Pica

Hennessy Hernandez, Tannaz Vandaie, Camila Raygada

What is Pica? ● “a persistent eating of substances such as dirt or paint that have no nutritional value”● Pica can be associated with

○ intellectual disability○ trichotillomania (hair pulling disorder)○ excoriation (skin picking) disorder

Video https://youtu.be/wqxWOJTovOE

Diagnosis: ● A medical evaluation is important for possible (X-rays & blood tests):

○ Anemia○ Intestinal blockages ○ Potential toxicity from ingested substances

● The doctor will also test for possible infections caused by eating items contaminated with bacteria or other organisms.

● If symptoms are present → doctor will being a evaluation○ Complete medical history○ Physical exams

Treatment/intervention:● Given the risk of medical complications (such as lead poisoning) associated with pica, close

medical monitoring is necessary throughout.○ Chelation therapy

■ Excrete the lead in urine● If the doctor thinks it is caused by nutrient imbalances → prescribe vitamin & mineral

supplements ● Until recently, research hasn’t focused on medications to help people with pica. A 2000 study published

in the Journal of Applied Behavior Analysis Trusted Source suggested that a simple multivitamin supplement may be an effective treatment in some cases.

○ Pica doesn’t always go away.

Who is at risk?○ Young children - ⅓ of kids aged 1-

6 years old display pica behaviors; nutrient deficiencies

○ Pregnant women - at risk for nutrient deficiencies

○ Adults - cravings for particular textures

Etiology ○ Malnutrition

■ e.g. iron deficiency ● Celiac disease can cause iron deficiency ● Pica can limit iron absorption ● Clay and soil consumption is associated with

iron deficiency

○ Social customs and superstition - e.g. clay and soil eating is practiced in some communities

■ Tany manara: white clay consumed to prevent future illness by people in Madagascar

○ Stress caused by depression, abuse, neglect, family problems, separation

Pathophysiology● Often associated with nutrient deficiency but the pathophysiology is

currently unknown● Common nutrient deficiencies:

○ Iron - deficiency can range from mild to severe■ Signs: brittle or spooning nails, cracks on sides of the mouth, pale skin. swollen or

sore tongue○ Zinc

■ Signs: Growth retardation, hair loss, diarrhea, delayed sexual maturation, hypogonadism (males)

○ Calcium - no short-term symptoms but poses long-term issues: ■ Osteopenia - can turn into osteoporosis ■ Bone fracture risk

Psychopathology○ Developmental delays - mentally

disabled individuals can have difficulty distinguishing food and non-food items

○ Autism - difficulty communicating with surroundings

○ OCD - involuntary pica behaviors ease anxiety and distress; some healthcare professionals classify pica as a form of OCD

1440 items removed from the stomach of a psychiatric patient on display at Glore Psychiatric Museum in Missouri

Medical complications of Pica ● Pica related hospitalizations jumped 93% however, patients hospitalized

for PICA remains small (Mishori, R., & McHale, C., 2014) ● Harmful effects:

○ Dental injury ○ Potassium abnormalities ○ Gastrointestinal conditions ○ Intestinal blockage○ Colon ischemia ○ Anemia

● Bidirectional Effects: ○ Iron deficiency○ Parasitic infections ○ Heavy metal exposure (lead, mercury, arsenic)

Recovery: How is pica managed?

● Pica in children commonly improves as they get older but can remain a problem for those with developmental disabilities

● Primarily preventive, educational and directed toward behavior modification ● Regular monitoring to ensure no dangerous objects are available ● Parents and caregivers to be aware of pica and monitor what children/patients

are ingesting ● Nutritional supplements and changes in diet ● Certain medications used to help manage behavioral problems ● Managing a patient’s environment and ongoing treatment is essential for

effective recovery

ReferencesAdvani, S., Chachra, S., Dhawan, P., & Kochhar, G. (2014). Eating everything

except food (PICA): A rare case report and review. Journal of International Society of Preventive and Community Dentistry, 4(1), 1–4. doi: 10.4103/2231-0762.127851

Agarwal, A. (2017). Pica- An Enigma of Malnutrition. Journal of Nutritional Disorders & Therapy, 07(02). doi: 10.4172/2161-0509.1000e132

Al-Sharbati, M.M., Zaidan, Z., Al-Hussaini, A., Al-Khalili, A., (2003) A strange type of pica. Journal for Scientific Research-Medical Sciences, 5(1-2). 49-50. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3174723/

Guinan, D., Drvar, T., Brubaker, D., Ang-Rabanes, M., Kupec, J., & Marshalek, P. (2019). Intentional Foreign Body Ingestion: A Complex Case of Pica. Case Reports in Gastrointestinal Medicine, 1–3. https://doi.org/10.1155/2019/7026815

Iron-Deficiency Anemia. (n.d.). Retrieved from https://www.nhlbi.nih.gov/health-topics/iron-deficiency-anemia

Kalgaonkar, S., & Ramakantan, R. (2018). Pica and the radiologist – beyond the radiology report … digging deeper. Indian Journal of Radiology & Imaging, 28(3), 330–332. https://doi.org/10.4103/ijri.IJRI_48_18

Kopf, J. (2020). Pica. The Recovery Village. https://www.therecoveryvillage.com/mental-health/pica/#gref

McManus, K., & Henderson, H. (2018). Pica, Lead Poisoning, and Public Health. Archives of Disease in Childhood. Education and Practice Edition, 1–3. doi: 10.1136/archdischild-2018-315217

Mishori, R., & McHale, C. (2014). Pica: An age-old eating disorder that’s often missed. The Journal of Family Practice, 63(7). http://bi.gale.com.libaccess.sjlibrary.org/essentials/article/GALE%7CA606173034?u=csusj

Munir, S., & Qadir, I. (n.d.). Pathophysiology and Management of Pica .Pica: MedlinePlus Medical Encyclopedia. (2018, March 26). Retrieved from https://medlineplus.gov/ency/article/001538.htm

Office of Dietary Supplements - Calcium. (n.d.). Retrieved from https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/#h5

Office of Dietary Supplements - Zinc. (n.d.). Retrieved from https://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/#h5

Pica. (2018, February 22). Retrieved from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/pica

Content Questions1. Please identify who is at risk of developing pica, what their risk factors

are, and any pathophysiological conditions associated with these risk factors.

2. What psychopathological conditions is pica be associated with and how do they influence the consumption of non-food items?

3. What are some effects pica causes to the body and how they are harmful?