Causes and management of Pica disorder among central Iraqi peoples.

OBJECTIVE: Aim: To find the causes and factors behind the Pica disorder, which helps in early diagnosis and appropriate treatments.. PATIENTS AND METHODS: Materials and Methods: A retrospective cross-section study was carried out between July 1, 2022, and April 20, 2023, enrolling 300 patients from different provinces of central and south Iraq with Pica disease whose diagnosis depended on specialized physicians according to WHO guidelines. The participants were following up for three to six months in private clinics. RESULTS: Results: 92.4% of the patients were female, and 41% of patients were under 20 years old, with low ferritin, HB, and vitamin D levels (80% of cases), and these markers showed a negative correlation with the number of Pica. Chowing of ice and clay were the common types of Pica, which represent about 30% each, while 34% of cases had multiple types, which had signs and symptoms of fever, palpitation, vomiting, abdominal pain, paleness, headaches, and hair loss. Six-month flows were better than three months. CONCLUSION: Conclusions: Pica was a disorder that could lead to behavior and emotional abnormalities that caused the patients to eat some things that were eaten by healthy people. This may be, as concluded from our results, due to reduced levels of ferritin, hemoglobin (Hb), and vitamin D that caused these psychological problems.

A systematic review of the effectiveness of behavioural treatments for pica in youths.

Pica is the persistent consumption of non-nutritive, nonfood substances and is associated with adverse health complications. However, there is limited research on interventions for pica in youth. The objective of this study is to systematically review the empirical evidence for the effectiveness of behavioural interventions for pica in children and adolescents and to generate treatment recommendations. A systematic search yielded 823 articles extracted from five databases: CINALH, Family and Society Studies Worldwide, Medline, PsycINFO, and Web of Science. Two reviewers completed initial sorting based on article titles and abstracts. Five reviewers completed sorting based on full article review. Thirty articles were included and double coded for demographic information, co-morbid conditions, and intervention characteristics. These studies were case studies involving behavioural treatments for pica. Seventeen behavioural interventions were categorized into four treatment approaches: reinforcement-based, response interruption, "other" interventions, and punishment-based procedures. Interventions that resulted in near-zero rates of pica were deemed effective. Findings showed support for contingent reinforcement, discrimination training as part of a combination treatment, physical restraint, time out, and contingent aversive stimulus. No evidence supported the effectiveness of response interruption procedures, including response blocking and visual facial screen. Other coded procedures did not appear effective. We recommend that the least restrictive procedures are implemented first, including a combination treatment with contingent reinforcement and discrimination training. As needed, more restrictive procedures can be added to the treatment package. This review will facilitate future empirical work and assist clinicians with treatment options for pica in youth. High-quality trials are needed.

Consequences of prenatal geophagy for maternal prenatal health, risk of childhood geophagy and child psychomotor development.

OBJECTIVE: To investigate the relationship between prenatal geophagy, maternal prenatal haematological indices, malaria, helminth infections and cognitive and motor development among offspring. METHODS: At least a year after delivery, 552 of 863 HIV-negative mothers with singleton births who completed a clinical trial comparing the efficacy of sulfadoxine-pyrimethamine and mefloquine during pregnancy in Allada, Benin, responded to a nutrition questionnaire including their geophagous habits during pregnancy. During the clinical trial, helminth infection, malaria, haemoglobin and ferritin concentrations were assessed at 1st and 2nd antenatal care visits (ANV) and at delivery. After the first ANV, women were administered daily iron and folic acid supplements until three what? post-delivery. Singleton children were assessed for cognitive function at age 1 year using the Mullen Scales of Early Learning. RESULTS: The prevalence of geophagy during pregnancy was 31.9%. Pregnant women reporting geophagy were more likely to be anaemic (AOR = 1.9, 95% CI [1.1, 3.4]) at their first ANV if they reported geophagy at the first trimester. Overall, prenatal geophagy was not associated with maternal haematological indices, malaria or helminth infections, but geophagy during the third trimester and throughout pregnancy was associated with poor motor function (AOR = -3.8, 95% CI [-6.9, -0.6]) and increased odds of geophagous behaviour in early childhood, respectively. CONCLUSIONS: Prenatal geophagy is not associated with haematological indices in the presence of micronutrient supplementation. However, it may be associated with poor child motor function and infant geophagy. Geophagy should be screened early in pregnancy.

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.

Fifteen-minute consultation: the child with pica.

Pica is defined as the persistent ingestion of non-nutritive substances for more than 1 month at an age at which this behaviour is deemed inappropriate. It occurs most commonly in children, in patients with learning disabilities and in pregnancy. The aetiology of pica is poorly understood and is probably multifactorial. Clinical assessment can be difficult. History and examination should be tailored to address potential complications of the substance being ingested. Complications can be life threatening. Pica often self-remits in younger children. In those with learning disabilities, however, pica may persist into adulthood. Management strategies should involve a multidisciplinary approach, and interventions are primarily behavioural in nature. There is limited evidence to support pharmacological interventions in the management of children with pica.

Pica and rumination behavior among individuals seeking treatment for eating disorders or obesity.

OBJECTIVE: Pica and rumination disorder (RD)-formerly classified within DSM-IV Feeding and Eating Disorders of Infancy or Early Childhood-are now classified within DSM-5 Feeding and Eating Disorders. Though pica and RD have been studied in select populations (e.g., pregnant women, intellectually disabled persons), their typical features and overall prevalence remain unknown. This study examined the clinical characteristics and frequency of DSM-5 pica and RD among individuals seeking treatment for eating disorders and obesity. METHOD: We conducted structured interviews with adolescent and young adult females from a residential eating disorder center (N = 149), and adult males and females with overweight or obesity from an outpatient weight-loss clinic (N = 100). RESULTS: Several participants reported ingesting non-nutritive substances (e.g., ice) for weight-control purposes. However, only 1.3% (n = 2; 95% CI: .06% to 5.1%) at the residential eating disorder center and 0% at the weight-loss clinic met DSM-5 criteria for pica, consuming gum and plastic. Although no eating disorder participants were eligible for an RD diagnosis due to DSM-5 trumping rules, 7.4% (n = 11; 95% CI: 4.0% to 12.9%) endorsed rumination behavior under varying degrees of volitional control. At the weight-loss clinic, 2.0% (n = 2; 95% CI: 0.1% to 7.4%) had RD. DISCUSSION: DSM-5 pica and RD were rare in our sample of individuals seeking treatment for eating disorders and obesity, but related behaviors were more common. The wide range of pica and rumination presentations highlights the challenges of differential diagnosis with other forms of disordered eating.

A CASE OF PICA FOLLOWING A PARAMILITARY PRE-EMPLOYMENT ORIENTATION CAMP.

BACKGROUND: Pica is an unusual craving for and ingestion of either edible or inedible substances first observed in pregnant women but has been reported in all groups of people. Pica poses a significant health risk that often requires medical attention but the awareness of pica among physicians seems to be have reduced. METHOD: We report a case study of a young lady who presented with anaemia (pcv = 21%) and craving for sand. Laboratory investigations carried outwere in keepingwith iron deficiency anaemia. CONCLUSION: It is therefore postulated that pica may actually be a sign of iron deficiency anaemia.

Pica in children with sickle cell disease: two case reports.

Children with sickle cell disease (SCD) are at greater risk for developing pica compared to other children. This comorbidity can result in harmful medical and nutritional, and neurodevelopmental consequences. This article will describe the medical, nutritional, and psychosocial functioning in two children with SCD and pica in order to illustrate the potential complications and correlates of this co-morbidity. In addition, the clinical implications of pica in children with SCD will be discussed.

A pica case confused with renal and bladder stones.

Pica is considered as an eating-nutritional disorder in childhood and is generally analysed within obsessive-compulsive disorders. A 15-year-old female patient was admitted to the urology clinic with nausea, vomiting, and stomach-ache. A 23 x 23 mm opacity was identified in left T-11-12 level in direct urinary graph. Full abdomen ultrasonography was reported to be normal. Later, it was learned that the patient had the habit of eating stone. The patient was diagnosed with obsessive-compulsive disorder following psychiatric consultation, and appropriate treatment was given.

[Ameliorative effect of Armillariella tabescens on cisplatin-induced gastrointestinal tract reaction in the rat].

OBJECTIVE: To evaluate the effect of Armillariella tabescens on cisplatin chemotherapy-induced gastrointestinal tract reaction. METHODS: Forty-eight male Sprague-Dawley rats were randomized into control group, model group, low dose Armillariella tabescens group, middle dose Armillariella tabescens group, high dose Armillariella tabescens group and ondansetron group. The rats were injected intraperitoneally with cisplatin to induce pica, and observe the effect of Armillariella tabescens on consumption of kaolin, food, water and body weight. RESULTS: 24-72 h after cisplatin administration, in the middle dose Armillariella tabescens group, the high dose Armillariella tabescens group and the ondansetron group, the kaolin intake was significantly lower than that in the model group, respectively (P<0.05). The most significant difference was between the high dose Armillariella tabescens group [(0.58 +/- 0.23) g/24 h] and the control group [(2.16 +/- 0.98) g/24 h] at 24 h after cisplatin administration. The variables, such as consumption of food during 48-72 h (P<0.05), water during 48-72 h (P<0.05), and body weight at 72 h (P<0.05) in the middle dose Armillariella tabescens group were significantly higher than those in the model group, but no statistically significant difference between the ondansetron group and the model group (P>0.05). CONCLUSIONS: Armillariella tabescens can effectively inhibit the cisplatin-induced pica response, and the middle dose Armillariella tabescens group is significantly better than the model group in improving the food intake reduction, water intake reduction and body weight loss.

Salinophagia in anorexia nervosa: case reports.

We report two cases of pathological ingestion of salt as a feature of anorexia nervosa, which we have previously termed "salinophagia." Both cases were young women with anorexia nervosa of the purging subtype and of sufficient severity to necessitate inpatient treatment. In both instances, excessive quantities of salt were ingested in the context of treatment programs requiring nutritional rehabilitation, and motivated by a wish to despoil the food and render it distasteful, to rob its ingestion of any hedonic qualities. In one instance, this behavior pattern was imitated by other patients on the unit. Having first briefly described salinophagia in 1999, the first author has received considerable correspondence from other specialists suggesting that this is not an isolated phenomenon. The issues of phenomenology and treatment are further discussed.

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.

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.

Pica: A Common Condition that is Commonly Missed - An Update Review.

BACKGROUND: Pica is a common condition in childhood that is commonly missed. OBJECTIVE: To familiarize physicians with the clinical evaluation and management of children with pica. METHODS: A PubMed search was completed in Clinical Queries using the key term "pica" OR "dirteating". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. Only papers published in English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. RESULTS: Pica refers to the persistent, compulsive craving for and the ingestion of substances usually considered inedible and the behavior is discordant with cultural practices and continues beyond the normal developmental phase of occasional indiscriminate and experimental mouthing and swallowing over a period of at least one month. The condition is more common among children in lower socioeconomic classes and those who are mentally handicapped or emotionally deprived. Pica is a significant cause of anemia and lead poisoning. Pica generally resolves in children of normal intelligence after they have been trained to discriminate between edible and inedible items and proper supervision is provided. While relief of family economic and housing difficulties is an adjunct, attention to the individual's emotional needs and stresses is of paramount importance. Children with iron deficiency anemia should be treated with iron replacement therapy. Complications such as gastrointestinal obstruction and lead poisoning should be promptly recognized and treated. CONCLUSION: Pica is often an overlooked phenomenon and its association with iron deficiency and lead poisoning has been known for centuries. The underlying cause and complications should be treated if possible. Primary care physicians should be aware of pica and proactively seek information about pica in patients that belong to the high-risk groups.

Assessment and behavioral treatment of feeding and sleeping disorders in children with autism spectrum disorders.

Children diagnosed with autism or autism spectrum disorders (ASD) are more likely than other children to exhibit behaviors characteristic of a feeding or sleeping disorder. Parents of children with these disorders may be extremely concerned about the health and safety of their child. Sleeping and feeding problems can cause a great deal of stress to parents and other family members. Behavioral assessment and treatment procedures have been developed to address behavior problems related to sleeping and feeding disorders. This article reviews the literature about assessment and treatment, and provides recommendations regarding services to family members of individuals diagnosed with ASD and feeding or sleeping disorders.

Remote treatment of sleep-related trichotillomania and trichophagia.

We used a biobehavioral treatment consisting of melatonin and a standardized bed and wake time to decrease one girl's head and mouth touches associated with sleep-related trichotillomania and trichophagia. We remotely coached the girl's caregiver to implement all procedures and monitored response to treatment using a DropCam Pro video camera equipped with night-vision capabilities. Head and mouth touches decreased, and her sleep pattern improved with the combination of treatment strategies. We discuss our use of a novel mode of service delivery to treat sleep-related problem behavior.

[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.

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.