hi everyone welcome back to another lesson we're talking about Pica in this lesson so Pica is an eating disorder involving craving and eating inedible non-nutritive objects or materials so we're going to talk about some common items people will eat when they have pica and we'll talk about certain medical and psychiatric conditions that are more likely to cause it as well and we'll also talk about some complications that can occur and ways to treat it so again Pika is this eating disorder where people are craving and eating things that they shouldn't be eating so they're non-edible or non-nutritive objects for materials now the DSM-5 or the diagnostic and statistical Manual of mental disorders has a particular criteria for making the diagnosis of Pica and it's going to be an eating of inedible non-nutritive objects persistently so it's not going to be rare occurrences it's also going to occur for at least one month of duration so it's going to be something that occurs persistently over the course of one month and there are particular exclusionary criteria in this particular diagnostic criteria and these include that in children below a certain age particularly those below the age of 24 months so two years or younger if they are eating inedible objects we would exclude them from saying that they have Pika there are also cultural and societal practices that also involve eating things that are inedible so if those individuals are a part of a culture or a society that accepts those practices then we would use that as an exclusionary criteria that means that they don't have Python and certain psychiatric conditions like schizophrenia unless it's very severe Pica that would be the only time we say that they have pica separate from their psychiatric disorder now Pike is something that occurs around the world and it does occur quite frequently in young children so it can occur in 25 to 33 percent of young children and then over time the likelihood that they will continue to eat inedible objects decreases so there's a decreasing prevalence with increasing age and as we mentioned before Pike is associated with certain medical and psychological or psychiatric conditions and we're going to talk about those later on in this lesson let's talk about certain things that patients may eat if they have pica so they're going to Crave or eat these particular inedible objects commonly these include rocks and Pebbles paper clay chalk crayons eggshells coffee grounds soap hair and pet food they can also crave or eat dirt and soil we would call this geophagy they can also consume charcoal ash cloth and baby powder and they also make crave or want to eat raw starches which we would call amylophagy so raw starches might mean that they might crave eating a raw potato for instance so these are the common things that these patients May crave or may want to eat now the reasons for for why Pike occurs is not entirely understood it's been proposed that it may be due to nutritional deficiencies so it has been found that certain deficiencies are more likely to occur in patients with Pica but there have been other cases where patients who are experiencing Pica don't have nutritional deficiencies so in some cases it may be the case that patients have a nutritional deficiency triggering Pica but in other cases it's not there's also another hypothesis as to why Pike occurs and that is due to the fact that some of the substances these patients can eat may be helpful in binding to harmful toxins so in children they may eat a lot of substances like eggshells or paper or clay and these compounds May bind to other harmful toxins in the environment so it may help them in some way gastrointestinaline so that is another hypothesis and there are other proposed ideas as to why Pica may occur with certain substances and we'll talk about those as we go through this lesson later let's talk about the medical conditions that are more likely to trigger Pica now we did mention nutritional deficiencies as a potential trigger for Pica and one of those is iron deficiency and especially iron deficiency anemia so Pica can occur in patients with iron deficiency anemia in quite a few patients it occurs in roughly half of patients with iron deficiency anemia and they're more likely to have a particular type of Pica and that is pagophagy now pagophagy is a craving for an eating of ice they're more likely to Crave and eat ice and it has been proposed that they may crave and eat ice as it may help with blood flow into the brain this is one proposed idea as to why these patients May crave ice and this particular craving this pagophagia is more specific to iron deficiency now another medical condition that has been associated with Pica is sickle cell disease now Pica is estimated to affect approximately 34 percent of patients with sickle cell disease and it seems to be related to worsening hemoglobin levels so in patients who have sickle cell disease if they have lower hemoglobin levels they're more likely to have pica and if they have increased reticular sites as well so worsening hemoglobin status and increased reticulocyte count is associated with worsening or a higher frequency of Pica related behaviors some other medical conditions that are associated with Pica include pregnancy in the postpartum period now Pike is not going to occur in all pregnant patients but it's more common in younger pregnant female patients particularly those in late adolescence so late adolescents perhaps early 20s they're more likely to experience Pica than other older individuals now Pike is estimated to affect approximately 27.8 percent of pregnant patients and typically the pike is going to resolve after pregnancy but it may continue in some patients intermittently so even after pregnancy the postpartum period they may have certain things that trigger their Pica and this can occur in some patients and there are some other medical conditions that can have pica as potential symptom these again are going to be mostly nutritional deficiencies particularly nutritional deficiencies of calcium in zinc so calcium and zinc deficiencies can lead to Pica in some patients now let's talk about psychological and psychiatric conditions that are more likely to have pica as a symptom so one one of them is going to be intellectual disability now in patients with intellectual disability it's been estimated that about 10 percent of those patients will have pica symptoms and there is a higher prevalence of Pica in patients with worsening intellectual disability so the worse the intellectual disability is the more likely they will have pica and pike-related behaviors and there also is a higher prevalence between the ages of 10 to 20. now another condition where patients can experience Pica is autism spectrum this is because autism spectrum co-occurs with intellectual disability in a lot of patients especially patients on the severe end of the spectrum they're more likely to have intellectual disability and this can lead to Pica symptoms as well and then there are some other psychiatric conditions that are associated with Pica these include schizophrenia trichotillomania which is pulling out of the hair and Stress and Anxiety Stress and Anxiety can be a trigger for Pica in some patients let's talk about the complications of Pica now we can imagine that because we're eating these inedible objects materials from all different parts of our environment we can have issues because of them these include lead poisoning so lead poisoning is actually going to be the most common poisoning in Pike it's a very important complication to look out for in patients with Pica so this is especially going to be in patients who are eating soil and dirt this is going to be the biggest complication to look out for so geophagy patients so again those eating soil and dirt more likely to ingest a lot of lead this can lead to lead poisoning patients with high levels of lead may not show symptoms they may be asymptomatic so they may not have any symptoms at all but in some cases they can have symptoms they can be fatigued or lethargic they can have intellectual disabilities they can have developmental delay for instance or School issues or they can have some gastrointestinal signs and symptoms like constipation or vomiting or weight loss as well we can also see issues with infections so again because these patients may be consuming things in the environment like dirt or other substances they can have infections particularly they can be infected with parasites or parasitic infections and the most common parasitic infections in patients with Pica is toxocoriasis and ascariasis so these are the most common parasitic infections in Pica patients and then another one that's very important is toxoplasmosis as well in the signs and symptoms for these particular parasitic infections varies so in toxocoriasis it depends on where the larva of the parasite migrate which organ systems May migrate to sometimes they'll migrate to the eyes this can cause eye issues so visual problems can be something to look out for in toxocariasis ascoriasis we're more likely to see gastrointestinal signs and symptoms so we can see abdominal pain and discomfort and other issues as well and then in toxoplasmosis a lot of times this doesn't really cause infections unless the patient is immunocompromised so that's something to look out for if you want more information on toxoplasmosis please check my lesson on that topic and then something else to also look out for in patients with Pica is a small bowel obstruction again you can imagine if you're eating a lot of dirt and soil it can cause an obstruction in the gastrointestinal system so it can lead to a what we call bezoar so either from ingestion of a bees orb so it's a concretion or a stone-like mass or formation of that bezorb so from all those things that the patient might be eating they may lead to a formation of a bees or that blocks the gastrointestinal system causes a bowel obstruction so this can lead to nausea and vomiting and other signs and symptoms if you want more information please check out my lesson on small bowel obstruction let's talk about the ways Pica is treated so it's important to treat the underlying conditions if it is a iron deficiency anemia using iron supplements can be helpful this can help resolve Pica if it's some other condition like a zinc or a Calcium deficiency it's going to be important to supplement with zinc or calcium and it's also important to identify and treat complications we talked about some of those before some of those infections and lead poisoning is going to be very important one to look out for a lot of the treatment for pike is going to require multi-disciplinary approach so oftentimes these patients are going to require individuals both inside and outside of the hospital or in community Behavioral Management is going to be a treatment for some patients with Pica especially those with psychological or psychiatric conditions that lead to Pica these include education training to discriminate between inedible and edible objects have it reversal training to alter the antecedent Trigger or behavior so if something's triggering them to more likely eat an inedible object perhaps that's stress or anxiety helping to manage that stress and anxiety is going to be very helpful positive reinforcement so using positive reinforcement methods for non-pika behaviors so if they start eating actual edible foods then rewarding that type of behavior and not rewarding the Pica behaviors and then environmental enrichment can help some patients so these are some of the potential behavioral managements for Pica please check my lesson on iron deficiency anemia and on lead poisoning if you found this lesson helpful please like this video And subscribe to the channel that would be greatly appreciated thank you so much for watching and I hope you have a great day