Pica resident survival guide: Difference between revisions
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* The diagnosis of pica includes a detailed history and physical examination, appropriate laboratory investigations. | * The diagnosis of pica includes a detailed history and physical examination, appropriate laboratory investigations. | ||
{{familytree/start}} | {{familytree/start}} | ||
{{familytree | | | | | | | | | | A01 | |A01=<div style="float: left; text-align: left; line-height: 150% ">'''Obtain a detailed history:'''<br>❑ Duration of symptoms <br>❑ What is the substance being ingested? <br>❑ When does the patient exhibit this behaviour? <br>❑ Is it during periods of emotional or physical stress? <br> What is the source of the substance? <br> | {{familytree | | | | | | | | | | | | | A01 | |A01=<div style="float: left; text-align: left; line-height: 150% ">'''Obtain a detailed history:'''<br>❑ Duration of symptoms <br>❑ What is the substance being ingested? <br>❑ When does the patient exhibit this behaviour? <br>❑ Is it during periods of emotional or physical stress? <br> What is the source of the substance? <br> | ||
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According to the [[DSM]]5, the following 5 criteria must be met to diagnose someone with pica<ref name="pmid24643829">{{cite journal| author=Hoek HW, van Elburg AA| title=[Feeding and eating disorders in the DSM-5]. | journal=Tijdschr Psychiatr | year= 2014 | volume= 56 | issue= 3 | pages= 187-91 | pmid=24643829 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24643829 }} </ref>: <br>❑ Person must be eating non-nutritive or non-food substances for at least one month. <br>❑ This behaviour must be considered abnormal for their stage of development. <br>❑ This behaviour must not be considered as a part of a cultural practice, and should be normal<br> in the social context of that person. <br>❑ For a person with an existing condition like [[mental retardation|mental disability]] or [[pregnancy]], this behaviour<br> is considered as pica only when it is dangerous or requires medical investigations and attention. </div>}} | According to the [[DSM]]5, the following 5 criteria must be met to diagnose someone with pica<ref name="pmid24643829">{{cite journal| author=Hoek HW, van Elburg AA| title=[Feeding and eating disorders in the DSM-5]. | journal=Tijdschr Psychiatr | year= 2014 | volume= 56 | issue= 3 | pages= 187-91 | pmid=24643829 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24643829 }} </ref>: <br>❑ Person must be eating non-nutritive or non-food substances for at least one month. <br>❑ This behaviour must be considered abnormal for their stage of development. <br>❑ This behaviour must not be considered as a part of a cultural practice, and should be normal<br> in the social context of that person. <br>❑ For a person with an existing condition like [[mental retardation|mental disability]] or [[pregnancy]], this behaviour<br> is considered as pica only when it is dangerous or requires medical investigations and attention. </div>}} | ||
{{familytree | | | | | | | | | | | | | |!| |}} | |||
{{familytree | | | | | | | | | | | | | B01 |B01=<div style="float: left; text-align: left; line-height: 150% ">'''Physical examination''' <br> While physical examination might be unrevealing in most cases, importance must be given to elicit<br> signs and symptoms of possible poisoning or other complications such as the following: <br>❑ '''Signs of lead ingestion''' <br>* [[Headache]] <br>* [[Insomnia]] <br>* [[Tremor]] <br>* [[Kidney failure]] in chronic ingestion <br>❑ '''Signs of parasitic infestation''' <br>* [[Fever]] <br>* [[Hepatomegaly]] <br>* [[Cough]] <br>* [[Encephalitis]] <br>❑ '''Signs of [[bezoar]] ingestion''' <br>* [[Pain]] per abdomen <br>* Gastrointestinal obstruction and <br>* [[Ulcer]]ation </div>}} | |||
{{familytree | | | | | | | | | | | | | |!| | | |}} | |||
{{familytree | | | | | | | | | | | | | C01 |C01=<div style="float: left; text-align: left; line-height: 150% ">'''Initial investigations''' <br>❑ [[Complete blood count]] <br>❑ [[Iron]] studies <br>❑ [[Zinc]] level <br>❑ [[Basic metabolic panel]] <br>❑ Psychiatric evaluation </div>}} | |||
{{familytree | | | | | | | | | | | | | |!| | | | | | | | | | |}} | |||
{{familytree | |,|-|-|-|-|-|-|-|v|-|-|-|+|-|-|-|-|.| | | | | |}} | |||
{{familytree | D01 | | | | | | D02 | | D03 | | | D04 |D01=<div style="float: left; text-align: left; line-height: 150% ">'''Iron deficiency anemia'''|D02=<div style="float: left; text-align: left; line-height: 150% ">'''Pregnancy related pica'''|D03=<div style="float: left; text-align: left; line-height: 150% ">'''Psychiatric disorders'''|D04=<div style="float: left; text-align: left; line-height: 150% ">'''Lead ingestion'''}} | |||
== Management == | == Management == | ||
Revision as of 15:52, 20 August 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sanjana Nethagani, M.B.B.S.[2]
Overview
Pica is defined as the compulsive craving for or eating non-nutritive or non-food substances for at least a period of one month[1]. Pica maybe a part of a cultural phenomenon, during childhood, in persons or children who are mentally disabled or even in pregnancy. Iron deficiency anemia is also an important cause of pica. Pica is treated by a multifocal approach which includes reduction of cravings, addressing the social and emotional issues faced by the individual and treating the anemia if present. Pica is further divided based on the type of substance ingested such as ice, lead, feces, soil etc.
Causes
- Pica is commonly seen in children over 2 years of age.
- Iron deficiency anemia
- Pregnancy
- Autism and other developmental disabilities
- Lower socioeconomic status
- Epilepsy
- Schizophrenia
- Recently, obsessive compulsive disorder has also been implicated as a cause [2].
Diagnosis
- The diagnosis of pica includes a detailed history and physical examination, appropriate laboratory investigations.
Management
Do's
- Check for lead levels in children with pica, particularly those living in houses built during and before 1960.
- Screen for parasitic infections such as Toxocara and Ascaris in people exhibiting geophagia (ingestion of soil, sand or clay).
- Basic metabolic tests should be done, particularly when hypokalemia is suspected as it is seen in people ingesting clay or chalk.
- Rule out substance abuse in adults with pica.
Dont's
- ↑ Leung AKC, Hon KL (2019). "Pica: A Common Condition that is Commonly Missed - An Update Review". Curr Pediatr Rev. 15 (3): 164–169. doi:10.2174/1573396315666190313163530. PMID 30868957.
- ↑ Hergüner S, Ozyildirim I, Tanidir C (2008). "Is Pica an eating disorder or an obsessive-compulsive spectrum disorder?". Prog Neuropsychopharmacol Biol Psychiatry. 32 (8): 2010–1. doi:10.1016/j.pnpbp.2008.09.011. PMID 18848964.
- ↑ Hoek HW, van Elburg AA (2014). "[Feeding and eating disorders in the DSM-5]". Tijdschr Psychiatr. 56 (3): 187–91. PMID 24643829.
Obtain a detailed history: ❑ Duration of symptoms ❑ What is the substance being ingested? ❑ When does the patient exhibit this behaviour? ❑ Is it during periods of emotional or physical stress? What is the source of the substance? According to the DSM5, the following 5 criteria must be met to diagnose someone with pica[3]: ❑ Person must be eating non-nutritive or non-food substances for at least one month. ❑ This behaviour must be considered abnormal for their stage of development. ❑ This behaviour must not be considered as a part of a cultural practice, and should be normal in the social context of that person. ❑ For a person with an existing condition like mental disability or pregnancy, this behaviour is considered as pica only when it is dangerous or requires medical investigations and attention. | |||||||||||||||||||||||||||||||||||||||||||||||||
Physical examination While physical examination might be unrevealing in most cases, importance must be given to elicit signs and symptoms of possible poisoning or other complications such as the following: ❑ Signs of lead ingestion * Headache * Insomnia * Tremor * Kidney failure in chronic ingestion ❑ Signs of parasitic infestation * Fever * Hepatomegaly * Cough * Encephalitis ❑ Signs of bezoar ingestion * Pain per abdomen * Gastrointestinal obstruction and * Ulceration | |||||||||||||||||||||||||||||||||||||||||||||||||
Initial investigations ❑ Complete blood count ❑ Iron studies ❑ Zinc level ❑ Basic metabolic panel ❑ Psychiatric evaluation | |||||||||||||||||||||||||||||||||||||||||||||||||
Iron deficiency anemia | Pregnancy related pica | Psychiatric disorders | Lead ingestion | ||||||||||||||||||||||||||||||||||||||||||||||