Pica (disorder)

Infobox_Disease
Name = PAGENAME


Caption = Stomach contents of an inmate with pica
DiseasesDB = 29704
ICD10 = ICD10|F|50|8|f|50, ICD10|F|98|3|f|90
ICD9 = ICD9|307.52
ICDO =
OMIM =
MedlinePlus =
eMedicineSubj = ped
eMedicineTopic = 1798
MeshID = D010842

Pica is a medical disorder characterized by an appetite for largely non-nutritive substances (e.g., coal, soil, feces, chalk, paper, soap, ash, etc.) or an abnormal appetite for some things that may be considered foods, such as food ingredients (e.g., flour, raw potato, starch, ice cubes). [ [http://www.emedicine.com/ped/topic1798.htm emedince.com article on "Eating Disorder: Pica"] ] 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 [http://www.wenwen.ws/bird/Birds/crows-and-magpies-whats-their-favourite-food-f5wg02698.htm] . Pica is seen in all ages, particularly in pregnant women and small children, especially among children who are developmentally disabled, where it is the most common eating disorder [http://www.dcqna.com/diseases-conditions/dcqna-index_179.html] .

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 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 stomachFact|date=May 2008. This is also true in animals. Another risk of dirt eating is the possible ingestion of animal feces and the accompanying parasites.

Causes

The scant research that has been done on the root causes of pica suggests that the majority of those afflicted tend to suffer some biochemical deficiency, and more often, iron deficiencyFact|date=May 2008. The association between pica and iron deficiency anemia is so strong that most patients with iron deficiency will admit to some form of pica.Fact|date=September 2007 Often the substance eaten by those with the disorder contains the mineral of deficiency. If a mineral deficiency is not identified as the cause of pica, it often leads to a diagnosis of a mental disorder.

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

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. [cite book | last = Plunkett | first = Signe J. | date = 2000 | title = Emergency Procedures for the Small Animal Veterinarian | publisher = Elsevier Health Sciences | pages = 11 | isbn = 0702024872] [cite book | last = Feldman | first = Bernard F. | coauthors = Joseph G. Zinkl, Nemi Chand Jain, Oscar William Schalm | date = 2000 | title = Schalm's Veterinary Hematology | publisher = Blackwell Publishing | pages = 506| isbn = 0683306928]

Treatment

Treatment emphasizes psychosocial, environmental, and family guidance approaches. Treatment options include: discrimination training between edible and inedible items, self-protection devices that prohibit placement of objects in the mouth, sensory reinforcement involving screening (covering eyes briefly), contingent aversive oral taste (lemon), contingent aversive smell sensation (ammonia), contingent aversive physical sensation (water mist), brief physical restraint, and overcorrection (punishment when child eats non-food items).

This involves associating negative consequences with eating non-food items and good consequences with normal behavior. 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 conditions may be associated with severe behavioral disturbances, including pica. These medications enhance dopaminergic functioning, which is believed to be associated with the occurrence of pica.

Examples

* Amylophagia (consumption of starch)
* Coprophagia (consumption of feces)
* Geophagy (consumption of soil, clay, or chalk)
** Consumption of dust or sand has been reported among iron-deficient patients.
* Vampirism (ingestion of blood)
* Hyalophagia (consumption of glass)
* Odawa (soft stones eaten by pregnant women in Kenya) [ [http://news.bbc.co.uk/2/hi/africa/7596067.stm Why Kenyan women crave stones] BBC News]
* 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)

Popular culture

* Michel Lotito has made a career in entertainment of eating chopped "inedibles" like a Cessna 150 small airplane.
* A patient suffering from pica was featured in the season four premiere of "Grey's Anatomy".
* Jimmy Kimmel has suggested several times in his stand-up that G. Gordon Liddy suffers from pica and, as such, may have been Deep Throat.
* In the "House" episode "Lines in the Sand", a severely autistic boy with pica is diagnosed with raccoon roundworms that he acquired from eating the sand in his sandbox.
* In the book "One Hundred Years of Solitude", Rebeca eats earth and whitewash.
* In Chapter 26 of John Steinbeck's Pulitzer Prize-winning 1939 novel, "The Grapes of Wrath", the pregnant and malnourished Rose of Sharon is caught eating "a piece of slack lime", and her mother admits to eating coal when she was pregnant. [http://www.archive.org/details/grapesofwrath030650mbp (Read at Archive.org)]
* Kristen Bell had unofficially declared on "Late Show with David Letterman" her black lab suffers from pica, having eaten, for example, shards of glass and bottles.
* In the film Undertow (2004) a young boy suffers from Pica.

ee also

*

References

External links

* [http://www.roadsideamerica.com/attract/MOSTJglor.html More information about the Glore Psychiatric Museum]
* [http://www.legendsofamerica.com/MO-PsychiatricMuseum2.html Information about the Glore Psychiatric Museum]
* [http://asylumeclectica.com/asylum/sightseer/us/mo/glore/index.html A blog about a visit to the Glore Psychiatric Museum]
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* [http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=cm.chapter.4440]
* [http://www.cnn.com/2004/HEALTH/02/18/coin.eater.ap/index.html Hundreds of coins found in patient's belly]