attempted or initiated regardless of a pica attempt. A recent study classified nine such classes of behavioral intervention:

• Presentation of attention, food, or toys, not contingent on pica being attempted
• Differential reinforcement, with positive reinforcement if pica is not attempted and negative reinforcement if pica is attempted
• Discrimination training between edible and inedible items, with negative consequences if pica is attempted
• Visual screening, with eyes briefly for a short time after pica is attempted
• Aversive presentation, contingent on pica being attempted:
  • oral taste (e.g., lemon)
  • smell sensation (e.g., ammonia)
  • physical sensation (e.g., water mist in face)
• Physical restraint:
  • self-protection devices that prohibit placement of objects in the mouth
  • brief restraint contingent on pica being attempted
• Time-out contingent on pica being attempted
• Overcorrection, with attempted pica resulting in required washing of self, disposal of nonedible objects, and chore-based punishment
• Negative practice (nonedible object held against patient's mouth without allowing ingestion)

Examples

• Amylophagia (consumption of starch)
• Coprophagy (consumption of feces)
• Geophagy (consumption of soil, clay, or chalk)
• Hyalophagia (consumption of glass)
• Consumption of dust or sand has been reported among iron-deficient patients.
• Mucophagia (consumption of mucus)
• Odowa (soft stones eaten by pregnant women in Kenya)
• Pagophagia (pathological consumption of ice)
• Self-cannibalism (rare condition where body parts may be consumed; see also Lesch-Nyhan syndrome)
• Trichophagia (consumption of hair or wool)
• Urophagia (consumption of urine)
• Xylophagia (consumption of wood)

Notes

1. emedince.com article on "Eating Disorder: Pica"
2. http://www.wenwen.ws/bird/Birds/crows-and-magpies-whats-their-favourite-food-f5wg02698.htm
3. ^ Rose, E.A., Porcerelli, J.H., & Neale, A.V. (2000). "Pica: Common but commonly missed". The Journal of the American Board of Family Practice. 13 (5): 353–358.{{cite journal}}: CS1 maint: multiple names: authors list (link) PMID 11001006
4. Hergüner, S., Ozyildirim, I., & Tanidir, C. (2008). "Is Pica an eating disorder or an obsessive-compulsive spectrum disorder?". Progress in Neuro-Psychopharmacology & Biological Psychiatry. 32 (8): 2010–2011.{{cite journal}}: CS1 maint: multiple names: authors list (link) PMID 18848964
5. Edwards, C.H., Johnson, A.A., Knight, E.M., Oyemade, U.J., Cole, O.J., Westney, O.E.; et al. (1994). "Pica in an urban environment". The Journal of Nutrition. 124 (6 Suppl): 954S – 962S. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link) PMID 8201446
6. al-Kanhal, M.A., & Bani, I.A. (1995). "Food habits during pregnancy among Saudi women". International Journal for Vitamin and Nutrition Research. 65 (3): 206–210.{{cite journal}}: CS1 maint: multiple names: authors list (link) PMID 8830001
7. Nyaruhucha, C.N. (2009). "Food cravings, aversions and pica among pregnant women in Dar es Salaam, Tanzania". Tanzania Journal of Health Research. 11 (1): 29–34. PMID 19445102
8. Ngozi, P.O. (2008). "Pica practices of pregnant women in Nairobi, Kenya". East African Medical Journal. 85 (2): 72–79. PMID 18557250
9. Ashworth, M., Hirdes, J.P., & Martin, L. (2009). "The social and recreational characteristics of adults with intellectual disability and pica living in institutions". Research in Developmental Disabilities. 30 (3): 512–520.{{cite journal}}: CS1 maint: multiple names: authors list (link) PMID 18789647
10. Danford, D.E., & Huber, A.M. (1982). "Pica among mentally retarded adults". American Journal of Mental Deficiency. 87 (2): 141–146.{{cite journal}}: CS1 maint: multiple names: authors list (link) PMID 7124824
11. Plunkett, Signe J. (2000). Emergency Procedures for the Small Animal Veterinarian. Elsevier Health Sciences. p. 11. ISBN 0702024872.
12. Feldman, Bernard F. (2000). Schalm's Veterinary Hematology. Blackwell Publishing. p. 506. ISBN 0683306928. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
13. Bhatia, M.S., & Gupta, R. (2007-05-11). "Pica responding to SSRI: An OCD spectrum disorder?". The World Journal of Biological Psychiatry.{{cite journal}}: CS1 maint: multiple names: authors list (link) Online publication ahead of print. PMID 17853279
14. Fotoulaki, M., Panagopoulou, P., Efstratiou, I., & Nousia-Arvanitakis, S. (2007). "Pitfalls in the approach to pica". European Journal of Pediatrics. 166 (6): 623–624.{{cite journal}}: CS1 maint: multiple names: authors list (link) PMID 17008997
15. McAdam, D.B., Sherman, J.A., Sheldon, J.B., & Napolitano, D.A. (2004). "Behavioral interventions to reduce the pica of persons with developmental disabilities". Behavior Modification. 28 (1): 45–72.{{cite journal}}: CS1 maint: multiple names: authors list (link) PMID 14710707
16. Why Kenyan women crave stones BBC News

External links

• More information about the Glore Psychiatric Museum
• Information about the Glore Psychiatric Museum
• A blog about a visit to the Glore Psychiatric Museum
• Abu-Hamdan DK, Sondheimer JH, Mahajan SK (1985). "Cautopyreiophagia. Cause of life-threatening hyperkalemia in a patient undergoing hemodialysis". Am. J. Med. 79 (4): 517–19. doi:10.1016/0002-9343(85)90042-7. PMID 4050837.{{cite journal}}: CS1 maint: multiple names: authors list (link)
• http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=cm.chapter.4440
• http://www.omnimedicalsearch.com/conditions-diseases/pica-disorder-causes-risk-factors.html

• Childhood psychiatric disorders
• Eating behaviors
• Pica (disorder)
• Eating disorders