Pica

Specialty: Psychiatry.

• Allotrophagy
• ingestion of non-food substances
• abnormal appetite

Why it occurs

• Primary pica disorder
• Severe iron deficiency anemia or zinc deficiency
• Autism spectrum disorder (ASD) with intellectual disability
• Severe disorganized schizophrenia
• Advanced dementia
• Pregnancy (gestational pica, often secondary to nutritional deficiencies)

Initial workup

Complete blood count, serum iron levels, ferritin, iron binding capacity, zinc levels; blood lead levels (plumbemia); simple abdominal x-ray if there is suspicion of obstruction or radiopaque foreign body; digestive endoscopy if necessary.

Standard management

• Supplementation with ferrous sulfate or zinc orally/intravenously — if a deficit is demonstrated, which usually resolves the pica quickly
• Risperidone or Aripiprazole — if pica is associated with self-injurious or agitated behaviors in autism or schizophrenia