pica and Substance-Related-Disorders

Nutrition assessment and counseling are integral components of preconception and prenatal care. The average-size woman should gain between 11.25 and 15.75 kg (25 and 35 lb) during a normal pregnancy. Some factors identify the pregnant woman with a nutrition risk. Vitamin and mineral supplementation should be based on a dietary assessment. Common discomforts of pregnancy frequently can be managed with dietary modification and safe pharmacotherapeutics. The coordinated efforts of health care providers, registered dietitians, the Women, Infants, and Children (WIC) nutrition program, local health departments and Cooperative Extension Service offices can provide appropriate nutrition assessment, education and intervention.

Topics: Caffeine; Constipation; Female; Humans; Lactose Intolerance; Nausea; Nutrition Assessment; Nutritional Physiological Phenomena; Pica; Pregnancy; Pregnancy Complications; Sodium, Dietary; Substance-Related Disorders; Vomiting; Weight Gain

Bulimarexia, an eating disorder that is characterized by binge eating followed by self-induced vomiting or abuse of cathartic or diuretic drugs, has been defined as both a sequela of anorexia nervosa and a distinct eating disorder. In this review the presentation, prevalence, and complications of the various eating disorders--anorexia nervosa, pica, rumination disorder of infancy, and bulimia/bulimarexia--are discussed. Detailed attention is given to the potential medical hazards of bulimarexia. These hazards may be categorized according to the organ system affected or the individual behavioral components of bulimarexia. Because bulimarexia is commonly practiced in secrecy, its presentation may be in the form of one of its medical complications. Therefore, physicians must know the behavioral components of bulimarexia and its potential medical hazards. Optimal care of these patients requires collaborative efforts from a physician and behavioral therapist.

Topics: Adolescent; Adult; Anorexia Nervosa; Cathartics; Diuretics; Feeding and Eating Disorders; Female; Gastroesophageal Reflux; Humans; Hyperphagia; Infant; Male; Nutrition Disorders; Pica; Substance-Related Disorders; Vomiting

Geophagia is an ancient practice subject to many prejudices. Recent animal experiments have shed light on its causes and consequences. Geophagia, a form of pica, may be induced by various factors. Clay, the material preferentially ingested by geophagic subjects, interacts with the food bolus and the digestive mucosa. Its capacity to form colloids and to adsorb and exchange ions results in both beneficial and harmful effects. In a less civilized age, the ingestion of clay may have reinforced digestive barriers against alkaloids and toxins, conferring a selective advantage on individuals practicing geophagia. However, in the modern Western world, complex interactions of clay with metals and ions are likely to generate low-level poisoning and deficiencies, potentially damaging the health of geophagic individuals and their offspring.

Topics: Aluminum Silicates; Behavior, Addictive; Clay; Comprehension; Eating; Humans; Pica; Substance-Related Disorders

Topics: Adult; Blood Chemical Analysis; Chlorobenzenes; Humans; Insecticides; Kidney Diseases; Leukoencephalopathies; Magnetic Resonance Imaging; Male; Neurologic Examination; New York City; Pica; Poison Control Centers; Substance-Related Disorders; Xenobiotics

Transdermal fentanyl is an opioid analgesic that is effective on chronic pain, and which appears to be advantageous due to several factors such as ease of administration, the relatively stable serum concentration and long dose intervals. Nevertheless, the danger of abuse and dependence exists among patients who are prescribed fentanyl patches. We present a case of transdermal fentanyl abuse, where the administration route of the drug was changed. Our patient, who had no history of substance abuse and who suffered from chronic nonmalignant pain, used the fentanyl transdermal patches as oral transmucosal medication, raising the dose by ten-fold. This abuse of the drug was only for analgesic purposes without seeking anxiolysis and/or euphoria. After treatment and progressive reduction of fentanyl, the patient remains in good condition, and is currently taking the initial dose of the drug transdermally, without having experienced any withdrawal symptoms.

Topics: Administration, Cutaneous; Administration, Oral; Adult; Chronic Disease; Depressive Disorder; Drug Administration Schedule; Drug Therapy, Combination; Dysthymic Disorder; Female; Fentanyl; Fluoxetine; Greece; Humans; Mouth Mucosa; Pain; Pica; Polychondritis, Relapsing; Self Administration; Substance-Related Disorders

The practice of pica, the compulsive ingestion of nonfood substances over a sustained period of time, was studied in 553 African American women who were admitted to prenatal clinics in Washington, D.C. Dietary, biochemical, and psychosocial correlates of the pica practices of a subset of this urban population are presented in this paper. Geophagia, compulsive eating of clay or dirt, was not observed in these women; pagophagia, or the ingestion of large quantities of ice and freezer frost, was self reported in 8.1% of the women, who consumed 1/2 to 2 cups a day from 1 to 7 days per week. Serum ferritin concentrations of pica women were significantly lower during the second and third trimesters of pregnancy; the average values for three trimesters of pregnancy for both ferritin and mean corpuscular hemoglobin were significantly lower in pica women than their nonpica counterparts (P = 0.0001 and P = 0.017, respectively). Although not significantly different, the iron (66 vs. 84% RDA) and calcium (60 vs. 75% RDA) contents of the diets of pica women were less those of nonpica women. Gestational age, body length, and body weight were not different, but head circumferences of infants delivered to pica women who consumed freezer frost and/or ice were smaller than those of nonpica women (P = 0.012). The hypothesis is presented that pica in African American women may be a mediator of stress, acting through the immune system. The size of the social support network of pica women was significantly less than that of nonpica women.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Black or African American; Cohort Studies; Diet; District of Columbia; Female; Ferritins; Folic Acid; Hemoglobins; Humans; Ice; Incidence; Infant, Newborn; Pica; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prenatal Care; Prevalence; Prospective Studies; Social Support; Soil; Substance-Related Disorders; Urban Population

Topics: Aluminum Silicates; Anemia, Hypochromic; Clay; Disorders of Excessive Somnolence; Female; Humans; Middle Aged; Pica; Substance-Related Disorders