Pica Symptoms Research Articles

Olanzapine‐associated pica in a schizophrenia patient

PICA IS DEFINED as the persistent eating of non-nutritive substances in an inappropriate and culturally unacceptable manner. To date, there is a lack of acceptable pathogenic mechanism underlying this behavior. Olanzapine, a commonly used antipsychotic, can block the central 5-HT2c and H1 receptors, therefore it has side-effects of increased bodyweight and appetite. There have been no reports, however, on pica occurring during olanzapine treatment. We here report on a schizophrenia patient who developed pica during the administration of olanzapine, which gradually remitted after this atypical antipsychotic had been discontinued. The present patient was a 35-year-old man with schizophrenia who had no medical or surgical diseases, eating disorders, drug abuse history or other psychiatric history. It had been 15 years since the first incidence and the patient had had several acute attacks during this period, but none of them resulted in pica. This time he developed negative symptoms of poor appetite, silence, social withdrawal; his medication had been changed from haloperidol 5 mg/day to olanzapine 10 mg/day, other medication remained unchanged. After he had taken olanzapine for 3 weeks, the negative symptoms and his appetite significantly improved without developing any positive symptoms. Of note, the patient started exhibiting pica by eating garbage, sand and pebble (based on the patient's statement, his behavior was unexplainable and uncontrollable, he just had a craving for eating them). The pica persisted for approximately 3 weeks. He was also found to have an increased appetite that even exceeded the amount of food that he could handle. No other hallucinations, delusions, or positive symptoms occurred. The patient also denied having intention of suicide or self-hurt. Nevertheless, the symptoms of pica persisted. Olanzapine was replaced by his previous medicine. After that, the pica gradually disappeared. Although we do not know the exact underlying mechanism of pica, there is increasing evidence that the craving for eating non-nutritional material could be considered as an obsessive–compulsive spectrum disorder.1 In addition, there are studies suggesting that some atypical antipsychotics may induce or aggravate the obsessive–compulsive symptoms.2 Given this, the mechanism of pica development in the present case could have been due to the blockade of olanzapine on the 5-HT2a receptors, resulting in an increase of dopamine release in the mid-brain and frontal cortex, and further causing the cortico-basal ganglia dysfunction. In conclusion, the present case suggests that pica may occur during the use of olanzapine in schizophrenia patients, which is similar to obsessive–compulsive symptom. Further studies are warranted to explore the relationship between pica and the use of olanzapine.

Pica in iron deficiency: a case series

IntroductionPica is an unusual condition where patients develop cravings for non-nutritive substances that can cause significant health risks. We report three patients with pica, two of them showing evolutionary changes associated with pica and the third demonstrating a peculiar nature of pica, which has yet to be reported.Case presentationWe describe three patients who presented with symptoms of pica. The first patient is a 36-year-old Caucasian woman who had dysfunctional uterine bleeding associated with daily ingestion of two super-sized cups of ice as iced tea. The second patient is a 62-year-old Caucasian man who presented with bleeding from colonic polyps associated with drinking partially frozen bottled water. Lastly, the third patient, a 37-year-old Hispanic woman, presented with dysfunctional uterine bleeding and habitually chewed rubber bands. All three patients presented with hematological parameters diagnostic for iron deficiency anemia.ConclusionPica has been practiced for centuries without a clear etiology. We have noticed that the younger community of academic and community physicians are not aware of the importance of complaints related to pica. None of our patients we describe here, as well as their primary care physicians, were aware of the importance of their pica related symptoms. Pica symptoms abated in one of our patients upon iron supplementation, while the other two are currently under treatment as of this writing. We believe pica is an important sign of iron deficiency that should never be ignored, and the craving for any unusual substance should compel clinicians to search for occult blood loss with secondary iron deficiency.

Foam Eater

A 5-year-old African female patient came to the emergency department after ingesting foam sponge from the back of a car seat. The entire foam content of the car seat had been consumed, and the child was nauseous and vomiting foam sponge. Her medical history was remarkable for sickle cell hemoglobin C disease. With a physical examination, a soft, non distended abdomen with normal bowel sounds was revealed. A soft palpable mass was detected in the left upper quadrant with abdominal palpation. A large mass density in the region of the stomach was revealed with a radiographic examination (Figure 1A) with accumulation and expansion after Gastrograffin radiocontrast (Figure 1B) consistent with a foam sponge bezoar. The foam sponge bezoar was managed conservatively, and the results of follow-up radiographic films of the abdomen were normal. Pica, the ingestion of non-nutrient material, has an unusually high prevalence in patients with sickle cell disease.1Ivascu N.S. Sarnaik S. McCrae J. Whitten-Shurney W. Thomas R. Bond S. Characterization of pica prevalence among patients with sickle cell disease.Arch Pediatr Adolesc Med. 2001; 155: 1243-1247Crossref PubMed Scopus (40) Google Scholar The substance of ingestion often includes foam sponge.2Lemanek K.L. Brown R.T. Armstrong F.D. Hood C. Pegelow C. Woods G. Dysfunctional eating patterns and symptoms of pica in children and adolescents with sickle cell disease.Clin Pediatr. 2002; 41: 493-500Crossref PubMed Scopus (19) Google Scholar Significant medical sequelae, depending on the item of ingestion, such as lead intoxication and lead encephalopathy, intestinal obstruction and perforation, and infection have been reported. Foam sponge bezoars in particular have the potential to absorb intestinal contents and occasionally cause intestinal obstruction and perforation.3Chiu B. Ciaccio C. West M.A. Intestinal obstruction from furniture cushion foam bezoar.Surgery. 2005; 138: 956-958Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar However, despite the dramatic radiological findings in a large foam sponge bezoar, in the absence of an acute abdomen or intestinal obstruction, most cases can be managed conservatively.

Parental Report of Eating Problems and Gastrointestinal Symptoms in Children With Pervasive Developmental Disorders

Parents of children of 89 children with pervasive developmental disorder were surveyed about their child's eating, gastrointestinal symptoms, and behavior problems. Results revealed potentially interesting relationships among self-injurious behavior, pica, feeding problems, and gastrointestinal symptoms in this population. Although over 60% of children were reported to have strong food preferences, only 6.7% of parents reported that their child had a feeding problem. Most children exhibited high rates of pica and self-injurious behavior that affected the family's quality of life. Some children experienced at least one symptom of gastrointestinal distress weekly, and bowel problems appeared to be related to some aspects of feeding. Although methodological issues limit these data, future research should focus on further relations among these factors in this population.

Dysfunctional eating patterns and symptoms of pica in children and adolescents with sickle cell disease.

The objective of this study was to examine the incidence and relationship of pica symptoms and dysfunctional eating patterns in children and adolescents with sickle cell disease (SCD). Children and caregivers (n = 146) completed questionnaires assessing eating difficulties and symptoms of pica. Information also was collected from medical records and analyzed for relationships with dysfunctional eating patterns. Incidence of problems and their association with disease parameters of SCD were examined. Dysfunctional eating patterns were found in those with no symptoms of pica and those with severe symptoms of pica. Caregiver-reported dysfunctional eating patterns were associated with caregiver- and child-reported frequency of painful episodes.

Potassium Depletion in Lactating Dairy Cows

A change-over feeding experiment involving eight individually fed lactating dairy cows was conducted to study potassium deficiency symptoms in lactating cows. Potassium deficient (0.06% and 0.15%K) and potassium adequate (0.80% K) rations were tested and responses to both compared. The deficient animals showed a marked decrease in feed intake, symptoms of pica, loss of hair glossiness, decreased pliability of hides, significantly lower blood plasma and milk potassium, and higher hematocrit readings. A relatively greater decrease of potassium concentration in milk over blood plasma was observed when the deficient ration was fed. Higher and significantly inverse relationships between potassium and sodium content of the milk when fed the deficient ration in contrast to the adequate ration were indicated. The reduced potassium and simultaneous increase in sodium elimination through milk probably helped the animal maintain a higher level of tissue potassium. Total cationic concentrations (K+ + Na+ + Mg++) in milk, blood plasma, and whole blood remained essentially the same, during both periods.