Pica Flashcards
how many diagnostic criteria are there for pica
4
criterion A for pica
persistent eating of NON-NUTRITIVE, NON-FOOD substances over a period of at least ONE MONTH
criterion B for pica
the eating of nonnutritive, non food substances is inappropriate for the developmental level of the individual
criterion C for pica
the eating behaviour is not part of a culturally supported or socially normative practice
criterion D for pica
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
what is the time criteria for pica
one month
what is the essential feature of pica
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
what are typical substances ingested with pica
*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
why is the term “nonfood” used?
because dx of pica does NOT apply to ingestion of diet products that have minimal nutritional content
is there an aversion to food in pica?
no, not typically
what is the minimum chronological age required before dx of pica can be made
suggest not diagnosing pica before age 2–> to exclude developmentally appropriate “mouthing” of objects by infants that results in ingestion
are there specific deficiencies or lab values associated with pica
typically no, though they can be associated
in some cases, pica only comes to clinical attention after medical complications
what are some possible medical complications of pica
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
what is the prevalence of pica
“unclear” (per DSM)
what is the relationship between pica and intellectual disability
the prevalence of pica seems to increase with the severity of the ID
what is the typical age of onset of pica
childhood, most commonly
tho can occur in adolescence or adulthood as well
does pica occur in normally developing children? adults?
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
what other medical/physiologic condition may be associated with pica in adults
pregnancy –> specific cravings (i.e chalk, ice) may occur
*only diagnose pica during pregnancy if such cravings/ingestions lead to potential medical risks
environmental risk factors for pica
neglect
lack of supervision
developmental delay
if the eating of earth or other seemingly nonnutritive substances is part of spirtual/medicinal/ has other social value, do you diagnose pica?
no–> see criterion C
how does pica impair functioning
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
what other mental disorders are associated with pica
ASD
schizophrenia
what is Kleine-Levin Syndrome?
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.
what causes Kleine-Levin syndrome
people arent sure–maybe autoimmune, maybe hereditary–> likely dysfunction in neural pathways related to regulation of sleeping, eating, sex
who does Kleine-Levin syndrome primarily affect
adolescent males
if you see an adolescent male with suspected pica, what should you also ask about
other hyperphagia
hypersomnolence
uninhibited sex drive
?Kleine-Levin syndrome
ddx pica
anorexia nervosa
factitious disorder
NSSI in personality disorders
how do you distinguish between pica and AN
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
what disorders are most commonly comorbid with pica
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
list possible treatments for pica
need comprehensive treatment plan
- environmental enrichment and noncontingent reinforcement (to start)
- differential reinforcement of alternative behaviour
- contingent visual screening for life threatening pica
- discrimination training
* mostly its behavioural interventions and you would want to involve a behavioral therapist
what food supplement has evidence in symptom reduction in pica in those with intellectual disability
zinc
