Download Pica for 36 Years with Mild Obsessive

Pica for 36 Years with Mild Obsessive-Compulsive
Disorder: A Case Report
Aksoy, Osman Hasan Tahsin Kilic, Bahadir Demir, Abdurrahman Altindag
Gaziantep University, Faculty of Medicine, Department of Psychiatry, TURKEY
Introduction
Discussion
Although the rates of pica among patients in hematology department
compulsive eating of various types of nutrients which are not
categorized as food for at least one month and it should be
inappropriate for the culture and the developmental level and it should
be severe enough for further clinical attention if it is seen with another
mental or medical condition (1). Pagophagia
Coltman, is a form of pica characterized with eating at least one
ordinary tray of ice everyday (2). Both physiological and psychological
factors have been held responsible for it’s etiology (3). There are no
conducted with patients with blood donors, the rate of pica was found
among donors whose iron levels were normal (9). Neither all the iron
and managing of pica on the basis of a multidimensional approach with
biological and psychiatric aspects (10).
There are now increasing amount of cases about at least some of the
pica may also belong to obsessive-compulsive spectrum disorders but
there is no clinical trial about the psychiatric symptoms among pica
can be seen with autism spectrum disorders, intellectual disability,
schizophrenia (6) and obsessive-compulsive disorder (1) as a repetitive
behavior. There are few case reports which point out the similarities of
pica with obsessive-compulsive spectrum disorders and suggest to
involve pica into this spectrum (7) whereas some cases tend to
interpret it as an impulse dys-control or an addiction (8).
to venlafaxine (12). Since our patient has mild OCD we started
treatment with exposure and response prevention towards her OCD
psychiatric aspect of this disorder seems lacking enough attention.
and iron-dextran treatment would fail to decrease her symptoms.
Case
A.G., 54 years old married woman. She attended to our outpatient
clinic of with complaints of irresistible urge to eat ice cubes. She said
that she had started eating clay when she was 18 years old and had
been eating everyday until last year. She stopped eating clay because of
gastrointestinal discomfort and embarrassing yellow coloring of her
skin after every time she ate clay. She reported having eaten
approximately 100 mg clay per day for about 35 years. After a couple
of pica free days she suddenly started to eat approximately 30-40 ice
cubes daily. She said that sometimes she was taking ice cubes with her
in order to eat on the road when she was supposed to stay in a place
other than her home for hours. When asked, she said that she was
washing her hands whenever she touches something other than food
during cooking and checking every tap of water or gas whenever she
leaves home. She reported mild impairment in functionality and she
had a good insight. Her mood was anxious and her affect was reactive
and congruent with her mood. There were no psychotic symptoms or
sign of intellectual disability. She has a daughter diagnosed with
yielded a score of 13 and The Symptom Checklist-90-R (SCL-90-R) for
obsessive-compulsive dimension yielded a score of 0.8. Her complete
(Hb)=7.3 g/dl; Hematocrit (Hct)=25.4%; Mean Corpuscular Volume
(MCV)=56.1
ng/ml. She was
anemia. We consulted her with hematology department due to very
low hemoglobin concentration where she was scheduled for
parenteral iron-dextran treatment. We started treatment with
exposure and response prevention therapy towards her OCD and pica
Conclusion
Most of the cases of pica exhibit a complex etiology of biological and
psychiatric factors. Therefore, multidisciplinary approach in treatment
for these patients are needed for better outcomes.
References
1.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders,
ed 5. Washington, American Psychiatric Association, 2013.
2.
Coltman CA Jr. Pagophagia and iron lack. JAMA. 1969 Jan 20;207(3):513-6.
3.
Parry-Jones B. Pagophagia, or compulsive ice consumption: a historical perspective.
Psychol Med. 1992 Aug;22(3):561-71.
4.
Hooda PS1, Henry CJ, Seyoum TA, Armstrong LD, Fowler MB. The potential impact of soil
ingestion on human mineral nutrition. Sci Total Environ. 2004 Oct 15;333(1-3):75-87.
5.
6.
Foulon C. Schizophrenia and eating disorders. Encephale. 2003 Sep-Oct;29(5):463-6.
7.
Hergüner S, Ozyildirim Tanidir
spectrum disorder? Prog Neuropsychopharmacol Biol Psychiatry. 2008 Dec 12;32(8):
2010-1.
8.
Ceschin L1, Giannunzio V, Favaro A, Santonastaso P. Pica in an eating disordered woman
with multiple sclerosis: impulse dys-control, compulsive symptom or self-medication
attempt? Eat Weight Disord. 2010 Mar-Jun;15(1-2):e116-8.
9.
Barbara J. Bryant, Yu Ying Yau, Sarah M. Arceo, Julie A. Hopkins, and Susan F. Leitman.
10.
behavioral and iron-dextran treatment would fail.
11.
12.
questions for pica and restless legs syndrome. Transfusion 2013;53:1637-1644.
Heger S, Teyssen S, Lieberz K. Pica--causes and complications of a little-known eating
disorder. Dtsch Med Wochenschr. 2001 Dec 14;126(50):1435-9.
Gundogar D, Baspinar Demir S, Eren
disorders? Gen Hos Psychiatr
Bhatia MS., Kaur N., Pagophagia - a common but rarely reported form of pica. J Clin
Diagn Res. 2014 Jan;8(1):195-6.
Copyright © 2014 Ihsan Aksoy, MD. Gaziantep University, Faculty of Medicine, Department of Psychiatry, ahinbey/ Gaziantep/ TURKEY Phone:+905326219960, Email: [email protected]
P.4.f.002
Pica ongoing for 36 years comorbid with obsessive-compulsive disorder: a case report
I. Aksoy 1, O.H.T. Kilic 1, B. Demir 1, A. Altindag 1
1Gaziantep Universitya Psychiatrya Gaziantepa Turkey
Introduction: Pica means craving to and compulsive eating of various types of nutrients which are not
categorized as food. Pagophagia is a form of pica characterized with eating at least one refrigerator tray of ice
everyday. Although pica is seen worldwide, it's etiology is still incomprehensible. It's relationship with iron
deficiency anemia has been reported. In non-pregnant adults it can be seen with autism spectrum disorders,
intellectual disability, schizophrenia and obsessive–compulsive disorder as a repetitive behavior [1]. There are
few case reports which point out the relationship of pica with obsessive–compulsive spectrum disorders and
suggest to involve pica into this spectrum [2]. In this case report, we aimed to present a case of pica who had
been eating clay for 35 years which turned into pagophagia in the past 1 year after gastrointestinal discomfort
and diagnosed with comorbid obsessive compulsive disorder (OCD).
Case: A.G., 54 years old married woman. She had started eating clay when she was 18 years old and had been
eating everyday until last year. She stopped eating clay because of gastrointestinal discomfort and embarassing
yellow coloring of her skin after everytime she ate clay. She reported having eaten approximately 100mg clay
per day for about 35 years. After a couple of pica free days she suddenly started to eat approximately 30–40 ice
cubes daily. When asked, she said that she was washing her hands whenever she touches something other than
food during cooking and checking every tap of water or gas whenever she leaves home. She reported mild
impairment of functionality and she had a good insight. There were no psychotic symptoms or sign of intellectual
disability. She has a daughter diagnosed with schizoprenia. Yale-Brown Obsessive Compulsive Scale (YBOC-S)
yielded a score of 13 and The Symptom Checklist-90-R (SCL-90-R) for obsessive–compulsive dimension yielded
a score of 1.3. Complete blood count showed deep iron deficiency anemia with Hb=7.3g/dl; Hct=25.4a;
MCV=56.1 fl; Fe=13mg/dl; Ferritin=1.76ng/ml. She was scheduled for parenteral iron-dextran treatment by
hematology department. Exposure and response prevention therapy has been started towards her OCD and pica
symptoms and SSRI augmentation was planned if behavioral and iron-dextran treatment would fail.
Discussion: Nowadays there is an increase in awareness that some of the pica cases may also belong to
obsessive–compulsive spectrum disorders, however there is no clinical trial about the psychiatric symptoms
among pica patients. Although the rates of pica in hematologic patients is high, rates of attendance to psychiatry
is very low. Neither all the iron deficiency anemia patients develop pica nor all pica patients exhibit iron deficiency
anemia so the emerging data suggests understanding and managing of pica on the basis of a multidimensional
approach with biological and psychiatric aspects [3].
Conclusion: There is a need for clinical studies about psychiatric factors among pica patients in order to
understand it's etiology better.
1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 5. Washington,
American Psychiatric Association, 2013.
2. Herguner, S., Ozyildirim, I., Tanidir, C., 2008. Is Pica an eating disorder or an obsessive–compulsive spectrum
disorder? Prog Neuropsychopharmacol Biol Psychiatry. 32(8):2010–2011.
3. Heger, S., Teyssen, S., Lieberz, K., 2001. Pica-causes and complications of a little-known eating disorder.
Dtsch Med Wochenschr. 126(50):1435–1439.
Citation: Eur Neuropsychopharmacol. 2014;24aSuppl 2):S620
Keywords
Obsessive compulsive disorders
Eating disorders
Antidepressants: clinical