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Query: UMLS:C0036341 (schizophrenia)
 60,220 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Schizophrenia patients often display multiple repetitive behaviors. We investigated relations among nine repetitive behaviors and evaluated the hypothesis that these behaviors are varied manifestations of a single underlying biobehavioral disturbance. Nine repetitive behaviors from the Elgin Behavioral Rating Scale were assessed in 400 schizophrenia patients residing at a state hospital. A majority of patients were smokers (76.3%) and very few had pica (3%). Several other repetitive behaviors showed substantial frequency. A principal components analysis revealed eight of nine behaviors shared at least 10% of their variance with a single, common component. However, a principal factor analysis suggested a five-factor model best represented the data. The five factors and items identifying them were: (1) 'oral consumption' behaviors-polydipsia and smoking; (2) 'Kluver-Bucy' behaviors-bulimia and hypersexuality; (3) 'movement' behaviors-mannerisms/postures and pacing; (4) 'bizarre use of objects'-bizarre grooming and hoarding; (5) 'Pica'. Associations among repetitive behaviors varied. Symptoms such as smoking and polydipsia appeared reliably related, and others such as pica appeared discrete and independent. Overall, the data did not support the 'single disturbance' hypothesis and suggested a multifactorial model is needed to characterize repetitive behavior disturbances in schizophrenia.
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PMID:Repetitive behaviors in schizophrenia: a single disturbance or discrete symptoms? 879 13

Pica is the persistent, culturally and developmentally inappropriate ingestion of non-nutritive substances (DSM-IV). AB is a 75-year-old lady with a 40-year history of schizophrenia and a 20-year history of pica who, at emergency laparotomy, had 175.32 Pounds of loose change in her stomach. Although pica has been reported to coexist with schizophrenia, she had had no positive symptoms of schizophrenia for at least 20 years. She has CT evidence of fronto-tempotal atrophy most marked on the left in the temporal lobe and on the right in the frontal lobe. Pica has been found to be related to cognitive deficits and hyperoral behaviour to temporal lesions. Neuropsychological testing reveals deficits closely related to these changes.
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PMID:An unusual case of pica. 977 29

Pica has rarely been reported in patients with geriatric mental illness. The authors describe 3 male patients with pica in the geriatric unit of a state mental hospital. Two of these patients had a diagnosis of developmental delay with concomitant diagnoses of schizophrenia and schizoaffective disorder, respectively. The third patient was diagnosed with paranoid schizophrenia. In all 3 cases, pica started late in life and was unrelenting and unresponsive to psychotropic medications, with limited to no response to behavioral interventions. In the 2 patients who died, pica was implicated as the direct cause of death in 1 and the likely cause of death in the other. When pica occurs in elderly patients with mental illness, the risk of mortality should be taken into account in clinical management.
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PMID:Pica in the geriatric mentally ill: unrelenting and potentially fatal. 1296 64

According to the DSM IV, pica is a trouble of alimentary behavior, which is characterized by the ingestion of non-nutriment substances during at least on the month. The main objective of this study conducted at the Clermont-de-l'Oise Interdepartmental Medical Center is to evaluate pica's prevalence for hospitalized patients. Secondary objectives are to describe clinical characteristics, complications and outcome upon the different therapeutic approaches. The patients hospitalized in the Adult and/or Pediatric Department of Psychiatry, which fulfilled the 4 criteria of the DSM IV, were considered eligible for the study. In order to better evaluate the severity of behavioral troubles evoked by item D of DSM IV definition, we elaborated specific severity and preoccupation scales. The severity scale reflects the complications due to the ingestion of the non-nutriment substances, the encountered risks in the case of persistence of these troubles as well as the patient's management. The preoccupation scale reflects the medical team's involvement towards the patient in order to prevent life-threatening complications. The two scales are graded from 0 to 5 according to the severity or to the degree of preoccupation, respectively. Only patients with scores 3 were considered as fulfilling the severity criteria. Among the 943 hospitalized patients at a selected time period, 23 adult patients have been considered eligible. According to these data, prevalence of pica was estimated at 2.44%. This value may seem an underestimation when compared to the values reported in the medical literature, which range from 9 to 25%. Additionally, among the 108 hospitalized infant patients, none fulfilled DSM IV criteria, which is surprising, as pica is relatively common in childhood. These results may be explained by the use of the more restrictive criteria of the DSM IV and also by the difficulties encountered in considering pica as an independent medical condition. Indeed, pica is often a secondary diagnosis associated with other psychiatric conditions characterized by profound mental deterioration. Two pathogenic factors were constantly searched in the medical records: iron-deficiency anemia and psychopathology. Cultural factors can be a priori eliminated, as most of these patients are in rupture with their family environment since low ages. Only two patients presented with iron-deficiency anemia and its correction did not result in pica's improvement. These findings do not support the -studies presenting pica as an iron-deficiency anemia induced trouble, which regress after a well-conducted iron replacement. Most patients were found to have precocious lack of affect in their medical history. All patients presented other associated psychiatric troubles including severe mental impairment (48%) and dysharmonic development (26%), as well as autistic troubles and schizophrenia. These data concur with other studies, which associate pica to other psychiatric disorders. Gluttony is a widely represented symptom in our study population (87%) and predisposes to food aspiration. It is the mark of frenetic orality and concerns comestible as well as non-comestible compounds. The ingestion of non-nutriment compounds could therefore be considered as an incapacity of discerning among different mouth-introduced substances. Auto- and hetero-aggressive disorders have been reported in 77% of the patients. These behaviors arise mostly in the phase of seeking of substances, especially if these are particularly attractive. The enhancement of the -anxiety, which often arises in the eventuality of hindering of the act, as well as the soothing effect of the ingestion, suggests a compulsive activity. This compulsive activity could be related to an addictive conduct. Pica could therefore be related to obsessive-compulsive disorders and benefit from its specific therapy, either behavioral or chemotherapy with serotonin-recapture inhibitors. The most common clinical forms of pica were phytophagia and geophagia, probably due to the facility of access to these substances. However, 31 distinct substances have been identified in our study. Pica's evolution often implies severe complications, which are sometimes life threatening in spite of a well-conducted treatment. Severity factors include the iteration of medical and surgical complications, as well as the type of ingested products. Our results show a high incidence of surgical complications, essentially gastro-intestinal. Due to the elevated incidence of complications and to the high rate of mortality, some authors proposed systematical search of pica for any gastro-intestinal troubles arising in patients suffering from mental disorders. For these patients for whom anamnesis is often difficult, a standard X-ray of the abdomen is an essential imaging study. Respiratory complications come in second position and infectious complications are seen mostly for the geo- and coprophagia-suffering patients, which contract intestinal parasitosis. Because of its multifactor causality, treatment of pica is complex, and results are often deceiving. Symptomatic neuroleptic therapy results in transient improvement and is indicated especially in delirious patients. Psychotherapy with behavioral approaches and different institutional approaches can be proposed. Indeed, pica could be considered as an acquired behavior, which could benefit from cognitive and behavioral therapies. Institutional management including supportive and compassionate care, restoration of self-confidence is interesting for these patients. Some authors even suggest that pica might be considered as a good indicator of the institution's care quality.
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PMID:[Pica: a descriptive study of patients in a speciality medical center]. 1461 90

The comorbidity of schizophrenia and eating disorders is understudied. In the early nineteenth century, Eugen Bleuler has reported cases of schizophrenia with eating disorders that were related to delusional ideas. Potomania, merycism and pica have often been described in schizophrenic patients. Schizophrenic patients with eating disorders usually do not meet all criteria for typical eating disorders and are therefore classified as "eating disorders not otherwise specified" (EDNOS). It may even be difficult to recognize schizophrenia in patients with eating disorders associated to delusional ideas and distorted cognitions related to food or body perception. In any case, the diagnosis of schizophrenia should preferably be made and is only valid after renutrition is achieved. The prevalence of schizophrenia in samples of patients with eating disorders is generally below 10% but reaches 35% in males, the most frequent form being hebephrenia. Cognitive behavioural therapies for eating disorders need to be adapted in cases of comorbid schizophrenia. The new antipsychotic medications seem helpful in patients with eating disorders with or without schizophrenia. They reduce anxiety towards eating and bring in better adherence to treatments.
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PMID:[Schizophrenia and eating disorders]. 1461 97

This article brings together some of the 'hidden disabilities' common amongst adolescents and young adults. Many of these conditions carry a social stigma and some are associated with secretive behaviour and even denial. The article will describe the features, management and oral implications of five eating disorders (Prader-Willi syndrome, anorexia nervosa, bulimia nervosa, binge eating disorder and pica) and three types of mental health problems (schizophrenia, obsessive-compulsive disorder and bipolar disorder). Without the input of the dental profession, and in the main the primary dental care service, all these conditions can have a detrimental effect on the dentition at a relatively early stage in life. Mental health problems are more common in adolescents and young adults than most people realise and this article will also consider the impact on oral health and delivery of dental care to young people who have experienced childhood sexual abuse.
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PMID:Access to special care dentistry, part 6. Special care dentistry services for young people. 1902 93

Coprophagia or the ingestion of feces, considered to be a variant of pica, has been associated with medical disorders like seizure disorders, cerebral atrophy, and tumors and with psychiatric disorders like mental retardation, alcoholism, depression, obsessive compulsive disorder, schizophrenia, schizoaffective disorder, fetishes, delirium, and dementia. But entomophagy or the practice of eating live or dead insects as food by humans has only been reported as part of eating habits by some cultures in the world and not in association with any medical or neuropsychiatric disorders. Till date, there is no report in medical literature of entomophagy as an association with any neuropsychiatric or medical illnesses. Coprophagy and entomophagy has not been together reported as well. We describe the first ever case report of a 19-year- old male patient diagnosed with undifferentiated schizophrenia and associated with both entomophagy and coprophagy. His schizophrenic symptoms, the entomophagic, coprophagic behaviors improved with olanzapine therapy. Entomophagy and coprophagy, two very unusual human behaviors, can be seen in association with schizophrenia.
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PMID:Entomophagy and coprophagy in undifferentiated schizophrenia. 2193 94

A 40-year-old mentally retarded Japanese man was admitted at rehabilitation facility for handicapped persons and found dead in his bed. His neonatal period was complicated by seizures, and he had a medical history of schizophrenia. A postmortem computed tomography scan suggested an intestinal obstruction, but the cause was unknown. To clarify the cause of death, a medicolegal autopsy was carried out. The gastrointestinal tract was found to contain copious amounts of cloth pieces. A diagnosis of intestinal obstruction secondary to pica of clothes was made. Despite still being an essentially neglect condition; mental retardation is cause to significant burden to the patient, his relatives and caregivers and the whole society. Moreover, people with mental retardation may be at increased risk for potentially self-injury due to ingestion of non-eating substance or incongruent intake of eating substances, which may on turn lead to severe or even life-threatening medical and surgical complications as herein reported. Specific attention also to pica in mentally-retarded patients with sudden, severe, gastrointestinal events, should therefore be placed in order to prevent potential death or otherwise severe chronic consequences, ideally aiming at enhancing the early recognition and multi-disciplinary management of those psychological stressors or triggers potentially responsible for pica too.
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PMID:Intestinal obstruction in a mentally retarded patient due to pica. 2623 86