Faculty Mentor
David Jackson
Major/Area of Research
Physician Assistant Studies
Description
Background. ‘Pica’ is the Latin word for magpie, a bird that ingests inedible substances. The DSM-V defines pica as a disorder of persistent eating of nonnutritive, nonfood substances over a period of at least one month. Although pica is a disorder that affects a widespread population, it is seen as a social anomaly which prevents patients from admitting their behavior. As the behavior continues unnoticed and untreated, patients will experience the adverse effects of ingesting foreign materials. Thus, healthcare providers and family members should educate themselves on pica’s etiologies and manifestations to prevent complications and avoid unnecessary hospitalizations.
Methods. The data was obtained using the Google search engine. Search terms used were: (a) history of pica, (b) diagnosing pica, and (c) treating pica for the years 1990-2018. The DSM-V was referenced for the medical definition of pica.
Results. The few studies done on pica have drawn inconclusive data. While the percentage of the population that suffers from pica is unknown, common risk factors are: (a) nutritional deficiencies such as iron-deficiency anemia, (b) low socioeconomic status due to the inaccessibility of nutritious foods, (c) nondiscriminating oral behaviors in those with intellectual disabilities, and (d) an underlying biochemical behavior. No specific laboratory tests are indicated to evaluate pica. Providers have found success in diagnosing pica through: (a) dietary history, (b) interviewing family members, and (c) a high index of suspicion. Without verbal admittance, the only way to evaluate pica is to test for nutrient deficiencies and identify ingested materials using: (a) abdominal radiography, (b) barium enema, and (c) upper GI endoscopy. Although this disorder is seen most frequently in children and the developmentally disabled, it is also observed in pregnant women who ingest starch to quell morning sickness. Pica patients have been reported to ingest a variety of substances including, but not limited to: (a) clay, (b) dirt, (c) stones, (d) cigarette butts, and, (e) lead paint and soil. Lead poisoning affects the central nervous system and leads to irreversible neurological damage; it is also associated with decreased renal function and hypertension.
Conclusions and Recommendations. Serious complications of pica include obstruction or perforation of the gastrointestinal tract, and lead poisoning. Early detection of lead toxicity is vital to prevent systemic complications. There is no definitive management for pica but current therapies include (a) nutrient replacement, (b) behavioral therapy, and (c) dopaminergic function enhancing medications such as olanzapine. Since very little is known about pica, it would be beneficial to perform longitudinal studies to observe and educate the general public on the long-term effects of pica so they understand that this behavior is more than a habit but one with serious consequences. Pica is a condition that requires a multidisciplinary approach utilizing physicians, psychologists, and social workers and it is recommended that healthcare providers treating high-risk patients ask appropriate primary and exploratory questions during physical exams. While many may be discouraged at the lack of data on pica, it should be seen as an opportunity to promote its clinical importance through awareness and education.
Included in
Pica: The Mysterious Eating Disorder
Background. ‘Pica’ is the Latin word for magpie, a bird that ingests inedible substances. The DSM-V defines pica as a disorder of persistent eating of nonnutritive, nonfood substances over a period of at least one month. Although pica is a disorder that affects a widespread population, it is seen as a social anomaly which prevents patients from admitting their behavior. As the behavior continues unnoticed and untreated, patients will experience the adverse effects of ingesting foreign materials. Thus, healthcare providers and family members should educate themselves on pica’s etiologies and manifestations to prevent complications and avoid unnecessary hospitalizations.
Methods. The data was obtained using the Google search engine. Search terms used were: (a) history of pica, (b) diagnosing pica, and (c) treating pica for the years 1990-2018. The DSM-V was referenced for the medical definition of pica.
Results. The few studies done on pica have drawn inconclusive data. While the percentage of the population that suffers from pica is unknown, common risk factors are: (a) nutritional deficiencies such as iron-deficiency anemia, (b) low socioeconomic status due to the inaccessibility of nutritious foods, (c) nondiscriminating oral behaviors in those with intellectual disabilities, and (d) an underlying biochemical behavior. No specific laboratory tests are indicated to evaluate pica. Providers have found success in diagnosing pica through: (a) dietary history, (b) interviewing family members, and (c) a high index of suspicion. Without verbal admittance, the only way to evaluate pica is to test for nutrient deficiencies and identify ingested materials using: (a) abdominal radiography, (b) barium enema, and (c) upper GI endoscopy. Although this disorder is seen most frequently in children and the developmentally disabled, it is also observed in pregnant women who ingest starch to quell morning sickness. Pica patients have been reported to ingest a variety of substances including, but not limited to: (a) clay, (b) dirt, (c) stones, (d) cigarette butts, and, (e) lead paint and soil. Lead poisoning affects the central nervous system and leads to irreversible neurological damage; it is also associated with decreased renal function and hypertension.
Conclusions and Recommendations. Serious complications of pica include obstruction or perforation of the gastrointestinal tract, and lead poisoning. Early detection of lead toxicity is vital to prevent systemic complications. There is no definitive management for pica but current therapies include (a) nutrient replacement, (b) behavioral therapy, and (c) dopaminergic function enhancing medications such as olanzapine. Since very little is known about pica, it would be beneficial to perform longitudinal studies to observe and educate the general public on the long-term effects of pica so they understand that this behavior is more than a habit but one with serious consequences. Pica is a condition that requires a multidisciplinary approach utilizing physicians, psychologists, and social workers and it is recommended that healthcare providers treating high-risk patients ask appropriate primary and exploratory questions during physical exams. While many may be discouraged at the lack of data on pica, it should be seen as an opportunity to promote its clinical importance through awareness and education.