Pica

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Pica
ICD-10	F50.8, F98.3
ICD-9	307.52
DiseasesDB	29704
MeSH	D010842

WikiDoc Resources for Pica
Articles
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Evidence Based Medicine
Cochrane Collaboration on Pica Bandolier on Pica TRIP on Pica
Clinical Trials
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Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Pica NICE Guidance on Pica NHS PRODIGY Guidance FDA on Pica CDC on Pica
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News
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Commentary
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Definitions
Definitions of Pica
Patient Resources / Community
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Experimental / Informatics
List of terms related to Pica

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2] Fahimeh Shojaei, M.D.

Synonyms and keywords: Pica syndrome

Historical Perspective

• Pica is derived from a Latin word 'pica pica' which means magpie, a bird known for its behavior of gathering and eating almost everything.

• It was first documented in the 13th century in Latin work of Bartholomeus de Glanville, although the actual term was not used.
• The first time term ‘Pica’ was mentioned in a medical context was in 1563 in a surgical work, ‘An Excellent Treatise of Wounds made with Gonne Shot’, by Thomas Gale, where pica was addressed in pregnant women and children.
• Historically, clay ingestion had been used for medical purposes probably due to its effect on gastrointestinal (GI) system. It was particularly suggested as a treatment of intestinal infection and spasm.

Classification

Pica may be classified according to the name of the eaten substance; the most common types by far are geophagia and amylophagia:

• Acuphagia (sharp objects)
• Amylophagia (purified starch)
• Cautopyreiophagia (burnt matches)
• Coniophagia (dust, dirt)
• Coprophagia (feces)
• Emetophagia (vomit)
• Geomelophagia (raw potatoes)
• Geophagia (earth, soil, clay, chalk)
• Hyalophagia (glass)
• Lithophagia (stones)
• Metallophagia (metal)
• Mucophagia (mucus)
• Pagophagia (ice)
• Plumbophagia (lead, paint chips)
• Trichophagia (hair, wool, fibers)
• Urophagia (urine)
• Hematophagia (blood)
• Xylophagia (wood, paper)
• Hyalophagia (glass)
• Ryzophagia (raw rice)
• Sapophagia (soap)

Pathophysiology

The exact pathogenesis of Pica is not fully understood. However there are different theories on developing Pica:

Nutritional Theory

• Children with anemia and low plasma zinc levels may develop Pica and crave for substances rich in the insufficient nutrients.
• Kaolinite, a clay mineral, which has negative surface charge commonly ingested in Pica and can absorb the ions with positive surface charge, such as iron and causes iron-deficiency anemia.
• There is not enough evidence to determine whether Pica is the cause of nutritional deficiency or nutritional deficiency leads to Pica development.

Gastrointestinal Distress

Geophagia causes increase in gastrointestinal PH. This effect can soothe gastric pain and gastroesophageal reflux. It also results in reduction of bioavailability of pathogens and toxins in gastrointestinal tract, a phenomenon on which a hypothesis is based. The hypothesis states that non-nutritive substances bind to toxins and lead to less toxins absorption. This event occurs in the most vulnerable period of cell replication and growth (childhood and pregnancy) in order to protect the body from dangerous toxins.

Neurological Theory

• Various human studies reveal that lesions in eating center of hypothalamus and anterior cingulate gyrus may lead hyperphagia and Pica especially in individuals with history of brain damage.
• Animal studies indicate that rats with iron deficiency anemia have fewer D2 receptors in the central nervous system (CNS). This proposes a theory stating that reduction of dopaminergic neurotransmission leads to development of Pica, and not the iron deficiency anemia.

Psychiatric Theory

A hypothesis states that Pica can be attributed to obsessive-compulsive spectrum disorders because Pica-related behaviors are mostly involuntary, recurrent, and persistent to soothe the anxiety and distress, and resistance to stop the behaviors causes increased level of anxiety and distress. This hypothesis is supported by studies that have found that Pica has the same treatment as OCD, i.e selective serotonin reuptake inhibitors.

Causes

The cause of Pica has not been identified. To review risk factors for the development of Pica, click here.

Differentiating ((Page name)) from other Diseases

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].

OR

[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].

Epidemiology and Demographics

The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.

OR

In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.

OR

In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate of [number range]%.

Patients of all age groups may develop [disease name].

OR

The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.

OR

[Disease name] commonly affects individuals younger than/older than [number of years] years of age.

OR

[Chronic disease name] is usually first diagnosed among [age group].

OR

[Acute disease name] commonly affects [age group].

There is no racial predilection to [disease name].

OR

[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].

[Disease name] affects men and women equally.

OR

[Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.

The majority of [disease name] cases are reported in [geographical region].

OR

[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].

Risk Factors

There are no established risk factors for [disease name].

OR

The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.

Screening

There is insufficient evidence to recommend routine screening for [disease/malignancy].

OR

According to the [guideline name], screening for [disease name] is not recommended.

OR

According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].

Natural History, Complications, and Prognosis

If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

Diagnosis

Diagnostic Study of Choice

The diagnosis of Pica is based on the criteria from Diagnosis and Statistical Manual of Mental Disorders (DSM-5), which include:

1.Person must have been eating non-nutritive nonfoods for at least one month.

2.This eating must be considered abnormal for the person's stage of development.

3.Eating these substances cannot be associated with a cultural practice that is considered normal in the social context of the individual.

4.For people who currently have a medical condition (e.g.: pregnancy) or a mental disorder (e.g.: autism spectrum disorder), the action of eating non-nutritive nonfoods should only be considered pica if it is dangerous and requires extra medical investigation or treatment on top of what they are already receiving for their pre-existing condition.

History and Symptoms

Symptom of Pica is variable and depends on the material which is ingested.

Physicians should seek the details of the exposure, including:

• the substance type,
• the amount of substance,
• duration of exposure,
• situations where behavior usually happens,
• any co-ingestions, and
• symptoms of toxicity

Physical Examination

Patients with Pica usually appear normal. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Laboratory Findings

An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

Electrocardiogram

There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

X-ray

There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

Echocardiography or Ultrasound

There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

CT scan

There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

MRI

There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

Other Imaging Findings

There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

Other Diagnostic Studies

There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

Treatment

Medical Therapy

There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

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The mainstay of treatment for [disease name] is [therapy].

OR

The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

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Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

Surgery

Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

Primary Prevention

There are no established measures for the primary prevention of [disease name].

OR

There are no available vaccines against [disease name].

OR

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

OR

[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].

Secondary Prevention

There are no established measures for the secondary prevention of [disease name].

OR

Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].