Pica

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

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

Synonyms and Keywords: Pica syndrome

Overview

Pica is an appetite for non-nutritive substances (e.g., coal, soil, chalk, paper etc.) or an abnormal appetite for some things that may be considered foods, such as food ingredients (e.g., flour, raw potato, starch).[1] 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 the magpie, a bird which is reputed to eat almost anything. 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.

Classification

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 deficiency. The association between pica and iron deficiency anemia is so strong, that most patients with iron deficiency will admit to some form of pica. Often the substance eaten by those with the disorder does not contain the mineral of deficiency. If a mineral deficiency is not identified as the cause of pica, it often leads to a misdiagnosis as a mental disorder.

Pica may also be a symptom of a hookworm infection.

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 complete CBC or at least Hematocrit levels. [2][3]

Differential Diagnosis

Epidemiology and Demographics

Prevalence

The prevalence of pica is unclear.[4]

Age

Pica is seen in all ages, particularly in pregnant women and small children.

Risk Factors

Natural History, Complications and Prognosis

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 stomach. Another risk of dirt eating is the possible ingestion of animal feces and the accompanying parasites.

Diagnostic Criteria

DSM-V Diagnostic Criteria for PICA[4]

  • A. Persistent eating of non nutritive, non food substances over a period of at least 1 month.

AND

  • B. The eating of non nutritive, non food substances is inappropriate to the developmental level of the individual.

AND

  • C. The eating behavior is not part of a culturally supported or socially normative practice.

AND

Treatment

Treatment emphasizes psychosocial, environmental, and family guidance approaches. Treatment options include: discrimination training between edible and nonedible 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 (correct the environment, or practice appropriate or alternative responses).

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.

References

  1. * emedince.com article on "Eating Disorder: Pica"
  2. Plunkett, Signe J. (2000). Emergency Procedures for the Small Animal Veterinarian. Elsevier Health Sciences. p. 11. ISBN 0702024872.
  3. Feldman, Bernard F. (2000). Schalm's Veterinary Hematology. Blackwell Publishing. p. 506. ISBN 0683306928. Unknown parameter |coauthors= ignored (help)
  4. 4.0 4.1 4.2 4.3 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.

Cost Effectiveness of Pica

| group5 = Clinical Trials Involving Pica | list5 = Ongoing Trials on Pica at Clinical Trials.govTrial results on PicaClinical Trials on Pica at Google


| group6 = Guidelines / Policies / Government Resources (FDA/CDC) Regarding Pica | list6 = US National Guidelines Clearinghouse on PicaNICE Guidance on PicaNHS PRODIGY GuidanceFDA on PicaCDC on Pica


| group7 = Textbook Information on Pica | list7 = Books and Textbook Information on Pica


| group8 = Pharmacology Resources on Pica | list8 = AND (Dose)}} Dosing of PicaAND (drug interactions)}} Drug interactions with PicaAND (side effects)}} Side effects of PicaAND (Allergy)}} Allergic reactions to PicaAND (overdose)}} Overdose information on PicaAND (carcinogenicity)}} Carcinogenicity information on PicaAND (pregnancy)}} Pica in pregnancyAND (pharmacokinetics)}} Pharmacokinetics of Pica


| group9 = Genetics, Pharmacogenomics, and Proteinomics of Pica | list9 = AND (pharmacogenomics)}} Genetics of PicaAND (pharmacogenomics)}} Pharmacogenomics of PicaAND (proteomics)}} Proteomics of Pica


| group10 = Newstories on Pica | list10 = Pica in the newsBe alerted to news on PicaNews trends on Pica


| group11 = Commentary on Pica | list11 = Blogs on Pica

| group12 = Patient Resources on Pica | list12 = Patient resources on PicaDiscussion groups on PicaPatient Handouts on PicaDirections to Hospitals Treating PicaRisk calculators and risk factors for Pica


| group13 = Healthcare Provider Resources on Pica | list13 = Symptoms of PicaCauses & Risk Factors for PicaDiagnostic studies for PicaTreatment of Pica

| group14 = Continuing Medical Education (CME) Programs on Pica | list14 = CME Programs on Pica

| group15 = International Resources on Pica | list15 = Pica en EspanolPica en Francais

| group16 = Business Resources on Pica | list16 = Pica in the MarketplacePatents on Pica

| group17 = Informatics Resources on Pica | list17 = List of terms related to Pica


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