Pica y traumatismo craneoencefálico en un paciente adolescente: recuperación <> con paliperidona / Pica and traumatic brain injury in an adolescent: complete improvement with paliperidone

Presentamos el caso clínico de un adolescente varón de 15 años derivado a Psiquiatría Infanto-Juvenil por realizar ingestas repetitivas de sustancias no nutritivas como gomas de borrar, escamas psoriásicas o incluso pintura de la pared. Entre sus antecedentes somáticos de interés, conviene destacar la Enfermedad de Kawasaki y psoriasis, además de haber sufrido un traumatismo craneoencefálico (TCE) tras lo cual presentó una exacerbación del cuadro. Tras el fracaso en el manejo conductual realizado por parte de su madre y teniendo en cuenta sus rasgos de personalidad caracterizados por una elevada suspicacia y desconfianza hacia los demás, se decide iniciar tratamiento con paliperidona oral produciéndose una rotunda mejoría clínica. Durante todo el seguimiento posterior hasta su mayoría de edad, se ha mantenido la desaparición de la pica. Presentamos el primer caso clínico publicado en la bibliografía actual de un adolescente con el diagnóstico de pica y un TCE previo y una adecuada respuesta a paliperidon

We present a case report of a 15-year-old male adolescent who was referred to our consultation of Children and Adolescent Psychiatry due to persistent eating of non-nutritive substances like rubber, psoriatic scale or wall paint. The patient had the previous diagnostic of Kawasaki Disease and psoriasis. In addition, he had suffered a traumatic brain injury, after which he presented an exacerbation of the clinic. After behaviour therapy failure realized by his mother and taking into account his personality features with high suspicion and distrust of others, he was prescribed paliperidone oral treatment and pica disappeared. During all subsequent follow-up until the age of majority, the disappearance of pica has been maintained. We describe the first case report in the current bibliography of an adolescent with the diagnosis of pica, a previous traumatic brain injury and a good response to oral paliperidone.

Demographic, clinical, and biochemical predictors of pica in a large cohort of blood donors.

BACKGROUND: Pica is characterized as repeatedly eating or chewing a non-nutritious substance including, but not limited to ice, clay and dirt, starch, raw pasta, chalk, coal, paint, or paper. Pica symptoms can be intense and addiction-like and disrupt quality of life. It is strongly linked to iron deficiency. Since substantial iron loss occurs during blood donation, blood donors may be susceptible to development of pica behaviors. METHODS: We investigated demographic, clinical, hematological, and biochemical factors associated with pica using univariable and multivariable logistic regression analysis in a cohort of 11,418 racially diverse blood donors. Pica was defined by questionnaire responses as consuming at least 8 oz of ice daily and/or consumption of non-ice substances regardless of the amount and frequency. RESULTS: Pica was present in 2.2% of the donors. The sensitivity and specificity of pica in iron-deficient donors were 36% and 82%, respectively. Lower ferritin (p = .001), non-Asian race (p < .001), higher red cell distribution width (p < .001), younger age, and restless legs syndrome (p = .008) were independently associated with pica. Female sex is associated with iron deficiency but was not an independent predictor of pica suggesting that iron deficient males and females were equally susceptible to the development of pica behaviors. Donors with normal ferritin levels also reported pica, reinforcing the role of non-iron related factors in its presentation. CONCLUSIONS: We have identified demographic, clinical, and biochemical predictors of pica that help identify those most at risk for developing pica behaviors, and thereby assist in its clinical diagnosis and treatment.

[A CASE OF EOSINOPHILIC GASTROENTERITIS FOUND BY PICA DURING ORAL IMMUNOTHERAPY].

Eosinophilic esophagitis has been reported as a complication of oral immunotherapy (OIT), but there are only a few reports of eosinophilic gastroenteritis (EGE) occurring after OIT. EGE causes eosinophil infiltration into the gastrointestinal (GI) tract and is characterized by various digestive symptoms. We report the case of a 6-year-old boy with EGE. He was diagnosed as having immediate-type food allergies (egg, milk and wheat) by oral food challenges at 1 year of age. OIT for each food was carried out, and the amounts of the offending foods were able to be gradually increased without causing any immediate-type allergy symptoms. However, the total IgE and specific IgE values were remarkably increased at the age of 4 years and 4 months. He first developed oral mucosa symptoms and vomiting at 4 years and 10 months of age, and they gradually worsened. Stopping eggs and milk alleviated the symptoms. Nevertheless, he still occasionally vomited. He started Pica eating disorder (sand and sponge) due to anemia from 5 years and 10 months of age and developed eosinophilia without diarrhea or bloody stool. Upper and lower GI tract endoscopic examinations found no bleeding. The GI mucosa showed eosinophil infiltration of more than 40/high-power field in the stomach and duodenum, so he was diagnosed with EGE. No eosinophils were found in the esophageal mucosa. His GI symptoms and anemia improved on a multiple-food-elimination diet. Patients undergoing OIT should be closely followed up for a long time, and those with GI symptoms should be evaluated by GI endoscopy.

High prevalence of kaolin consumption in migrant women living in a major urban area of France: A cross-sectional investigation.

Geophagia is a feeding behavior involving the regular intake of soil, including clay-like kaolin. Frequent in Africa, kaolin consumption is associated with heavy metal intoxication, iron and other micronutrient deficiencies, geohelminth infection and inactivation of concomitantly taken drugs. It is expected that this practice would be imported into an asylum country during the immigration process. To confirm this hypothesis, a single center, cross-sectional study was conducted at the University Hospital of Nantes, France, whose main objective was to assess whether the prevalence of kaolin consumers was high in a migrant population living in a large French metropolitan area (the city of Nantes). Each woman consulting for the first time at the Medical and Psychosocial Gynecology Obstetric Unit during the inclusion period ranging from January 1, 2017, to July 1, 2017, was asked for consent to be included in the study. The main outcome was the proportion of positive answers regarding consumption of kaolin within the last twelve months, with its 95% confidence interval (CI). A logistic regression was performed to identify drivers of consumption, and a clustering approach was conducted to identify profiles of consumers. A total of 284 women were included in the study, of whom 110 (38.7%) were pregnant. Our main finding was a 14.1% (95% CI: 10.5-18.6) prevalence of clay consumers. Second, the characteristic most strongly associated with consumption was Central or West Africa origin (adjusted Odds Ratio (aOR) = 52.7; 95% CI: 13.7-202.2). Finally, 60% of consumers showed signs of addictive-like phenomena, and three profiles were identified, depicting a continuum of patients in regard to their control over their kaolin consumption. Our results suggest that kaolin consumption is frequent in particular subpopulations of migrants. This warrants further study of the clinical consequences of kaolin consumption and its associated addictive-like symptoms.

Characteristics of Pica Behavior among Mothers around Lake Victoria, Kenya: A Cross-Sectional Study.

Background: Pica, the craving and purposeful consumption of nonfoods, is poorly understood. We described the prevalence of pica among women on Mfangano Island, Kenya, and examined sociodemographic and health correlates. Methods: Our cross-sectional study included 299 pregnant or postpartum women in 2012. We used a 24-h recall to assess pica, defined as consumption of earth (geophagy), charcoal/ash, or raw starches (amylophagy) and built multivariable logistic regression models to examine sociodemographic and health correlates of pica. Results: Eighty-one women (27.1%) engaged in pica in the previous 24 h, with 59.3% reporting amylophagy and 56.8% reporting geophagy, charcoal, and/or ash consumption. The most common substances consumed were raw cassava (n = 30, 36.6%), odowa, a chalky, soft rock-like earth (n = 21, 25.6%), and soil (n = 17, 20.7%). Geophagy, charcoal, and/or ash consumption was negatively associated with breastfeeding (OR = 0.38, 95% CI: 0.18-0.81), and amylophagy was associated with pregnancy (OR = 4.31, 95% CI: 1.24-14.96). Pica was more common within one of six study regions (OR = 3.64, 95% CI: 1.39-9.51). We found no evidence of an association between food insecurity and pica. Conclusion: Pica was a common behavior among women, and the prevalence underscores the need to uncover its dietary, environmental, and cultural etiologies.

Pica, a Little-Known Condition in Dentistry. Case Report / Pica, una Condición Poco Conocida en Odontología. Reporte de un Caso

ABSTRACT: Pica is a condition associated with the chronic, compulsive consumption of a particular substance or material that is not considered food. Culturally it is not accepted by society and its nutritional value is non-existent. When this behavior is repeated consistently for more than one month, it is considered to be Pica. This eating disorder does not have a clear etiology, but is associated with; orality in children, psychotic disorders, nutritional deficiencies, psychosocial problems, autism, family problems, OCD, stress, abuse, family separations and other traumatic events. In order to detect it, it is necessary to perform a correct anamnesis, clinical examination, radiographic examination, complementary examinations such as blood count, as well as a relationship of trust between the dentist and the patient are necessary. All of them will be able to guide us and make us come out of suspicion that this harmful behavior exists, since patients often hide it.

RESUMEN: Pica es una condición asociada al consumo compulsivo y crónico de alguna sustancia o material en particular, que no es considerada alimento. Culturalmente no es aceptado por la sociedad y su valor nutricional es inexistente. Cuando esta conducta se repite consiste-ntemente durante más de un mes, se considera como Pica. Este desorden de comportamiento alimenticio no tiene una etiología clara, pero se asocia a la oralidad en niños, trastornos psicóticos, deficiencias nutricionales, problemas psicosociales, autismo, problemas familiares, TOC, estrés, abuso, separaciones familiares y otros eventos traumáticos. Para detectarla, es necesaria una correcta anamnesis, examen clínico, radiográfico, exámenes complementarios como hemograma, además de una relación de confianza rapport odontólogo- paciente. El conjunto de ellos nos podrán guiar y salir de sospecha que esta conducta dañina existe, ya que los pacientes muchas veces lo esconden.

Pagophagia in men with iron-deficiency anemia.

Few case series of pagophagia and iron deficiency include men. We performed a retrospective study of non-Hispanic white men with iron-deficiency anemia whose anemia and pagophagia, thrombocytosis, and thrombocytopenia (if present) resolved after iron replacement. Iron-deficiency anemia was defined as transferrin saturation (TS) <15%, serum ferritin (SF) <30 µg/L, and hemoglobin (Hb) <13.0 g/dL. We excluded men with: anemia, thrombocytosis, or thrombocytopenia due to non-iron-deficiency causes; malignancy; chronic inflammatory conditions; hemochromatosis; or creatinine >1.1 mg/dL. We computed univariate and multivariable pagophagia associations with: age; gastrointestinal bleeding; TS; SF; Hb; red blood cell (RBC) count; mean corpuscular volume (MCV); RBC distribution width (RDW); and platelet count. Median age of 41 men was 54 y (range 18-81). Fourteen men (34.1%) had pagophagia. Thirty-six men (87.8%) had gastrointestinal bleeding. Mean Hb was 9.4 ±â€¯2.2 g/dL. Six men (14.6%) had thrombocytosis; two (4.9%) had thrombocytopenia. Logistic regression on pagophagia revealed: age (p = 0.0158; odds ratio 0.92 [95% confidence interval: 0.85, 0.99]) and platelet count (p = 0.0187; 0.98 [0.97, 1.00]) (41.4% of pagophagia occurrence; ANOVA p = 0.0053). We conclude that pagophagia occurred in 34% of men with iron-deficiency anemia and was negatively associated with age and platelet count, after adjustment for other variables.

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.

Collagenous gastritis: An unusual cause of generalized oedema in a child.

Collagenous gastritis is an uncommon gastrointestinal disease in children. Its cause remains uncertain. It may present as severe hypoproteinaemia manifesting as generalized oedema. We report a 15 months old female who presented with pica, generalized body oedema and diarrhoea. Diagnostic workup revealed gastric replacement of the lamina propria by hyalinized collagen on histology. This case seeks to highlight the need for early paediatric gastroenterology referral including oesophagogastroduodenoscopy with multiple tissue biopsies as part of a broad diagnostic workup in children with non-specific gastrointestinal symptoms to improve diagnostic yield and enable accurate histologic diagnosis, so that appropriate therapy can be timeously applied.

[Pica].

Pica is an extremely troublesome behaviors and causes a particularly high burdens for family caregivers. It can lead to dangerous medical consequences, such as malnutrition and intoxication, which sometimes require emergency medical treatment. Its neural basis and underlying mechanisms, however, have not been clarified. We addressed these issues by investigating patients with acquired brain injury who presented with pica. We found that semantic memory deficits were most often associated with pica rather than frontal release signs or changes in eating behaviors. Individuals with pica displayed lesion in the posterior part of the middle temporal gyrus, although spread across a wide area. Taken together, our findings suggest that semantic memory deficits, because of temporal lobe damage might be associated with pica. Moreover, Alzheimer's disease and semantic dementia are the two main degenerative disease etiologies that cause pica. Our findings may also be applied to degenerative disorders as temporal lobe involvement and semantic memory deficits are common. The most common items ingested in pica are daily necessities that are easy to swallow or drink; as such, these items should be avoided in patients with pica.

Involvement of the Hypothalamic Glutamatergic System in the Development of Radiation-Induced Pica in Rats.

Since the peripheral serotoninergic pathway is involved in the development of radiation-induced nausea and vomiting, referred to as radiation sickness, serotonin 5-HT3 receptor antagonists are used as a preventive measure, although patients still suffer from these symptoms. Glutamate is known as the excitatory neurotransmitter and is involved in various autonomic symptoms. We investigated the effect of radiation on glutamate release in rats, as measured by in vivo brain microdialysis, and the effects of glutamate receptor antagonists on radiation-induced pica, which can be used as a behavioral assessment of radiation sickness in rats. A microdialysis probe was inserted into the hypothalamus of rats that received 4 Gy total-body irradiation (TBI) with or without pretreatment of 5-HT3 receptor antagonist (granisetron, 0.1 mg/kg, i.p.), and dialysates were collected for 3 h after TBI and subjected to HPLC assay of glutamate. In addition, rats were intracerebroventricularly injected with NMDA receptor antagonist (MK-801: 3 µg/rat) or AMPA receptor antagonist (CNQX: 1 µg/rat) before TBI, and radiation-induced pica was determined. An increase in glutamate release was observed within 1 h postirradiation. The increased glutamate release was suppressed by granisetron. We also found that CNQX, but not MK-801, effectively inhibited radiation-induced pica. These results indicate that the hypothalamic glutamatergic system contributes to radiation-induced pica through the AMPA receptors.

Syndrome occlusif au décours d'une ingestion chronique de Kaolin ("Kew"). A propos d'une observation

Le pica est un trouble du comportement alimentaire fréquemment rencontré chez les femmes et les enfants. Il se caractérise par l'ingestion d'objets ou de substances non-comestibles comme la craie, le charbon, le savon, le métal, le sable etc... Nous rapportons une observation d'une patiente de 20 ans avec notion d'autisme depuis l'enfance et d'addiction à la géophagie (Kaolin appelé "kéw" au Sénégal) depuis plusieurs années qui a eu à consulter pour des douleurs abdominales associées à des ballonnements abdominaux, une hématémèse et un arrêt complet des matières et des gaz. Son examen clinique avait objectivé un abdomen légèrement sensible sans défense ni cris de l'ombilic et le toucher rectal avait objectivé un fécalome de consistance dure. Le bilan biologique était normal en dehors d'une légère hypokaliémie, le test de Wide était négatif. La radiographie de l'abdomen sans préparation avait objectivé des micro calcifications en amas au niveau du rectum confortée par la tomodensitométrie abdomino-pelvienne qui avait en plus infirmé l'existence d'une perforation d'organe et de souffrance viscérale. Un traitement évacuateur mécanique consistant en la mise en place d'une sonde d'intubation orotrachéale charnière n°6 au niveau du rectum avec ballonnet gonflé et irrigation par 500 ml de sérum savonneux stérile suivi d'une évacuation au doigt avait permis d'évacuer la quasi-totalité des corps étrangers endorectaux confirmée par la radiographie de contrôle. Devant la constatation d'une ré-ingestion au bout d'une semaine avec une radiographie de l'abdomen sans préparation qui avait montré des images quasi-superposable, la patiente a été adressée en consultation psychiatrique pour un suivi

Pica in Pregnancy: An Unusual Presentation.

BACKGROUND: Pica is common in pregnancy and is often felt to be benign. The following case of severe pica presenting without anemia is unusual in its presentation, laboratory findings, and treatment. CASE: A 31-year-old multiparous woman at 37 0/7 weeks of gestation presented with esophagitis and gastritis secondary to laundry detergent consumption. She had borderline anemia (hemoglobin of 11 g/dL and hematocrit of 37%, mean corpuscular volume 80%) but was severely iron-deficient (serum ferritin 7 micrograms/dL). Parenteral iron infusion was associated with dramatic resolution of her cravings within 36 hours of treatment. CONCLUSION: Pica may be related to deficient iron stores in the absence of anemia and can result in serious morbidity. Parenteral iron may be associated with rapid pica resolution in symptomatic pregnant patients.

Sodium chloride pica causing recurrent nephrolithiasis in a patient with iron deficiency anemia: a case report.

BACKGROUND: Iron deficiency anemia is a common finding in women of child-bearing age. Pica, or the ingestion of non-food or non-nutritive items, is a well-known manifestation of iron deficiency. A high sodium diet increases risk for nephrolithiasis. We describe the case of a 31-year-old woman with recurrent calcium nephrolithiasis and anemia who ate ice chips as well as spoons of salt daily. Treatment of pica may prove effective in preventing recurrent nephrolithiasis. CASE PRESENTATION: A 31-year-old white woman with a past medical history of menorrhagia, anemia, and recurrent calcium nephrolithiasis presented for preoperative evaluation prior to ureterolithotomy. She described a daily pattern of eating continually from a cup of ice chips accompanied by multiple spoons of salt directly out of a salt shaker. These cravings had been present for many years, were bothersome to her, and interfered with her daily life. Laboratory findings revealed hemoglobin of 10.9 g/dL with ferritin of 3 ng/mL. History, physical, and laboratory data were consistent with pica secondary to iron deficiency anemia. She was prescribed orally administered ferrous sulfate 325 mg three times a day with meals. She continues to struggle with the symptoms of pica and orally administered supplementation. CONCLUSIONS: It is important that clinicians consider the possible diagnosis of sodium chloride pica in patients with iron deficiency anemia and recurrent nephrolithiasis. Treatment of anemia and resolution of pica may prove effective in preventing future nephrolithiasis. Specific questioning about pica symptoms in patients with iron deficiency anemia and recurrent nephrolithiasis may be helpful diagnostically and therapeutically.

Pica in a Child with Anterior Cingulate Gyrus Oligodendroglioma: Case Report.

The anterior cingulate gyrus (ACG) is a continued focus of research as its exact role in brain function and vast connections with other anatomical locations is not fully understood. A review of the literature illustrates the role the ACG likely plays in cognitive and emotional processing, as well as a modulating role in motor function and goal-oriented behaviors. While lesions of the cingulate gyrus are rare, each new case broadens our understanding of its role in cognitive neuroscience and higher order processing. The authors present the case of an 8-year-old boy with a 1-month history of staring spells, agitated personality, and hyperphagia notable for the consumption of paper, who was found to have a 3-cm tumor in the left ACG. Following surgical resection of the tumor, his aggressive behavior and pica were ameliorated and the patient made an uneventful recovery, with no evidence of recurrence over the last 6 years since surgical resection. Here we discuss a unique behavioral presentation of pica, along with a review of the current literature, to illustrate functions of the ACG relevant to the location of the lesion.

Esperance pica study.

BACKGROUND: Pica, the eating of non-foods, occurs particularly in children and pregnant women. It has been observed in communities all over the world. Pica is associated with iron deficiency and, in some environments, lead poisoning. This is the first time a study has assessed the prevalence of pica in Australia. METHODS: The study assessed the prevalence of pica in an Australian rural community, using a questionnaire given to parents of 223 children aged 2-10 years attending the five general practice surgeries in the shire. RESULTS: The prevalence of non-ice pica in the study group was 9.4%, and 3.6% of this group ate soil. DISCUSSION: The presence of pica should alert the treating clinician to consider iron deficiency and, in the case of polluted environments, lead exposure.

Geophagy during pregnancy: Is there a health risk for infants?

Prenatal lead exposure is a public health concern. Geophagy, the practice of soil eating, is documented for pregnant women of sub-Saharan Africa to treat pregnancy-related malaise. The soils however can contain substantial amounts of lead. In an exploratory study on 48 mother-child pairs in the Democratic Republic of Congo, we found striking site-specific differences in prenatal lead exposure, i.e., higher lead levels at Kisangani than at Isiro. Kisangani women consumed 1/ more often soil during the first trimester of pregnancy as well as 2/ a different type of soil compared to Isiro women (P<0.05). We conclude geophagy may be a potential source of prenatal lead exposure.