A huge abdominal mass revealing a depressive syndrome.

Trichobezoar is a rare condition that occurs mostly in young women with psychiatric disorders such as trichotillomania and trichophagia. We report the case of a giant gastric trichobezoar in a 21-year-old woman who presented with chronic abdominal pain, vomiting and weight loss. Abdominal examination revealed a large epigastric mass. Endoscopic and imaging findings were highly suggestive of a gastric trichobezoar. Surgical extraction of the huge hair mass was successfully performed through an open gastrotomy. Postoperatively, history of a neglected chronic depression with suicidal ideation was diagnosed. Consequently, the patient was referred to the psychiatric department for mental healthcare, to prevent trichobezoar recurrences.

Pica, Autism, and Other Disabilities.

BACKGROUND AND OBJECTIVES: Pica, the repeated ingestion of nonfood items, can be life-threatening. Although case reports describe pica in children with autism spectrum disorder (ASD) or intellectual disability (ID), there has been little systematic study of pica prevalence. We assessed pica in children 30 to 68 months of age (median = 55.4 months) with and without ASD. METHODS: Our sample from the Study to Explore Early Development, a multisite case-control study, included children with ASD (n = 1426), children with other developmental disabilities (DDs) (n = 1735), and general population-based controls (POPs) (n = 1578). We subdivided the ASD group according to whether children had ID and the DD group according to whether they had ID and/or some ASD characteristics. Standardized developmental assessments and/or questionnaires were used to define final study groups, subgroups, and pica. We examined pica prevalence in each group and compared ASD and DD groups and subgroups to the POP group using prevalence ratios adjusted for sociodemographic factors. RESULTS: Compared with the prevalence of pica among POPs (3.5%), pica was higher in children with ASD (23.2%) and DD (8.4%), and in the following subgroups: ASD with ID (28.1%), ASD without ID (14.0%), DD with ID (9.7%), DD with ASD characteristics (12.0%), and DD with both ID and ASD characteristics (26.3%); however, pica prevalence was not elevated in children with DD with neither ID nor ASD characteristics (3.2%). Between-group differences remained after adjustment (adjusted prevalence ratio range 1.9-8.0, all P <.05). CONCLUSIONS: Pica may be common in young children with ASD, ASD characteristics, and ID. These findings inform the specialized health care needs of these children.

Eating behavior, non-food substance consumption and negative urgency in women.

Objective To evaluate aspects of eating behavior, presence of non-food substance consumption and negative urgency in women from an on-line support group for eating disorders. Methods Participants (n=147) completed questionnaires for binge eating assessment, Intuitive Eating, negative urgency, cognitive restraint and a question of non-food substance consumption. Participants were separated according to criteria for bulimic symptoms and compulsive symptoms. Results The consumption of non-food substances was 4.8% (n=7). The Bulimic Group (n=61) showed higher values for binge eating (p=0.01), cognitive restraint (p=0.01) and negative urgency (p=0.01) compared with the Compulsive Group (n=86). Only the Compulsive Group showed an inverse correlation between scores for binge eating and Intuitive Eating (p=0.01). In both groups, binge eating was inversely correlated with the subscale of body-food choice congruence of Intuitive Eating scale. As expected, the Bulimic Group reached higher values for measures of disordered behaviors such as cognitive restraint and binge eating, and lower scores for Intuitive Eating. Conclusion The aspects of Intuitive Eating are inversely associated with compulsive and bulimic symptoms and the correlation analyses for binge eating and negative urgency agreed with models reported in published literature about negative urgency.

Chronic Esophagitis and Gastritis After Ingestion of Box Jellyfish (Class Cubozoa).

This is a case report of chronic esophagitis and gastritis following the ingestion of box jellyfish (Alatina alata) by a 12-year old boy with severe autism spectrum disorder and pica. Biopsies taken at esophagogastroduodenoscopy at two months post ingestion revealed histological evidence of esophagitis and gastritis, which resolved after treatment with H2 receptor agonist and proton pump inhibitor.

Trastorno pica como síntoma depresivo en un paciente con trastorno bipolar y discapacidad intelectual / Pica disorder as a symptom of depression in a patient with bipolar disorder and intellectual disability

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Rapunzel syndrome causing partial gastric outlet obstruction requiring emergency laparotomy.

A 16-year-old girl with a background of childhood trichophagia presented with a 2-day history of epigastric pain and associated anorexia with vomiting. An epigastric mass was palpable on examination. A CT scan revealed an intragastric trichobezoar, extending into the duodenum consistent with Rapunzel syndrome with evidence of partial gastric outlet obstruction and a possible perforation. The patient underwent an urgent laparotomy and extraction of the trichobezoar. The bezoar was removed without complication and no intraoperative evidence of perforation was detected. After an uncomplicated postoperative recovery, she was discharged home with psychiatric follow-up.

Pica behaviors in a German community-based online adolescent and adult sample: an examination of substances, triggers, and associated pathology.

PURPOSE: To examine self-reported pica substances, situational triggers for, and associated psychosocial burden of pica eating in adolescents and adults in a Western European population. METHODS: A total of 78 individuals aged 16 years and over, who indicated consuming a substance that in their opinion is not considered as food, participated in an online survey. Two questionnaires assessed eating disorder and general psychopathology, and a third asked about the substances consumed, duration and frequency of consumption, triggers for consumption, emotions thereafter, and interest in treatment. RESULTS: The most frequently reported substances included foods in an uncooked or non-edible form, body parts/fluids, grass, leaves, paper, and earth-like substances, with 54 (69.23%) participants reporting a substance that would qualify as pica substance according to DSM-5. The main triggers for consumption were taste of the substance/indulgence, boredom, curiosity, and release of internal tension. The most common emotion after consumption was relief. Pica eating frequency was not significantly related to eating disorder and general psychopathology (both p > 0.05). A total of 24 individuals considered their pica eating as disruptive, of whom only eight declared an interest in treatment. CONCLUSIONS: The kind of substances consumed is in line with the previous reports in other populations. Pica eating does not seem to be associated with significant psychosocial burden; only a subgroup indicated that they experience it as disruptive and expressed interest in treatment. Nevertheless, for these individuals, triggers for pica eating and emotions thereafter might provide first hints for the development of interventions. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

An Evaluation of Differential Reinforcement in the Treatment of Pica.

Common approaches to pica treatment involve intensive staffing and near continuous behavioral monitoring to proactively disrupt any attempts at this potentially life threatening behavior. Including differential reinforcement of discarding pica items as a contingency in such interventions has been suggested as a more practical treatment model, but the evidence base for this approach is limited. We replicated this work by evaluating differential reinforcement for discarding pica items in conjunction with response blocking and differential reinforcement of other behavior in the treatment of pica exhibited by two children. We extended this work by evaluating sustained reductions when therapist and caregiver monitoring was reduced.

Eating behavior, non-food substance consumption and negative urgency in women / Comportamento alimentar, consumo de substâncias não alimentares e urgência negativa em mulheres

ABSTRACT Objective To evaluate aspects of eating behavior, presence of non-food substance consumption and negative urgency in women from an on-line support group for eating disorders. Methods Participants (n=147) completed questionnaires for binge eating assessment, Intuitive Eating, negative urgency, cognitive restraint and a question of non-food substance consumption. Participants were separated according to criteria for bulimic symptoms and compulsive symptoms. Results The consumption of non-food substances was 4.8% (n=7). The Bulimic Group (n=61) showed higher values for binge eating (p=0.01), cognitive restraint (p=0.01) and negative urgency (p=0.01) compared with the Compulsive Group (n=86). Only the Compulsive Group showed an inverse correlation between scores for binge eating and Intuitive Eating (p=0.01). In both groups, binge eating was inversely correlated with the subscale of body-food choice congruence of Intuitive Eating scale. As expected, the Bulimic Group reached higher values for measures of disordered behaviors such as cognitive restraint and binge eating, and lower scores for Intuitive Eating. Conclusion The aspects of Intuitive Eating are inversely associated with compulsive and bulimic symptoms and the correlation analyses for binge eating and negative urgency agreed with models reported in published literature about negative urgency.

RESUMO Objetivo Avaliar aspectos do comportamento alimentar, presença do consumo de substâncias não alimentares e urgência negativa em mulheres de um grupo de apoio para transtornos alimentares. Métodos As participantes (n=147) preencheram instrumentos para avaliação de compulsão alimentar, Comer Intuitivo, urgência negativa, restrição cognitiva e uma questão para consumo de substâncias não alimentares. Elas foram divididas de acordo com critérios para sintomas bulímicos e sintomas compulsivos. Resultados O consumo de substâncias não alimentares foi de 4,8% (n=7). O Grupo Bulímico (n=61) apresentou maiores valores para compulsão alimentar (p=0,01), restrição cognitiva (p=0,01), e urgência negativa (p=0,01) em relação ao Grupo Compulsivo (n=86). Apenas o Grupo Compulsivo demonstrou correlação inversa entre escores para compulsão alimentar e Comer Intuitivo (p=0,01). Para ambos os grupos, a compulsão alimentar foi inversamente correlacionada com a subescala de escolhas alimentares realizadas em congruência com o estado do corpo do Comer Intuitivo. Como esperado, o Grupo Bulímico apresentou maiores valores para medidas de comportamentos disfuncionais como restrição e compulsão alimentar, e menores escores para Comer Intuitivo. Conclusão Os aspectos do Comer Intuitivo estiveram inversamente associados com os sintomas compulsivos e bulímicos, e os resultados das análises de correlação para Escala de Compulsão Alimentar e urgência negativa concordam com modelos da literatura sobre o envolvimento da urgência negativa.

Severe hypercalcaemia due to household cleaner ingestion.

We report the case of a 59-year-old man with a history of type 2 diabetes, hypertension and chronic kidney disease who presented with symptomatic severe hypercalcaemia (calcium 15.8 mg/dL) and acute kidney injury. Evaluation revealed that the hypercalcaemia was not mediated by parathyroid hormone (PTH), PTH-related peptide or 1,25-hydroxyvitamin D. Adrenal insufficiency was subsequently diagnosed and was initially thought to be the aetiology of the hypercalcaemia. He was treated with intravenous fluid, pamidronate and started on hydrocortisone with resolution of his hypercalcaemia. Over the next several months, despite adherence to hydrocortisone therapy, the patient continued to have recurrent severe hypercalcaemia requiring hospitalisation. Additional laboratory evaluation showed similar results to the initial evaluation. On further questioning, the patient admitted to routinely ingesting the household cleaning product Comet, which contains a large amount of calcium. Psychiatric assessment confirmed the diagnosis of pica. The patient eventually discontinued ingestion of Comet with resolution of his hypercalcaemia.

Investigating the association between stress. Anxiety and geophagy among pregnant women in mwanza, Tanzania.

Geophagy, the craving and intentional consumption of soil, is common especially among pregnant women in some low- and middle-income settings. Soils may contain a variety of non-nutritive components such as heavy metals and microbes or substances that interfere with gastrointestinal absorptive processes, posing health risks to pregnant women. Several hypotheses regarding the practice have been proposed but very few have examined the role of maternal stress. The practice of geophagy may help to alleviate stress or anxiety during gestation from perceived dietary or other pregnancy-related concerns. In this study, we evaluated several measures of maternal stress (general anxiety, Pregnancy-Related Anxiety Scores (10-item revised), and Perceived Stress Scores) and other covariates in relation to geophagic behaviour in early pregnancy in 227 women (12-19 weeks gestation) recruited from two hospitals in the Nyamagana district of Mwanza City, Tanzania. Geophagy was reported by 24.7% of the pregnant women. Using LASSO regression, self-reported treatment of nausea or vomiting during pregnancy (adjusted OR = 3.12, 95%CI: 1.43 to 6.83), paternal education level (adjusted OR = 2.79, 95%CI: 1.32 to 5.87 for primary or lower education level), antenatal hospital site (adjusted OR = 3.71, 95%CI: 1.78 to 7.75), prescription drug use prior to pregnancy (adjusted OR = 1.76, 95%CI: 0.87 to 3.56) and general anxiety (feeling worried, tense or anxious in the past four weeks) (adjusted OR = 1.81, 95%CI: 0.88 to 3.72) were associated with geophagic behaviour. Given that relatively little has been done to examine geophagy in relation to the public health risk it may pose to pregnant women, these findings suggest the need for further investigations regarding maternal stress.

Pica in end-stage chronic kidney disease: Literature review. / Pica en enfermedad renal crónica avanzada: revisión de la literatura.

Pica is an individual entity in the patient with chronic kidney disease (CKD), which phenomenon has not been widely studied despite the high reported prevalence. Moreover, pica complications (anemia, altered electrolytes, poor absorption of micro and macronutrients and malnutrition) could be exacerbated in CKD and limit the quality of renal replacement therapy. The intake of non-caloric and non-nutritional substances could be harmful and cause effects on satiety and metabolic / electrolyte imbalance and modify the biocompatibility of micronutrients, toxins and pathogens worsening health status. In daily practice, pica could be under-reported because patient's shame to recognize it, or fear that such behavior influences their treatment. Additionally, clinicians who not investigate the presence of pica or its complications contribute to the lack of information about the magnitude and relevance of this problem in CKD.

Development of the Pica, ARFID, and Rumination Disorder Interview, a multi-informant, semi-structured interview of feeding disorders across the lifespan: A pilot study for ages 10-22.

OBJECTIVE: Avoidant/restrictive food intake disorder (ARFID), pica, and rumination disorder (RD) were added to the revised DSM-5 Feeding and Eating Disorders chapter in 2013. We developed a structured interview-the Pica, ARFID, and Rumination Disorder Interview (PARDI)-to assess the presence and severity of these diagnoses for evaluation and treatment planning in clinical and research settings. Here, we describe the development of the PARDI and provide a preliminary report on feasibility, acceptability, reliability, and validity in relation to ARFID. METHOD: We created an initial item pool from existing measures of similar constructs and clinical experience. The PARDI includes items assessing the level of endorsement and overall severity of common ARFID features organized into profiles (i.e., sensory sensitivity, lack of interest in eating, and fear of aversive consequences) and algorithms for diagnosing ARFID, pica, and RD. We collected initial psychometric data from participants (10-22 years) with ARFID (n = 39), clinically significant avoidant/restrictive eating (n = 8), and healthy controls (n = 10). RESULTS: On average, the PARDI took 39 min to complete and was acceptable to participants. All subscales achieved internal consistency greater ≥0.77, and inter-rater reliability for the ARFID diagnosis was moderate (κ = 0.75). Individuals with ARFID scored significantly higher than healthy controls on ARFID severity and ARFID profiles. DISCUSSION: The PARDI appears acceptable to respondents and preliminary evidence of reliability and validity has been demonstrated in an initial sample. Larger-scale validation studies are currently underway. The PARDI is freely available to clinicians and researchers.

Geophagy in India: a qualitative exploratory study on motivation and perception of female consumers.

BACKGROUND: Geophagy, the consumption of soil, is well documented in Africa and other continents, but is rarely investigated in Asia and even less so in India. The main aim of this exploratory qualitative study was therefore to understand the motivation for clay consumption, the social perception of the habit, the mode and quantity of consumption, as well as subjectively perceived effects of clay consumption in Himachal Pradesh, North India. METHODS: We conducted semi-structured interviews with 27 female geophagists aged 18-80 years. RESULTS: We could show that geophagy exists across all ages and social groups. The main type of consumed soil is yellow clay used for house wall plastering. Geophagy is usually practised because of a craving for soil despite various fears of negative health effects. It is normally done secretly and under-reported to local doctors. The most common self-reported positive effect of geophagy was the feeling of relief. Geophagy was generally considered as harmful to health and various complaints were associated with it. It is not practised because of food shortages or as a remedy. On the contrary, it is generally seen as an addiction detrimental to health. CONCLUSIONS: Awareness of geophagy has to be ameliorated in the Indian population and specifically among health workers to improve support for affected individuals. Geophagy should be routinely included in national antenatal care guidelines.

[Pagophagia in a Female with Recurrent Depressive Disorder:A Case Report with Review of Literature]. / Tekrarlayan Majör Depresif Bozuklugu Olan Bir Kadin HastadaPagofaji: Bir Olgu Sunumu ve Literatür Derlemesi.

"Pica" is the term used to describe craving for non-food and nonnutritive items like dirt, chalk, or paper. Pagophagia (compulsive ice chewing) is a particular form of pica that is characterized by ingestion of ice, freezer frost, or iced drinks. It is usually associated with iron deficiency anemia or mental abnormalities like intellectual disabilities, autism, etc. Very few case reports have reported association of eating ice cubes with compulsive behavior or depressive disorders. In this case report, we present the association of pagophagia with sadness in a patient with recurrent depressive disorder. A 44-year-old female suffering from depressive disorder since the age of 33 years presented with symptoms of an intense desire to eat ice cubes that she was unable to resist and would feel better only after consumption of ice cubes or iced drinks. Initially she would consume about 250-500 g of ice cubes per day, but gradually the quantity of consumption of ice increased to about 10-12 kg of ice cubes per day. These symptoms were related to low mood and stress. The preoccupation with consumption of ice was associated with significant psychosocial dysfunction and interpersona problems with the spouse. She was managed with venlafaxine 187.5 mg/day and cognitive behavior psychotherapy (identifying her cognitive errors, generating alternative thoughts, problem solving, activity scheduling and mastery, and pleasure technique) with which her depressive symptoms improved and her pagophagia reduced significantly but did not subside completely. She learned to use alternative coping mechanisms to deal with her psychosocial stressors.

A Fatal Outcome of Pica Syndrome: An Unusual Case of Delayed Mortality.

We present the case of a 42-year-old man, with a medical history of schizophrenic psychosis, who was found dead on the floor of his bedroom. At the autopsy, a bottle lid with a notched edge was found in the lower pharynx, partially obstructing the larynx and thus keeping the epiglottis in an open position. Airway obstruction was caused by edema and inflammation of the surrounding tissue. After removal of the foreign body, the tissue of the larynx was left with an impression of the bottle lid. The adjacent mucosa was swollen, hyperemic, partly necrotic, and covered with fibrin deposits. Also, foreign bodies were found in the stomach. The histological analysis of the hypopharynx showed severe nonspecific inflammation and necrosis of epithelium. The cause of death was a complication of subacute laryngeal obstruction caused by a foreign body.

Prevalence of pica and rumination behaviors in German children aged 7-14 and their associations with feeding, eating, and general psychopathology: a population-based study.

Despite potentially severe medical consequences of pica and rumination disorder (RD), little is known about their prevalence and association with other psychopathology in childhood. As a part of a larger population-based study, 804 children aged 7-14 years and their parents were asked about their experience of pica and RD behaviors, and associated eating, feeding and general psychopathology. A total of 12.31 and 11.49% of the participants reported having engaged in pica or RD behaviors, respectively, at least once. Recurring pica or RD behaviors had been experienced by 4.98 and 1.49% of the participants, respectively. The behaviors showed a significant but small correlation with one another (r = 0.28, p < 0.01). Correlations with symptoms of avoidant/restrictive food intake disorder (ARFID) were significant but small (pica: r = 0.18, RD: r = 0.27, both p < 0.01). Prevalence rates of recurring pica behavior were significantly increased if recurring RD was present (58.33%), and also vice versa (17.50%). The prevalence rates of recurrent pica and RD behaviors were also increased in the presence of an ARFID diagnosis (both behaviors 12.0%). However, correlations with restraint and eating, weight, and shape concern were non-significant (all p > 0.05). Additionally, RD behavior was positively correlated with emotional and conduct problems (r = 0.15 and 0.22, both p < 0.01), and both behaviors were negatively correlated with prosocial behavior (r = -  0.10 and - 0.09, both p < 0.05). Our findings underscore the clinical significance of pica and RD behaviors. More research is warranted on both disorders and their association and relation with ARFID to deepen the understanding of their presentation and to ascertain diagnostic validity.

Lead in a case of encephalopathy.

A 2-year-old boy with a history of pica was admitted with vomiting and treated overnight for viral tonsillitis. A week later, he presented with a prolonged afebrile seizure and required intubation and ventilation. Antibiotics and acyclovir were started. Despite extensive investigations including MRI head, no cause was identified. Four days later, he deteriorated with signs of raised intracranial pressure. On day 5, blood lead concentration in the sample collected at admission was reported as grossly elevated, consistent with a diagnosis of severe lead poisoning from ingesting lead-containing paint at the family home. Chelation therapy was started but, unfortunately, he did not make a neurological recovery, and care was withdrawn. A serious case review identified a lack of awareness of lead poisoning and its relation to pica as a root cause. We report this case to share our experience and the importance of considering lead poisoning in children with pica.