Pica

Question 1

how many diagnostic criteria are there for pica

Answer 1

4

Question 2

criterion A for pica

Answer 2

persistent eating of NON-NUTRITIVE, NON-FOOD substances over a period of at least ONE MONTH

Question 3

criterion B for pica

Answer 3

the eating of nonnutritive, non food substances is inappropriate for the developmental level of the individual

Question 4

criterion C for pica

Answer 4

the eating behaviour is not part of a culturally supported or socially normative practice

Question 5

criterion D for pica

Answer 5

IF the eating behaviour occurs in the context of another mental disorder (i.e intellectual disability, ASD, schizophrenia) or medical condition (including pregnancy), it must be sufficiently severe to warrant additional clinical attention

Question 6

what is the time criteria for pica

Answer 6

one month

Question 7

what is the essential feature of pica

Answer 7

the eating of ONE OR MORE nonnutritive, nonfood substances on a persistent basis over a period of at least one month that is severe enough to warrant clinical attention

Question 8

what are typical substances ingested with pica

Answer 8

*tend to vary with age and availability

paper
soap
cloth
hair
string
wool
soil
chalk
talcum powder
paint
gum
metal
pebbles
charcoal
ash
clay 
starch
ice

Question 9

why is the term “nonfood” used?

Answer 9

because dx of pica does NOT apply to ingestion of diet products that have minimal nutritional content

Question 10

is there an aversion to food in pica?

Answer 10

no, not typically

Question 11

what is the minimum chronological age required before dx of pica can be made

Answer 11

suggest not diagnosing pica before age 2–> to exclude developmentally appropriate “mouthing” of objects by infants that results in ingestion

Question 12

are there specific deficiencies or lab values associated with pica

Answer 12

typically no, though they can be associated

in some cases, pica only comes to clinical attention after medical complications

Question 13

what are some possible medical complications of pica

Answer 13

mechanical bowel problems

intestinal obstruction–> ie bezoar

intestinal perforation

infections ie toxoplasmosis or tococariasis resulting from ingestion of dirt or feces

poisoning–> ie due to lead based paint

Question 14

what is the prevalence of pica

Answer 14

“unclear” (per DSM)

Question 15

what is the relationship between pica and intellectual disability

Answer 15

the prevalence of pica seems to increase with the severity of the ID

Question 16

what is the typical age of onset of pica

Answer 16

childhood, most commonly

tho can occur in adolescence or adulthood as well

Question 17

does pica occur in normally developing children? adults?

Answer 17

pica can occur in otherwise normally developing children, but in adults, it appears more likely to occur in context of ID or other mental disorders

Question 18

what other medical/physiologic condition may be associated with pica in adults

Answer 18

pregnancy –> specific cravings (i.e chalk, ice) may occur

*only diagnose pica during pregnancy if such cravings/ingestions lead to potential medical risks

Question 19

environmental risk factors for pica

Answer 19

neglect

lack of supervision

developmental delay

Question 20

if the eating of earth or other seemingly nonnutritive substances is part of spirtual/medicinal/ has other social value, do you diagnose pica?

Answer 20

no–> see criterion C

Question 21

how does pica impair functioning

Answer 21

it can significantly impair functioning, but it is rarely the only cause of impairement in social functioning–> often co occurs with other disorders with impaired social functioning

Question 22

what other mental disorders are associated with pica

Answer 22

ASD

schizophrenia

Question 23

what is Kleine-Levin Syndrome?

Answer 23

pica can occur during the course of Kleine-Levin syndrome

KL Syndrome = rare disorder characterized by:

• hypersomnolence (up to 20 hours per day)
• compulsive hyperphagia
• abnormally uninhibited sex rive

When awake, affected individuals may exhibit irritability, lack of energy (lethargy), and/or lack of emotions (apathy). They may also appear confused (disoriented) and experience hallucinations. Symptoms of Kleine-Levin syndrome are cyclical.

Question 24

what causes Kleine-Levin syndrome

Answer 24

people arent sure–maybe autoimmune, maybe hereditary–> likely dysfunction in neural pathways related to regulation of sleeping, eating, sex

Question 25

who does Kleine-Levin syndrome primarily affect

Answer 25

adolescent males

Question 26

if you see an adolescent male with suspected pica, what should you also ask about

Answer 26

other hyperphagia
hypersomnolence
uninhibited sex drive

?Kleine-Levin syndrome

Question 27

ddx pica

Answer 27

anorexia nervosa

factitious disorder

NSSI in personality disorders

Question 28

how do you distinguish between pica and AN

Answer 28

usually by the eating of nonfood/nonnutritive substances

however–> some presentations of AN include ingestion of such substances such as paper tissues as a means to control appetite

when this is used as a means of weight control, should dx AN not pica

Question 29

what disorders are most commonly comorbid with pica

Answer 29

ASD

ID

lesser degree: SCZ, OCD

trichotillomania, excoriation disorders (when the hair or skin is then ingested)

ARFID–> especially if strong sensory component to presentation

Question 30

list possible treatments for pica

Answer 30

need comprehensive treatment plan

1. environmental enrichment and noncontingent reinforcement (to start)
2. differential reinforcement of alternative behaviour
3. contingent visual screening for life threatening pica
4. discrimination training
   * mostly its behavioural interventions and you would want to involve a behavioral therapist

Question 31

what food supplement has evidence in symptom reduction in pica in those with intellectual disability

Answer 31

zinc