A case of pica in childhood with intellectual disability: focus on non­-psychopharmacology management

  • Fransiska Kaligis Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia https://orcid.org/0000-0003-3776-7064
  • Mirza Hapsari Massarapa Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia https://orcid.org/0000-0001-5781-0977
  • Raden Irawati Ismail Marsubrin Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Tjhin Wiguna Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Keywords: behaviour, child, pica, therapy
Abstract viewed: 1225 times
PDF downloaded: 837 times
HTML downloaded: 253 times
EPUB downloaded: 246 times

Abstract

Non-psychopharmacology management is crucial in pica in childhood with intellectual disability. This case report shows the effectiveness of pica management centered on behavioral therapy over the use of pharmacotherapy in improving the patient’s symptoms. A-7-year-old girl had been eating plastic bags since she was 3. In the last 6 months, this behavior worsened and coupled with emotional and behavioral problems. Her intellectual function showed that she had a moderate intellectual disability, which was confirmed by her intelligence quotient test result. She also had iron deficiency anemia and constipation. Non-psychopharmacological management was delivered to the patient and family. The patient was treated with a reinforcement strategy of behavioral therapy, involving parental education during the process to stimulate desirable behavior, discourage unwanted behavior, and improve parent-child interaction. After six sessions of behavioral therapy and parental psychoeducation, the patient showed improvement as the frequency of eating nonfood substances was decreasing.

References

  1. Al Nasser Y, Alsaad AJ. Pica [Internet]. Treasure Island: StatPearls Publishing; 2019 [cited 2019 June 3]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK532242/.

  2. Young SL, Sherman PW, Lucks JB, Pelto GH. Why on earth?: evaluating hypotheses about the physiological functions of human geophagy. Q Rev Biol. 2011;86(2):97-120. https://doi.org/10.1086/659884

  3. Singhi S, Ravishanker R, Singhi P, Nath R. Low plasma zinc and iron in pica. Indian J Pediatr. 2003;70(2):139-43. https://doi.org/10.1007/BF02723740

  4. Matson JL, Belva B, Hattier MA, Matson ML. Pica in persons with developmental disabilities: characteristics, diagnosis, and assessment. Res Autism Spect Disord. 2011;5(4):1459-64. https://doi.org/10.1016/j.rasd.2011.02.006

  5. Leung AKC, Hon KL. Pica: a common condition that is commonly missed - an update review. Curr Pediatr Rev. 2019;15(3):164-9. https://doi.org/10.2174/1573396315666190313163530

  6. Carter SL, Wheeler JJ, Mayton MR. Pica: a review of recent assessment and treatment procedures. Educ Train Dev Disabil. 2004;39(4):346-58.

  7. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Association Publishing; 2013. https://doi.org/10.1176/appi.books.9780890425596

  8. Stiegler LN. Understanding pica behavior: a review for clinical and education professionals. Focus Autism Dev Disabil. 2005;20(1):27-38. https://doi.org/10.1177/10883576050200010301

  9. Borgna-Pignatti C, Zanella S. Pica as a manifestation of iron deficiency. Expert Rev Hematol. 2016;9(11):1075-80. https://doi.org/10.1080/17474086.2016.1245136

  10. Khan Y, Tisman G. Pica in iron deficiency: a case series. J Med Case Reports. 2010;4:86. https://doi.org/10.1186/1752-1947-4-86

  11. Munir S, Qadir M. Pathophysiology and management of pica. Pharmacologyonline. 2010;3:677-81.

  12. El nemer FM, Alian DM, Eldin MS, Khalil HEM. Prevalence of pica among children attending pediatrics clinic at El-Menoufiya University Hospital. AJBIO. 2014;2(4):147-52. https://doi.org/10.11648/j.ajbio.20140204.15

  13. Hartmann AS, Poulain T, Vogel M, Hiemisch A, Kiess W, Hilbert A. Correction to: Prevalence of pica and rumination behaviors in German children aged 714 and their associations with feeding, eating, and general psychopathology: a population-based study. Eur Child Adolesc Psychiatry. 2018;27(11):1499-508. https://doi.org/10.1007/s00787-018-1179-z

  14. Sosinsky LS, Gilliam WS, Mayes LC. The preschool child. In: Martin A, Bloch MH, Volkmar FR. Lewis's child and adolescent psychiatry a comprehensive textbook. 5th ed. Philadelphia: Wolters Kluwer; 2018.

  15. Miao D, Young SL, Golden CD. A meta-analysis of pica and micronutrient status. Am J Hum Biol. 2015;27(1):84-93. https://doi.org/10.1002/ajhb.22598

  16. Robinson BA, Tolan W, Golding-Beecher O. Childhood pica. Some aspects of the clinical profile in Manchester, Jamaica. West Indian Med J. 1990;39(1):20-6.

  17. Autism speaks ATN/AIR-P. PICA: a guide for professionals. Autism speaks ATN/AIR-P; 2011.

  18. Liu YH, Pesch MH, Lumeng JC, Stein MT. Pica in a four-year-old girl with global developmental delay. J Dev Behav Pediatr. 2015;36(9):758-60. https://doi.org/10.1097/DBP.0000000000000228

  19. Singh AP. Pica- a case report on eating disorder of rural adolescent girl. IJSRP. 2013;3(9):1-5.

  20. Call NA, Simmons CA, Mevers JE, Alvarez JP. Clinical outcomes of behavioral treatments for pica in children with developmental disabilities. J Autism Dev Disord. 2015;45(7):2105-14. https://doi.org/10.1007/s10803-015-2375-z

  21. Dobson, KS. Handbook of cognitive-behavioral therapies. 2nd Ed. New York: The Guilford Press; 2001.

  22. Hergüner S, Hergüner AS. Pica in a child with attention deficit hyperactivity disorder and successful treatment with methylphenidate. Prog Neuropsychopharmacol Biol Psychiatry. 2010;34(6):1155-6. https://doi.org/10.1016/j.pnpbp.2010.06.005

  23. Hergüner A, Hergüner S. Pica in an adolescent with autism spectrum disorder responsive to aripiprazole. J Child Adolesc Psychopharmacol. 2016;26(1):80-1. https://doi.org/10.1089/cap.2015.0184

Published
2020-10-16
How to Cite
1.
Kaligis F, Massarapa MH, Marsubrin RII, Wiguna T. A case of pica in childhood with intellectual disability: focus on non­-psychopharmacology management. Med J Indones [Internet]. 2020Oct.16 [cited 2024Apr.24];29(4):422-6. Available from: http://mji.ui.ac.id/journal/index.php/mji/article/view/4010
Section
Case Report/Series

Most read articles by the same author(s)