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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