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PubMed2025

Pica in Childhood: Concurrent and Sequential Psychiatric Comorbidity.

OBJECTIVE: Pica is the persistent eating of nonnutritive, nonfood substances, and is associated with serious medical consequences. There has been a lack of research into the psychiatric comorbidities of pica, despite being important for informing clinical care. The current study examines psychiatric comorbidities of pica in childhood and the longitudinal relationship between childhood pica and adolescent eating disorders. METHOD: We analyzed data from the Avon Longitudinal Study of Parents and Children study. Pica and psychopathology, assessed with the Development and Well-Being Assessment and the Strengths and Difficulties Questionnaire, were assessed at about 7- and 10-years of age, and reported eating disorders (EDs) at 14-, 16-, and 18-years of age. We conducted linear and logistic regression models, adjusting for covariates, to identify concurrent psychiatric comorbidities, as well as risk for later EDs. We conducted the Benjamini-Hochberg correction procedure to correct for multiple testing. RESULTS: Pica (prevalence ranged from 0.33% to 2.33% dependent on age) was associated with increased odds of any psychiatric disorder and behavioral disorders in early childhood (OR = 7.30, q < 0.001, and OR = 5.65, q < 0.001, respectively) and mid-childhood (OR = 5.75, q < 0.001, and OR = 10.66, q < 0.001, respectively), and greater concurrent hyperactivity, conduct problems, peer problems, prosocial difficulties, and emotional difficulties (q < 0.01 across analyses). We did not find evidence that pica presence increased odds for concurrent emotional disorders nor for later ED risk. DISCUSSION: The association between pica and psychiatric and behavioral disorders indicates a likely shared etiology. Our findings provide insight into the psychiatric characteristics of children with pica and highlight they may require complex behavioral support beyond their eating difficulties.

Humans↗

PubMed1976

[Surgery of vertebral aneurysms at the origin of PICA (author's transl)].

Thirteen cases of vertebral aneurysm at the origin of PICA (VA-PICA aneurysm) were operated on at the Department of Neurological Surgery of Kitano Hospital from March, 1970 through July, 1975. Those included 9 cases of saccular aneurysm and 5 cases of fusiform aneurysm (Table 1). The incidence of VA-PICA aneurysms among our whole series of intracranial aneurysms was 4.2%. Patients with subarachnoid hemorrhage were subjected to our routine 4 vessel angiography. For those with suspected vertebral aneurysm vertebral angiography was performed in a transoral projection. In this method, when the angle between the film and the horizontal plain of Frankfurt is fixed at 50 degrees, the origin of PICA is projected on the film between the upper and lower teeth line. Since X-ray beam falls vertically on the origin of PICA, the resultant vascular shadow is free from shortening, elongation and distortion, leading to precise demonstration of anatomical arrangement of the vessels. At surgery a lateral suboccipital incision was made. With the position of VA-PICA junction the surgical approach was slightly different. When the junction was located higher than the line between the lowest point of the occipital bone and the basion by 1 cm or more, the approach was made through the middle of the sigmoid sinus which was exposed by suboccipital osteoclastic craniectomy (mid-lateral cerebellar approach). When the VA-PICA junction was situated lower than the line by 1 cm or more, the operation was initiated at the upper limit of the lower one-third of the sigmoid sinus (lower-lateral cerebellar approach). Since VA-PICA junction is ventrally situated to the lower cranial nerves, surgical attack to the junction can be attained only through the space among the nerves. Two spaces are available for this direct attack. One is the space between the facial nerve, acoustic nerve and the group of vagal nerves. The other is between accessory nerve bundles or between the group of accessory nerves and the hypoglossal nerves. The former procedure is employed for reaching the aneurysm by mid-lateral cerebellar approach and the latter by lower-lateral cerebellar approach. In the patients in acute stage of ruptured VA-PICA aneurysm, hemisuboccipital craniectomy and laminectomy of the atlas were carried out for the purpose of decompression. Surgical procedures used included coating in 2 cases, trapping in 2, proximal ligation of the vertebral artery in 2 and neck clipping in 6. Two patients died due to grastrointestinal bleeding. Surgical complications noted were hypoglossal nerve palsy in 1 case mild sensory disturbance contralateral to the aneurysm in 3 cases. Those symptoms were thought to be caused either by direct injury to the lower cranial nerves or circulatory disturbance in the medullary branches of the vertebral artery. To eliminate those postoperative complications it is desirable to devise smaller aneurysm clips and smaller clip foreceps.

Adult↗

PubMed1992

[Pica and iron deficiency in adolescence].

BACKGROUND: Pica is a habit disorder involving the compulsive, irrational ingestion of nutrient or non-nutrient substances which usually, in young infants, include clay and earth. Pica is rare in adolescents but is more likely to occur in subjects with severe iron deficiency. POPULATION AND METHODS: 17 (16 girls, 1 boy) cases of pica were recognized over a period of 4 years in an adolescent unit. 15 of the cases presented with anemia and/or iron deficiency. Hematological and biochemical investigations included measurements of hemoglobin content, MCV, serum iron and ferritin, transferrin saturation and serum iron-binding capacity. Blood loss was considered as a possible cause in all patients. RESULTS: 13 of the patients ingested large amounts of raw rice and 11 ingested ice cubes; 10 patients ingested both substances. Their mean serum ferritin was 7.17 ng/ml and the mean hemoglobin was 8.7 g/dl. One out of 7 patients showed intestinal blood loss. Excessive menstrual bleeding occurred in 8 girls. All patients were treated with adequate amounts of iron. Pica disappeared within a few weeks, although biochemical evidence of iron deficiency persisted in some patients. In one case, pica persisted despite correction of the iron deficiency. CONCLUSION: Pica is more prevalent in lower socio-economic classes and in some areas, such as the island of Reunion. It may be masked, and must be looked for in adolescents presenting with signs of iron deficiency. Treatment of the iron deficiency is usually followed by its disappearance.

Adolescent↗

PubMedDate not supplied

Conditioned taste aversions accompanied by geophagia: evidence for the occurrence of "psychological" factors in the etiology of pica.

A conditioned taste aversion procedure was used to produce an avoidance of saccharin by rats. In the first experiment, saccharin consumption was paired with cyclophosphamide in two conditioning trials during which the animals were permitted to engage in pica. In the second experiment, saccharin consumption was paired with lithium chloride in four conditioning trials during which the animals were not allowed to engage in pica. Conditioned animals in both experiments subsequently engaged in geophagia when presented with saccharin alone. The absence of geophagia in noncontingently poisoned and "sham" injected control groups indicates that the pica was due to the acquisition of a conditioned illness during the conditioning trials. In addition to providing a demonstration of "psychological" involvement in the etiology of pica, these results indicate that visceral conditioning may accompany the formation of conditioned taste aversions. It is suggested that if there is a relationship between infantile pica and adult drug addiction, a plausible mediational mechanism is that pica-prone and addiction-prone individuals are similar in possessing a high susceptibility to visceral conditioning.

Animals↗

PubMed1992

Pica: symptom or eating disorder? A historical assessment.

In DSM-III-R, pica, with anorexia nervosa, bulimia nervosa and rumination disorder of infancy, is accorded the status of a separate eating disorder. However, in the Draft of ICD-10, only anorexia nervosa and bulimia nervosa are listed under eating disorders. Pica in children, and feeding disorder in infancy and childhood, are incorporated with enuresis, encopresis, and feeding, movement and speech disorders in a separate "heterogeneous group of disorders". Extensive research on the history and terminology of eating disorders from the 16th to the 20th century suggests that, historically, pica was regarded as a symptom of other disorders rather than a separate entity. This paper aimed to locate and assess chronologically significant definitions and accounts of pica, to provide a fuller clinical description of a condition which, despite its current relevance, has received little detailed historical examination, and to give some consideration to the multiple aetiological theories which have been put forward. The historical findings are related to the descriptive criteria for pica in DSM-III-R and Draft ICD-10.

Anemia, Hypochromic↗

PubMed1977

Motion sickness-induced pica in the rat.

Two experiments investigating the effects of motion sickness on pica (the consumption of non-nutritive substances) are reported. In the first experiment rats subject to rotational stimulation subsequently engaged in geophagia (clay consumption). In the second experiment use of a conditioned aversion paradigm confirmed that the method of rotational stimulation used in the first experiment causes motion sickness in rats. The results of these experiments indicate that simple gastrointestinal malaise in the absence of a deficiency state or acute toxemia will elicit pica. It is suggested that gastrointestinal distress may be a significant factor in the etiology of pica and its relationship to other causes of pica is discussed.

Animals↗

PubMedDate not supplied

Pathogenetic considerations of pica in lead poisoning.

An important factor associated with lead poisoning in children is the habit of eating non-food substances, a condition termed pica. In search for underlying mechanisms involved in the pathogenesis of pica, this investigation presents evidence in support of the hypothesis that in many families failure of normal mother-child interaction, paternal deprivation, culturally dependent maternal oral interests and significant stress factors in the home where abundant lead-containing material is available are etiologically related to the development of pica in lead poisoning. Other factors, which have been thought to be associated with pica, are nutritional deficiencies and maladaptive behavior patterns. A multifocal treatment approach is considered to be most effective.

Child↗

PubMed1992

Intraperitoneally injected cholecystokinin-octapeptide activates pica in rats.

Cholecystokinin-octapeptide (CCK-8) was injected intraperitoneally into rats to see if it could cause them to eat kaolin (clay)--a pica behavior which has been shown to indicate gastric distress. In the first study, a single large dose of CCK-8 (20 micrograms/kg) failed to produce pica. In the second study, 4 smaller doses of CCK-8 (8 micrograms/kg), 30 min apart, produced significant ingestion of kaolin compared to the baseline condition of vehicle injections. The pica was comparable to that observed in another group of rats given a toxic dose of LiCl (127 mg/kg, IP). It is concluded that intraperitoneal injections of CCK-8 can induce a state of gastric distress in the rat.

Animals↗

PubMedDate not supplied

Pica: a peculiar behavior with oral involvement.

Pica is a behavior commonly displayed by children, pregnant females, and individuals with mental retardation. A population of institutionalized adults with mental retardation was assessed for pica. Of this population, 10.8% were identified with this behavior. Also, this article discusses aspects of pica and describes how this behavior can affect the mouth.

Adolescent↗

PubMed1977

Psychotic pica, nicotinism, and complicated myocardial infarction.

The authors report a case of a schizophrenic patient who repeatedly consumed a wide variety of inedible materials, including significant quantities of tobacco. The phenomenology of this behavior, as well as its psychiatric and medical complications are discussed. It is probable that chronic nicotinism contributed to this patient's refractoriness to psychiatric treatment and to his eventual cardiovascular crisis. The occurrence of pica as a manifestation of severe psychopathology was vividly described by the early pioneers of neuropsychiatry, but has received little attention in recent psychiatric literature. This is in marked contrast to the syndrome of psychogenic water intoxication which continues to be reported frequently. The majority of descriptions of pica have dealt with its occurrence in children, in pregnant women, and as a societal practice in certain cultures studied from a medico-anthropologic point of view. The toxic organic brain syndrome caused by chronic ingestion of nicotine-containing products has also been neglected in psychiatric publications. Descriptions of the neuropsychiatric complications of subacute and chronic nicotinism have been restricted to textbooks of toxicology, where greater emphasis has been given to the acute effects of large quantities of nicotine, often in forms other than tobacco. The following case illustrates the near-fatal practice of tobacco pica in a psychotic patient and dramatically demonstrates the systemic and central nervous system effects of nicotinism.

Adult↗

PubMed1975

Acute cerebellar infarction in the PICA territory.

Although old or recent infarcts of a cerebellar hemisphere in the territories of the posterior inferior (PICA), superior, or anterior inferior cerebellar arteries are commonplace autopsy findings, in no case have corresponding clinical symptoms been clearly identified. We have studied three cases, two clinocaopthologically and one clinicosurgically, in which an acute infarct involving only the cerebellum lay in the PICA territory distal to the branches to the medulla oblongata. The clinical manifestations consisted of rotatory dizziness intensified by motion, nausea, vomiting, imbalance, and nystagmus. In two cases, the clinical diagnosis had been a benign labyrinthine disorder. Recognition of a syndrome corresponding to cerebellar infarction in the PICA territory is important insofar as it assists in the differential diagnosis of dizziness. It becomes of crucial importance when cerebellar infarction is the prelude to cerebellar swelling and brain stem conpression leading to coma and death unless surgically relieved.

Acute Disease↗

PubMed1976

Pica and elevated blood lead level in autistic and atypical children.

Children with severely atypical development often display pica, habitual mouthing, and odd food preferences as symptoms from the first year of life. Such children can ingest dangerous amounts of lead even in environments that are usually considered safe. Mean blood lead concentration was notably higher in 18 autistic children than in 16 nonautistic psychotic children or in ten normal siblings. Fifteen (44%) of the psychotic children (autistic and nonautistic) had blood lead levels greater than two standard deviations above the mean for normal controls. Behavioral and neurological sequelae of elevated blood lead level may be obscured in severely disorganized children. Screening for blood lead should be part of the medical care of these vulnerable children with pica.

Adolescent↗

PubMed1975

Radiological changes in pica.

The significance of pica and geophagia as a public health problem is well known. The objective radiographic diagnosis of geophagia depends on the abnormal opacification of the bowel as an immediate manifestitation of the condition. The chance of detectability of geophagia is highest in the colon and can be improved by using low penetration films, particularly for smaller amounts of ingested clay. Other radiologic changes frequently associated with the prolonged practice of geophagic are an atonic pattern of the colon, secondary radiographic changes due to iron-deficiency anemia and bone-age retardation. The occurrences of intestinal obstruction due to pica in the presence of preexisting bowel stricture is demonstrated.

Anemia, Hypochromic↗

PubMed1979

Pica diagnosed by abdominal X-rays.

A young Arab woman with pica is presented. The diagnosis was suggested by the recurrent presence of numerous radiopaque particles in the course of the gastrointestinal tract. The particles changed location and concentration in successive abdominal X-rays taken at intervals of several weeks. Pica and its implications are discussed.

Adult↗

PubMed1992

Distinguishing outdoor soil ingestion from indoor dust ingestion in a soil pica child.

This paper represents the first quantitative attempt to distinguish the amount of outdoor soil ingestion from indoor dust ingestion in a soil pica child. Based on a methodology using a comparison of differential element ratios it is estimated that the predominant proportion of the fecal tracers were from outdoor soil and not indoor dust origin. The methodology employed can be utilized on a broader scale to assess the relative amounts of soil and dust consumed by individuals.

Child↗

PubMed1992

Baking powder pica mimicking preeclampsia.

We report a case of baking powder pica during pregnancy that was associated with maternal hypertension, hypokalemia, and elevated liver function tests. After discontinuation of baking powder ingestion and correction of electrolyte abnormalities, the blood pressure and the liver function tests normalized.

Adult↗

PubMed1975

Dental lead, blood lead, and pica in urban children.

Lead storage in teeth was evaluated by examining the lead concentration in deciduous teeth of 32 children whose habits of pica and state of lead exposure had been studied when they were between 1 and 3 years of age. Concentratios of lead in their teeth depended on the reported amount of paint or plaster intake and the duration of exposure. The mean dental concentration of lead in exposed children was significantly higher than the mean value in 36 controls, who presumably did not have undue exposure to lead. A difference in dental lead concentration related to living area was noted. The significant difference in lead content of teeth between the two groups, even though the concentrations of lead in blood at 8 years of age were similar, emphasizes the importance of dental lead measurments for retrospective studies of lead exposure.

Calcium Sulfate↗

PubMed1992

[Reappearance of pica symptoms during erythropoietin treatment].

Absolute or functional iron deficiency decreases the effectiveness of erythropoietin in patients undergoing hemodialysis. We describe a patient who developed pica associated to a ferritin level of 800 ng/ml during recombinant human erythropoietin treatment. The symptom subsided after supplementation with iron dextran. Therefore we recommend iron supplementation during the initial phase of treatment with erythropoietin until serum ferritin levels raise above 1000 ng/ml.

Adult↗