Functional network interactions in patients with schizophrenia with persistent auditory verbal hallucinations: A multimodal MRI fusion approach using three-way pICA.

Over the last decade, there have been an increasing number of functional magnetic resonance imaging (fMRI) studies examining brain activity in schizophrenia (SZ) patients with persistent auditory verbal hallucinations (AVH) using either task-based or resting-state fMRI (rs-fMRI) paradigms. Such data have been conventionally collected and analyzed as distinct modalities, disregarding putative crossmodal interactions. Recently, it has become possible to incorporate two or more modalities in one comprehensive analysis to uncover hidden patterns of neural dysfunction not sufficiently captured by separate analysis. A novel multivariate fusion approach to multimodal data analysis, i.e., parallel independent component analysis (pICA), has been previously shown to be a powerful tool in this regard. We utilized three-way pICA to study covarying components among fractional amplitude of low-frequency fluctuations (fALFF) for rs-MRI and task-based activation computed from an alertness and a working memory (WM) paradigm of 15 SZ patients with AVH, 16 non-hallucinating SZ patients (nAVH), and 19 healthy controls (HC). The strongest connected triplet (false discovery rate (FDR)-corrected pairwise correlations) comprised a frontostriatal/temporal network (fALFF), a temporal/sensorimotor network (alertness task), and a frontoparietal network (WM task). Frontoparietal and frontostriatal/temporal network strength significantly differed between AVH patients and HC. Phenomenological features such as omnipotence and malevolence of AVH were associated with temporal/sensorimotor and frontoparietal network strength. The transmodal data confirm a complex interplay of neural systems subserving attentional processes and cognitive control interacting with speech and language processing networks. In addition, the data emphasize the importance of sensorimotor regions modulating specific symptom dimensions of AVH.

Fatal Intestinal Obstruction in a Patient With Fetal Alcohol Syndrome.

We describe an 8-year-old white boy with a history of fetal alcohol syndrome and pica, who was found dead on the floor by his mother. The child died from massive intestinal dilatation causing asphyxia. We discuss the potential pathogenetic mechanisms of intestinal dilation in patients with fetal alcohol syndrome.

Amino Acid Hydration Decreases Radiation-Induced Nausea in Mice: A Pica Model.

Nausea and diarrhea are common yet inconsistent side effects of abdominal and pelvic irradiation. Their frequency, chronicity, and severity vary greatly, and the reasons for inter-subject variability are unknown. We studied the potential for radiation-induced changes in amino acid absorption and mucosal barrier function to lead to gastrointestinal toxicity. We found profound and prolonged changes in the absorption and secretion of several electrolytes and nutrients, caused by changes in transporter function, after radiation doses as low as 1 to 3 Gy. After identifying absorbed and non-absorbed amino acids, we demonstrated the role of a beneficial amino acid drink to alleviate radiation-related gastrointestinal symptoms in a mouse model.

A review of the forensic implications of pica.

Pica is characterized by the persistent eating of non-nutritive substances over some time that is inappropriate for the maturation stage of the individual and is not culturally sanctioned. A 9-year-old boy with Goldenhar syndrome, significant developmental delay and pica, collapsed and died after a short history of diarrhea and vomiting. Death was due to a sigmoid volvulus resulting from filling of the distal colon with feces containing dirt, stones, and rice with evidence of ischemic intestinal necrosis. Lethal complications of pica include intestinal obstruction and perforation with peritonitis and generalized sepsis. Other findings at autopsy may include airway obstruction, heavy metal poisoning, and parasitic infestation. Presenting symptoms and signs of such complications may be subtle or masked given the nature of underlying conditions, and so careful evaluation of the medical histories of individuals with pica may be necessary to provide pertinent details of associated medical and psychiatric conditions.

Homicide or suicide? Xylophagia: a possible explanation for extraordinary autopsy findings.

Determining the cause of death and differentiating self-inflicted injuries from non-self-inflicted injuries is a primary goal in legal medicine. Especially with unidentified decedents, autopsy findings alone are often not sufficient; there is no knowledge of pre-existing conditions and only circumstantial evidence is available from the scene of death. In our case, radiological, histological, and toxicological examinations provided an explanatory model for extraordinary autopsy findings consistent with pica, a rare eating disorder. In cases of pica, variable and potentially lethal complications emerge, depending on the type and amount of material ingested. Our case is of an apparently uncontrolled intake of wooden objects (xylophagia). The resulting mechanical damage to the gastrointestinal tract and subsequent soft tissue damage supports that this behavioral disorder is not only of medical concern, but also identifies it as a mental disease with medico-legal relevance.

Oxidized trilinoleate and tridocosahexaenoate induce pica behavior and change locomotor activity.

Pica behavior, a behavior that is characterized by eating a nonfood material such as kaolin and relates to the degree of discomfort in animals, and the variations of locomotor activity of rats after eating deteriorated fat and oil extracted from instant noodles were examined in our previous study. The result shows that oxidized fat and oil with at least 100 meq/kg in peroxide value (PV) increase pica behavior and decrease locomotor activity. In the present study, the same two behaviors were measured using autoxidized trilinoleate (tri-LA) and tridocosahexaenoate (tri-DHA) as a model of vegetable and fish oil, respectively, to compare fatty acid differences against the induction of two behaviors. The oxidized levels of tri-LA and tri-DHA were analyzed with PV and p-anisidine value (AnV), the method to analyze secondary oxidized products. The oxidation levels of respective triacylglycerol (TAG) samples were carefully adjusted to make them having almost the same PV and AnV. As the results, 600 or more meq/kg in PV of both TAGs significantly increased the consumption of kaolin pellets compared to the control group. Furthermore, 300 or more meq/kg in PV of tri-LA and 200 or more meq/kg in PV of tri-DHA demonstrated significant decrease in locomotor activity compared to control group. These results would indicate that the oxidized TAG having the same PV and/or AnV would induce the same type of pica behavior and locomotor activity. Furthermore, that the structure of oxidized products might not be important and the amount of hydroperoxide group and/or aldehyde group in deteriorated fats and oils might affect the pica behavior and locomotor activity were thought.

Combined symptomatology of psychosis, pica syndrome, and hippocampal sclerosis: a case report.

Pica is the developmentally and culturally inappropriate eating of nonnutritive substances for at least 1 month. Herein, we present the case of a male patient that suddenly showed behavioral changes including aggressiveness, withdrawal, and perceptional disturbances at the age of 12. About 7 years later, pica symptoms emerged additionally. Neither pharmacotherapy nor electroconvulsive therapy led to success. Magnetic resonance imaging showed bilateral sclerosis of the hippocampus. The therapy with carbamazepine, clozapine, diazepam, and zinc finally improved the symptoms including the pica symptoms.

Pica behavior induced by body rotation in mice.

OBJECTIVES: To study whether rotational stimulus induced pica and whether the vestibular apparatus was necessary for obtaining rotation-induced pica in mice. METHODS: Pica behavior in mice was investigated following 60 min of rotation once daily at 70 rpm (15 s on with 5 s off) for 3 consecutive days. After evaluating vestibular function and histology of vestibular epithelia, we examined rotation-induced kaolin intake, so-called pica, in sham-lesioned and chemically labyrinthectomized mice. RESULTS: The labyrinthectomized mice exhibited loss of the contact righting and swimming capability while the destruction of hair cells of vestibular epithelia was observed. Moreover, mice subjected to rotation, but not labyrinthectomized mice, showed a significant increase in kaolin intake at the last 2 rotation sessions and the first postrotation session. CONCLUSIONS: The findings indicated that a functioning vestibular system is necessary for rotation-evoking pica in mice and thus pica can be a behavioral index of motion sickness in mice.

Pica in pregnancy in a privileged population: myth or reality.

BACKGROUND: In the literature pica is reported to be prevalent in pregnant women. Most studies have focused on less privileged populations, but is pica prevalent among privileged pregnant women? METHODS: 100,000 pregnant women in the Danish National Birth Cohort were asked about pica in a food frequency questionnaire mailed in gestation week 25. RESULTS: The response rate of the questionnaire was 70% of Danish National Birth Cohort participants. Only 14 women reported to have eaten substances that were clearly not foods, i.e. 0.02% had pica in this cohort of well nourished Danish women. CONCLUSION: It seems that, in privileged populations, pica is more a myth than a reality.

Pica-associated cerebral edema in an adult.

Acute cerebral edema due to lead intoxication is an unusual presentation in an adult. Here we describe an adult with pica presenting with severe encephalopathy due to extremely high lead levels (>200 microg/dl) with marked cerebral edema and mild hyperammonemia. Rapid initiation of chelation therapy led to a reduction in serum lead and ammonia levels and a resolution of the cerebral edema and encephalopathy, suggesting a close relationship between lead toxicity and hepatic dysfunction.

Case report of sideroblastic anemia caused by ingestion of coins.

This is a report of a 54-year-old schizophrenic patient with a 15-year history of ingesting metal objects (pica). He presented with severe anemia (hemoglobin of 3 g/dl and hematocrit of 8.3%) and leukopenia (white blood count of 1,300/mm3). Work-up revealed copper deficiency (copper level of <0.05 microg/ml) and elevated zinc levels (280 microg/ml). The zinc toxicity was produced by the zinc content in the coins ingested by the patient over a period of many years. He was initially treated with -acetylcysteine and sodium bicarbonate followed by intravenous copper sulfate. He was also placed on Adolph's meat tenderizer and pancreatin thrice a day orally to loosen the massive amount of metallic objects including coins in his bowel and allow them to pass out in his feces. He was also continued on oral copper sulfate. His copper levels began to rise and reached a maximum of 0.72 microg/ml, and his zinc level fell to 153 microg/ml. However, as he refused surgery to remove the metal objects from his bowel and continued to ingest more coins, there was continued absorption of zinc, which later overcame the efforts to reduce the zinc level and increase copper levels in his blood. He finally succumbed to sepsis and multiorgan failure. Autopsy revealed a coin mass in the stomach weighing 1,870 grams in addition to a sigmoid volvulus caused by another coin bezoar in the colon.

Influence of minerals on the aetiology of geophagia in periurban dairy cattle in the derived savannah of Nigeria.

The aetiology of geophagia in periurban dairy cattle in Nigeria was assessed in relation to the mineral status of the serum, the herbage consumed, and the soil from where the herbage was consumed. The study was carried out using nine herds in the derived savannah zone during both the wet and dry seasons. Generally, the Na, Ca, Fe, Zn and Cu levels in the samples were adequate. However, the forages were low in Ca and the serum was deficient in P. Forage, soil and termite hill samples were also deficient in P. The low levels of P in the soil and termite hill samples showed that the consumption of sand by the cattle did not have any positive impact on their P intake. A seasonal effect was apparent (p < 0.05) on the serum Na+, PO4(3-), Cu2+ and Fe2+ concentrations but not on Ca2+ and Zn2+ concentrations. A seasonal effect was also significant (p < 0.05) on the minerals in the forage. There were also seasonal differences in most of the soil and termite hill minerals. Most samples had higher (p < 0.05) mineral levels in the dry season. Herd size and farming activity had no apparent influence on the aetiology of geophagia as they did not affect (p > 0.05) the concentration of P in the serum, the reported cause of geophagia. Geophagia is probably caused by a marginal level of P in the serum and low levels in the forage and soil. Experimental trials will be required to confirm these observations.

Partial Klüver-Bucy syndrome arising from a multicentric glioblastoma: anatomo-clinical study of a case with unusual involvement of CNS.

The authors describe the case of a patient showing clinical symptoms consistent with a partial Klüver-Bucy syndrome. CT-scan, macroscopic and histological findings showed the presence of a multicentric glioblastoma with almost exclusive involvement of subcortical gray nuclei and white matter. The possible anatomo-clinical correlations of these unusual locations in KBS are discussed. In addition, the authors emphasize that KBS can arise not only from lesions located in the temporal cortex and/or amygdala, but also from strategically located subcortical lesions particularly involving striatal nuclei and subcortical white matter in the insular area.

Geophagia in Turkey: iron and zinc deficiency, iron and zinc absorption studies and response to treatment with zinc in geophagia cases.

A brief summary of the research carried out on the problem of geophagia is reported in this paper. Geophagia was a common finding among Turkish children and women in villages, associated with severe iron deficiency anemia in addition to zinc depletion. The syndrome characterized by geophagia, iron deficiency anemia, growth retardation, hypogonadism and zinc deficiency has been observed in both sexes in Turkey for several decades. Zinc deficiency has been also shown by our group in this syndrome. The decreased concentrations of zinc in serum, plasma, RBC, hair and urine were measured by atomic absorption spectrophotometer. Oral iron (both inorganic and radioactive iron) and zinc absorption tests were carried out with and without clay and revealed decreased iron and zinc absorption in some cases with prolonged geophagia. Therefore, malabsorption of iron and zinc was considered to be an additional and/or a new finding in the syndrome. Furthermore, Turkish clay most probably inhibits zinc absorption in a way similar to its inhibition of iron absorption. It was worthy of observation that some Turkish patients with this syndrome had a thalassemia-like appearance with similar skull-bone changes. Finally, growth retardation and delayed puberty were shown to be corrected by oral zinc treatment for 6-month terms. Linear growth and sexual maturation were found to be greater in the zinc-treated group than in the controls.

Studies on clinical, haematological aspects and pathological changes of gastric mucosa in geophagia.

1) Geophagia characterized by, severe, anaemia, dwarfism, hypogonadism and hepatosplenomegaly is sometimes seen in young patients (and children) in Iran. 2) Haematological aspects of the syndrome are those of, severe, iron deficiency anaemia. 3) Gastric biopsies and histological findings revealed superficial or atrophic gastritis showing some resemblance to those seen in pernicious anaemia. 4) Haematological features, anaemia and many of the clinical signs of the syndrome were improved after appropriate iron therapy. 5) Histological changes of gastric mucosa improved, in 5 patients, 6 months after correction of the anaemia.