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SUMMARY: Pica is a condition associated with a number of physical and mental health diagnoses. The potentially fatal consequences of pica and the links with significant physical health problems are not always recognised. Pica is like other forms of behaviour that can challenge: clinicians must seek the underlying cause and treat this first, before primarily pursuing a behavioural form of treatment. In this article, we discuss the associations, consequences, assessment and management options available for pica to guide professionals. Pica often presents in a way individual to the particular patient, so tailoring of assessment and treatment is important. [ABSTRACT FROM AUTHOR]

Niacin deficiency causes pellagra, the symptoms of which include dermatitis, diarrhoea and dementia. Investigating the mechanism underlying these phenotypes has been challenging due to the lack of an appropriate animal model. Here, we report a mouse model of pellagra-related nausea induced by feeding mice a low-niacin diet and administering isoniazid (INH), which is thought to induce pellagra. Mice fed a normal or low-niacin diet received INH (0·3 or 1·0 mg/mg per animal, twice daily, 5 d), and nausea was evaluated based on pica behaviour, which considered the rodent equivalent of the emetic reflex. Furthermore, the effect of therapeutic niacin administration on nausea was evaluated in this model. Urinary and hepatic metabolite levels were analysed by LC coupled with MS. INH-induced pica was observed in mice fed a low-niacin diet but not in those fed a normal diet. Levels of urinary metabolites, such as 1-methyl-2-pyridone-5-carboxamide, kynurenic acid and xanthurenic acid, were significantly reduced in the mice treated with INH compared with those that did not receive INH. Furthermore, niacin supplementation prevented pica and restored the levels of some metabolites in this mouse model. Our findings suggest that INH-related nausea is pellagra-like. We also believe that our newly established method for quantifying pica is a useful tool for investigating the mechanisms of pellagra-related nausea. [ABSTRACT FROM AUTHOR]

Aims: Pica and rumination disorder are known as feeding disorder diagnoses in childhood, but little is known about their occurrence in adulthood. This study aimed to assess prevalence rates of one-time and recurrent pica and rumination behaviours (PB and RB) in adults, including sociodemographic subgroups, and to examine associations with other eating disorder and general psychopathology. Methods: The representative population sample (N = 2403) completed measures on PB and RB, symptoms of avoidant/restrictive food intake disorder (ARFID), body image and symptoms of depression and anxiety. Results: Any PB and RB were reported in 5.33 and 5.49%, respectively, while recurrent PB or RB occurred in 1.08 and 0.71%, respectively. Co-occurrence was high, with 35.29% of recurrent PB in RB, and 23.08% vice versa. Prevalence rates of recurrent PB or RB did not differ by gender, weight status, educational or migration history from those without recurrent behaviours. Adults with v. without recurrent PB and RB showed more symptoms of ARFID, general eating disorders depression and anxiety, and behavioural symptoms of eating disorders (with the exception of compensatory behaviours in recurrent PB), and less positive body image. However, there were no differences regarding age and body mass index. Conclusions: Our findings highlight the clinical significance of PB and RB in adults regarding both prevalence and associations with other psychopathological symptoms. In particular, associations with body image need to be investigated further, as in contrast to other eating disorders, body image disturbance is not yet represented in the diagnostic criteria for pica and rumination disorder. In sum, the findings highlight the need for clinical attention for these disorders and related behaviours in adults. [ABSTRACT FROM AUTHOR]

Geophagy is the intentional consumption of earth. Although widely documented among vulnerable populations, including children and pregnant women, the causes and consequences of geophagy remain poorly understood. Relevant literature was, therefore, reviewed to describe geophagy across species, geographies, life stages, and disease states. After a brief consideration of hypothesized etiologies, the potential harmful and beneficial consequences of geophagy are described, considering current evidence for each. Data available to date suggest that the greatest potential risks of geophagy include toxicity or heavy metal poisoning, and diseases resulting from consumed clays binding nutrients and beneficial pharmaceuticals in the gut. Evidence also suggests that geophagy may be beneficial by protecting against harmful pathogens and toxins through two distinct physiological pathways. Future research should explore causal relationships between geophagy and iron deficiency, as well as investigate the biological and psychosocial conditions that govern geophagy. [ABSTRACT FROM AUTHOR]

The article comments on the potential value of evidence on the historical manifestations of eating disorders: anorexia, bulimia, rumination and pica. The eating disorders are characterised by the changing prominence of different features, the assumption that the process has been influenced and the prevailing sociocultural factors. The classification systems fulfil an essential utilitarian function for clinical, research and education purposes.

In Prudhoe Hospital, a large mental-handicap hospital of 1000 residents, it was found that of the 94 deaths that occurred between 1982 and 1986, three were closely associated with the habit of pica. These deaths occurred in severely and profoundly handicapped males, whose average age was 32, compared with an average age of death of 58 for the combined groups of severely and profoundly mentally handicapped patients (22 cases), and an average age of death of 60 for all degrees of handicap (94 cases). It seems likely that the habit of pica constitutes a cause of considerable morbidity and mortality in certain institutionalised patients. [ABSTRACT FROM AUTHOR]

Introduction: Pica is a strange eating disorder that consists of eating non-nutritive substances, inappropriate to the developmental level/cultural normative of the individual. The prevalence is not widely studied, but might occur in the context of other mental disorders, such as schizophrenia, that hinders the management and treatment of these patients. Objectives: To report a severe pica in a patient with late schizophrenia, and highlight the impact this syndrome might cause on the life of these patients. Methods: We present a case of a 65 year-old-woman with schizophrenia attended in the emergency area for dysphagia due to the intake of a metal washer. Reviewing the patient medical history, an early and severe schizophrenia was described. Within years, disorganization and residual symptoms have become the main disabilities, developing a pica eating disorder with preference in greater metal objects (images are included). Results: The management has been hindered due to the consequences of pica eating disorder. The patient describes an unstoppable urge to make the intake when she sights wide metallic objects (batteries, docks, washers...). Different antipsychotic drugs have been used, combined with psychotherapy and family education. Despite this, the patient has required multiple attentions in the emergency area due to esophagueal impaction, intestinal obstruction, perforation and peritonitis, that have led to countless surgeries and hospitalizations. Conclusions: Pica can become a highly dysfunctional syndrome that may lead to severe organic and life impact. The comorbidity with schizophrenia is understudied, but further investigation might be useful to show up specific management strategies of these patients. [ABSTRACT FROM AUTHOR]

The case of a person with severe mental handicap whose pica became uncontrollable during episodes of depressive illness is described. Treatment of the depression with lofepramine markedly reduced the pica, and withdrawal of lofepramine led to recurrence. It is suggested that biological symptoms of depression should be monitored in people with severe mental handicap who show significant episodic worsening of long-standing repetitive behaviour. [ABSTRACT FROM AUTHOR]

A case of an unusual pica in a patient with anorexia nervosa is described. The patient was also found to have iron-deficiency anaemia. The relationship of mineral deficiency to pica and anorexia nervosa is discussed. [ABSTRACT FROM AUTHOR]

The article discusses a study which examined the frequency of pica in pediatric patients with autistic tendencies. Pica is defined as the ingestion of non-food substances. 70 autistic patients were compared with 70 hospitalized Down's syndrome patients. 60% of 70 autistic patients had indulged in pica at some stage, while only 4% of the Down's syndrome group had indulged in pica. Only nine of the autistic pediatric patients could their pica be regarded as a serious problem that requires correction.

Introduction Pica is an eating disorder characterized by eating of nonnutritive materials. It has been reported in different population, from certain ethnic groups, children, pregnant woman or organic disorders (eg. mineral deficiency) to psychiatric patients, including psychotic. Objectives To describe a patient who ingest nonfood substances and its relationship with delusions. Methods X is a 26 year-old male with Paranoid Schizophrenia who came into the psychiatric emergency service because of an acute exacerbation of his mental illness, presenting auditory hallucinations and delusional mysticism. Draws our attention the presence of an aberrant eating behavior ingesting animals, lime, earth and leaves. The patient was hospitalized in the Impatient Psychiatric Unit for examination and treatment. Results Several medical tests were performed and the only finding was an idiopathic eosinophilia, considered secondary to pica. He referred that the ingested items provided him from energy and better sight, as an explanation for his eating behavior. No suicidal ideation was objectified. Neuroleptic treatment was prescribed and behavioral and psychotic symptoms improved progressively. Conclusions The etiology of pica is unknown. Schizophrenic motivation for deliberate foreign body ingestion is a poorly understood phenomenon. In the case presented, the ingestions seems to be secondary to delusional beliefs that these objects contains properties that the patient lacks, not obeying to suicidal behavior and objectifying parallel remission of the pica and delusional activity. Further research is needed to clarify the etiology and mechanisms of this disorder, as it can lead to serious medical consequences (eg. metal poisoning, parasitosis, intestinal obstruction). [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article about a case of pathological salt ingestion or salinophagia as a symptom of anorexia nervosa.

The article presents the clinical study concerning coprophagia among adult patients in psychiatric hospitals in Great Britain. Coprophagia refers to the eating of one's own feces. A total of fourteen patients who suffer from coprophagia from two large psychiatric hospitals were studied. An examination was made on the case notes of these patients for the data including pica, cissa, boredom, and aggressive behavior. Pica, cissa, and food fads had been found to be phenomenogically similar to and potentially linked with coprophagia. Nine of the patients appeared to be affected with madness or insanity and two of them had been found to have a definite history of alcoholism. Eight of the patients were discovered as wanderers and 4 were seen to have persistent abnormal mouth movements.

Introduction: Persistent Hyperphagia, Pica, and Severe Food Restriction are rare but potentially life threatening complications following acquired brain injury. These disorders are not formally coded in disease classification systems though do present with significant management challenges in both inpatient and outpatient settings. Objectives: To inform treatment and management strategies and service development for complex neuropsychiatric conditions Aims: To study presentation and prevalence of organic eating disorders following acquired brain injury. Methods: Systematic review of medical literature on Medline, PsychInfo, CINAHL, Embase, Cochrane database of systematic reviews, using terms eating disorders, organic eating disorders, binge eating, bulimia, anorexia nervosa, atypical eating disorders, food restriction, pica, head injury, acquired brain injury, traumatic brain injury. Service consultations and identification of grey literature Results: Systematic review identified case reports, case series, and case studies relevant to these disorders. It also identified lack of research in this area and absence of well structured longitudinal studies that can identify true prevalence in a representative sample. Persistent Hyperphagia has been reported in 2–3% of adult cases requiring inpatient post acute rehabilitation. Pica has been reported in young children after acquired brain injury only. Two reports identified this condition in post neurosurgery period. Severe food restriction, at times also described as atypical anorexia, has been reported following acquired brain injury. However, it remains rather difficult to estimate prevalence in different patient populations. Conclusions: Organic eating disorders present with significant levels of challenges in patient management and do carry identifiable mortality risk. [ABSTRACT FROM AUTHOR]