- A printer's unit of type size, equal to 12 points or about 1/6 of an inch.
- An equivalent unit of composition measurement used in determining the dimensions of lines, illustrations, or printed pages.
- A type size for typewriters, providing ten characters to the inch.
[Probably from Medieval Latin pīca, list of church services (perhaps from the typeface used to print it).]
An abnormal craving or appetite for nonfood substances, such as dirt, paint, or clay.
[New Latin pīca, from Latin, magpie (from its omnivorous nature).]
paper and printing British One specific size or, when qualified, one of two else more sizes of a type body size, of height 11 points for small pica, 12 for pica, plus various fractions and multiples. Also used, in the sense of the pica em, to mean virtually ⅙ in(4.233~ mm). Applied to a typewriter of fixed pitch, it refers to a type size equivalent to pica, with 6 lines per inch and, horizontally, 10 characters per inch; compare elite.
(1) In word processing, a monospaced font that prints 10 characters per inch.
(2) In typography, about 1/6th of an inch (0.166") or 12 points.
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An unnatural desire for foods; alternative words are cissa, cittosis, and allotriophagy. Also a perverted appetite (eating of earth, sand, clay, paper, etc.).
A craving for substances not normally considered to be nutrients. The curious behaviour of some pregnant women who crave for ice (pagophagia) or eat mouthfuls of clay (geophagia) may be caused by a real need for extra minerals, especially iron and zinc. If pica is due to a mineral deficiency, it clears up very quickly after the appropriate mineral supplement is taken.
The puzzling phenomenon of pica has been recognized and described since ancient times. Pica has been observed in ethnic groups worldwide, in both primitive and modernized cultures, in both sexes, and in all age groups. The word pica comes from the Latin name for magpie, a bird known for its unusual and indiscriminate eating habits. In addition to humans, pica has been observed in other animals, including the chimpanzee.
True pica affects people of all ages, although it is more common in children. There are some regional variations concerning specific substances. For example, eating clay is more prevalent among women in the American southeast than in other areas of the country. Adolescents may chew ice due to peer pressure or because they are deficient in iron. Without a blood test for serum iron, there is no way to differentiate these causes.
Causes and Symptoms
Pica in humans has many different subgroups, defined by the substance that is ingested. Some of the most commonly described types of pica are eating earth, soil, or clay (geophagia); ice (pagophagia); and starch (amylophagia). However, pica involving dozens of other substances, including cigarette butts and ashes, hair, paint chips, and paper have also been reported.
Although pica can occur in individuals of any background, a higher incidence of pica is associated with:
- developmental disabilities
- mental retardation
- psychiatric disease and autism
- early childhood (under age three)
- poor nutrition or low blood levels of iron and other minerals
- certain cultural or religious traditions
When to Call the Doctor
A health care professional should be consulted whenever a child over the age of three repeatedly ingests non-food substances for a period over one month. The behavior might be merely habitual, but it can become a compulsion that needs treatment.
In order for the diagnosis of pica to be made, there must be a history of persistent consumption of a non-food substance continuing for a minimum period of one month. Infants and toddlers are typically excluded from this diagnosis since mouthing objects is a normal developmental behavior at that age. Individuals with mental retardation who function at or below an approximate cognitive level of 18 months may also be exempt from this diagnosis.
Pica is most often diagnosed when a report of such behaviors can be provided by an individual or documented by another person. In other cases, pica is diagnosed after studies have been performed to assess the presenting symptoms. For example, imaging studies ordered to assess severe gastrointestinal complaints may reveal intestinal blockage with an opaque substance; such a finding is suggestive of pica. Biopsy of intestinal contents can also reveal findings, such as parasitic infection, consistent with pica. Pica may also be suspected if abnormal levels of certain minerals or chemicals are detected in the blood.
Treatment of pica will often depend on the cause and type of pica. Conventional medical treatment may be appropriate in certain situations. For example, supplementation with iron-containing vitamins has been shown to cause the unusual cravings to subside in some iron-deficient people.
Medical complications and health threats, including high lead levels, bowel perforation or intestinal obstruction, will require additional medical management, beyond addressing the underlying issue of pica.
Because most cases of pica do not have an obvious medical cause, treatment with counseling, education, and nutritional management is often more successful and more appropriate than treatment with medication. Some therapists specializing in eating disorders may have expertise in treating pica.
The prognosis for individuals with pica varies greatly, according to the type and amount of substance ingested, the extent of presenting side effects, and the success of treatment. Many of the side effects and complications of pica can be reversed once the behavior is stopped, while other complications, including infection and bowel perforation, pose significant health threats and if not successfully treated may result in death.
When seen in children, pica behavior tends to lessen with age. However, individuals with a history of pica are more likely to experience it again. Counseling and nutritional education can reduce the risk of recurrence.
There are no known methods of preventing pica. However, once pica is known or suspected, measures can be taken to reduce further ingestion of non-food substances. Removing the particular substance from readily accessible areas can be helpful. Close observation of the individual with pica may limit inappropriate eating behaviors.
Pica may be a symptom of an underlying nutritional deficiency. Correcting the deficiency usually stops the pica.
Parents should monitor the food and other substances that their children eat. Repeated ingestion of non-food substances may be cause for concern. An evaluation by a pediatrician is recommended in such circumstances. Parents should be especially careful of children who eat paint chips, because this can cause lead poisoning if the paint is from an older home in which lead paint was used.
Heird, William C. "Food Insecurity, Hunger and Undernutrition." In Nelson Textbook of Pediatrics. 17th ed. Ed. by Richard E. Behrman, et al., Philadelphia: Saunders, 2003, 167-172.
Matthews, Dawn D. Eating Disorders SourceBook Detroit, MI: Omnigraphics, Incorporated, 2001.
Walsh, B. Timothy. "Eating Disorders." In Harrison'sPrinciples of Internal Medicine. 15th ed. Ed. by Eugene Braunwald et al., New York, McGraw Hill, 2001, 486-90.
West, Delia S. "Eating Disorders." In Cecil Textbook of Medicine. 22nd ed. Ed. by Lee Goldman, et al. Philadelphia: Saunders, 2003, 1336–8.
Dreyer MJ, Chaushev PG, and Gledhill RF. "Biochemical investigations in geophagia." Journal of the Royal Society of Medicine 97, no. 1 (2004): 48-53.
Lavoie PM and Bailey B. "Lead poisoning from "lead-free" paint." Canadian Medical Association Journal 170, no. 6 (2004): 956–8.
Moya J, Bearer CF, and Etzel RA. "Children's behavior and physiology and how it affects exposure to environmental contaminants." Pediatrics 113, no. 4 Supplement (2004): 996–1006.
National Eating Disorders Organization (NEDO). 6655 South Yale Ave, Tulsa, OK 74136. (918) 481-4044. Hotline: (800) 931.2237. Web site: www.NationalEatingDisorders.org.
"Children and Eating Disorders." Vanderbilt University. Available online at www.vanderbilt.edu/AnS/psychology/health_psychology/childrenandED.html.
"Eating Disorder: Pica." eMedicine. Available online at www.emedicine.com/ped/topic1798.htm.
"Eating Disorders." Encyclopedia.Com. Available online at www.encyclopedia.com/html/e1/eatingdi.asp.
[Article by: L. Fleming Fallon, Jr., MD, DrPH]
What is pica?
Pica refers to the craving for unnatural or non-nutritious substances. It is named after the magpie (Pica pica), which has a reputation for sticking its beak into all kinds of things to satisfy its hunger or curiosity. It can happen in both sexes, all races, and in all parts of the world, but is especially noted in pregnant women.
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The craving of non-food substances. Pica occurs occasionally during pregnancy and in infants.
A persistent, pathologic desire to eat nonfood items such as paper or dirt.
categories related to 'pica'
- Afflictions and Conditions - pica: abnormal craving for unnatural foods due to nutritional deficiencies
- Special Measures - pica: unit of measure in typography equal to one-sixth inch or 12 points
- Printing and Typefaces - pica: letter size measuring ten characters per inch; unit of measure equal to twelve points or 1/6 of an inch
|Classification and external resources|
Stomach contents of a psychiatric inpatient with pica
Pica (pron.: // PY-kə) is characterized by an appetite for substances largely non-nutritive, such as clay, chalk, dirt, or sand. For these actions to be considered pica, they must persist for more than one month at an age where eating such objects is considered developmentally inappropriate. There are different variations of pica, as it can be from a cultural tradition, acquired taste or a neurological mechanism such as an iron deficiency, or chemical imbalance. It can lead to intoxication in children which can result in an impairment in both physical and mental development. In addition, it can also lead to surgical emergencies due to an intestinal obstruction as well as more subtle symptoms such as nutritional deficiencies and parasitosis. Pica has been linked to mental disorders and they often have psychotic comorbidity. Stressors such as maternal deprivation, family issues, parental neglect, pregnancy, poverty, and a disorganized family structure are strongly linked to pica.
Pica is more commonly seen in women and children, where it affects people of all ages in these subgroups. Particularly it is seen in pregnant women, small children, and those with developmental disabilities such as autism. Children eating painted plaster containing lead may suffer brain damage from lead poisoning. There is a similar risk from eating dirt near roads that existed prior to the phaseout of tetraethyllead in petrol (in some countries) or prior to the cessation of the use of contaminated oil (either used or containing toxic PCBs or dioxin) to settle dust. In addition to poisoning, there is also a much greater risk of gastro-intestinal obstruction or tearing in the stomach.[unreliable medical source?] Another risk of dirt-eating is the ingestion of animal feces and accompanying parasites. Pica can also be found in other animals and is most commonly found in dogs.
Signs and symptoms
Pica is the consumption of substances with no significant nutritive value such as earth or ice. Subtypes are characterized by the substance eaten for example:
- Amylophagia (consumption of starch)
- Coprophagy (consumption of feces)
- Geophagy (consumption of soil, clay, or chalk)
- Hyalophagia (consumption of glass)
- Consumption of dust or sand has been reported among iron-deficient patients.
- Lithophagia (a subset of geophagia, consumption of pebbles or rocks)
- Mucophagia (consumption of mucus)
- Odowa (soft stones eaten by pregnant women in Kenya)
- Consumption of paint.
- Pagophagia (pathological consumption of ice)
- Self-cannibalism (rare condition where body parts may be consumed; see also Lesch-Nyhan syndrome)
- Trichophagia (consumption of hair or wool)
- Urophagia (consumption of urine)
- Xylophagia (consumption of wood or paper)
This pattern of eating should last at least one month to fit the diagnosis of pica.
Complications may occur due to the substance consumed. For example lead poisoning may result from the ingestion of paint or paint-soaked plaster, hairballs may cause intestinal obstruction and Toxoplasma or Toxocara infections may follow ingestion of feces or dirt.
There is no single test that confirms pica. However, because pica can occur in people who have lower than normal nutrient levels and poor nutrition (malnutrition), the health care provider should test blood levels of iron and zinc. Hemoglobin can also be checked to test for anemia. Lead levels should always be checked in children who may have eaten paint or objects covered in lead-paint dust. The health care provider should test for infection if the person has been eating contaminated soil or animal waste.
- Persistent eating of nonnutritive substances for a period of at least one month
- Does not meet the criteria for either having autism, schizophrenia, or Kleine-Levin syndrome.
- The eating behavior is not culturally sanctioned
- If the eating behavior occurs exclusively during the course of another mental disorder (e.g., intellectual disability, pervasive developmental disorder, schizophrenia), it is sufficiently severe to warrant independent clinical attention.
In individuals with autism, schizophrenia, and certain physical disorders (such as Kleine-Levin syndrome), nonnutritive substances may be eaten. In such instances, Pica should not be noted as an additional diagnosis.
The scant research that has been done on the causes of pica suggests that the disorder is a specific appetite caused by mineral deficiency in many cases, such as iron deficiency, which sometimes is a result of celiac disease or hookworm infection. Often the substance eaten by someone with pica contains the mineral in which that individual is deficient. More recently, cases of pica have been tied to the obsessive–compulsive spectrum, and there is a move to consider OCD in the etiology of pica. However, pica is currently recognized as a mental disorder by the widely used Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Sensory, physiological, cultural and psychosocial perspectives have also been used by some to explain the causation of pica.
It has been proposed that mental-health conditions, such as obsessive-compulsive disorder (OCD) and schizophrenia, can sometimes cause pica.
However, pica can also be a cultural practice not associated with a deficiency or disorder. Ingestion of kaolin (white dirt) among African-American women in the US state of Georgia shows the practice there to be a DSM-IV "culture-bound syndrome" and "not selectively associated with other psychopathology". Similar kaolin ingestion is also widespread in parts of Africa. Such practices may stem from health benefits such as the ability of clay to absorb plant toxins and protect against toxic alkaloids and tannic acids.
Treatment for pica may vary by patient and suspected cause (e.g., child, developmentally disabled, pregnant or psychotic) and may emphasize psychosocial, environmental and family-guidance approaches, (iron deficiency) may be treatable though iron supplement through dietary changes. An initial approach often involves screening for and, if necessary, treating any mineral deficiencies or other comorbid conditions. For pica that appears to be of psychotic etiology, therapy and medication such as SSRIs have been used successfully. However, previous reports have cautioned against the use of medication until all non-psychotic etiologies have been ruled out.
Looking back at the different causes of Pica related to assessment, the clinician will try to develop a treatment. First, there is Pica as a result of social attention. A strategy might be used of ignoring the person’s behavior or giving them the least possible attention. If their Pica is a result of obtaining a favorite item, a strategy may be used where the person is able to receive the item or activity without eating inedible items. The individual’s communication skills should increase so that they can relate what they want to another person without engaging in this behavior. If Pica is a way for a person to escape an activity or situation, the reason why the person wants to escape the activity should be examined and the person should be moved to a new situation. If Pica is motivated by sensory feedback, an alternative method of feeling that sensation should be provided. Other non-medication techniques might include other ways for oral stimulation such as gum. Foods such as popcorn have also been found helpful. These things can be placed in a “Pica Box” which should be easily accessible to the individual when they feel like engaging in Pica.
Behavior-based treatment options can be useful for developmentally disabled and mentally ill individuals with pica. These may involve using positive reinforcement normal behavior. Many use aversion therapy, where the patient learns through positive reinforcement which foods are good and which ones they should not eat. Often treatment is similar to the treatment of obsessive compulsive or addictive disorders (such as exposure therapy). In some cases treatment is as simple as addressing the fact they have this disorder and why they may have it. A recent study classified nine such classes of behavioral intervention: Success with treatment is generally high and generally fades with age, but it varies depending on the cause of the disorder. Developmental causes tend to have a lower success rate. Pregnancy craving causes tend to have higher success rates.
Treatment techniques include:
- Presentation of attention, food or toys, not contingent on pica being attempted
- Differential reinforcement, with positive reinforcement if pica is not attempted and consequences if pica is attempted
- Discrimination training between edible and inedible items, with negative consequences if pica is attempted
- Visual screening, with eyes covered for a short time after pica is attempted
- Aversive presentation, contingent on pica being attempted:
- oral taste (e.g., lemon)
- smell sensation (e.g., ammonia)
- physical sensation (e.g., water mist in face)
- Physical restraint:
- self-protection devices that prohibit placement of objects in the mouth
- brief restraint contingent on pica being attempted
- Time-out contingent on pica being attempted
- Overcorrection, with attempted pica resulting in required washing of self, disposal of nonedible objects and chore-based punishment
- Negative practice (non-edible object held against patient's mouth without allowing ingestion)
The prevalence of pica is difficult to establish because of differences in definition and the reluctance of patients to admit to abnormal cravings and ingestion. Thusly leading to the prevalence recordings of pica being in the range of 8% and 65% depending on the study. A study published in 1994 found that 8.1% of pregnant African-American women in the United States self-reported pagophagia, the ingestion of large quantities of ice and freezer frost. A study conducted in 1991 found a prevalence of pica in 8.8% of pregnant women in Saudi Arabia. Rates of pica among pregnant women in developing countries, however, can be much higher, with estimates of 63.7% and 74.0% reported for two different African populations. This is due to different cultural norms as well as greater levels of malnutrition. Two studies of mentally retarded adults living in institutions found that 21.8% and 25.8% of these groups suffered from pica. Prevalence rates for children with and without developmental disabilities are unknown.
The term pica originates from the Latin word for magpie, a bird that is reputed because of their unusual eating behaviors where they are known to eat almost anything. In 13th century Latin work, pica was referenced by the Greeks and Romans; however, it was not addressed in medical texts until 1563. In the southern United States in the 1800s, geophagia was a common practice among the slave population. Geophagia is a form of pica in which the person consumes earthly substances such as clay, and is particularly prevalent to augment a mineral-deficient diet. Research on eating disorders in the 16th century to the 20th century suggests that during that time in history, pica was regarded more as a symptom of other disorders rather than its own specific disorder. Even today, what can be classified as pica behavior is a normative practice in some cultures as part of magical beliefs, healing methods, or religious ceremonies.
In other animals
Unlike in humans, pica in dogs or cats may be a sign of immune-mediated hemolytic anemia, especially when it involves eating substances such as tile grout, concrete dust and sand. Dogs exhibiting this form of pica should be tested for anemia with a CBC or at least hematocrit levels. However since it may be an evolved natural mechanism to increase micronutrient levels this type of geophagia may not be accurately described as pica since it is not actually a diseased behaviour.
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This entry is from Wikipedia, the leading user-contributed encyclopedia. It may not have been reviewed by professional editors (see full disclaimer)
n. - pica
n. - (Méd) pica
n. - Pika (unnatürliches Eßgelüst)
n. - pica, malacia
n. - 異食癖
n. - 이식증
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