What are options for treating PICA (eating crap)? Part 2

The role of Social worker

In toddlers and young children, pica behavior training must also bring about a positive appreciation of the environment and/or sensory stimulation. In young children with PICA, other issues that may need to be addressed are improvement of financial problems, schooling, social welfare, and prevention of isolation. One may also need to assess cultural beliefs and practices, educate both child and family, and teach about the harm of PICA. In children, it is vital that the surrounding environment be free of lead based paints, toys and furniture.

Medications

The majority of health care workers believe that PICA resolves spontaneously or can be improved with behavior treatment. Moreover, this is true in a number of individuals. However, there are many reports of adults with PICA who realize that their eating habits are troublesome. Many of these individuals have tried behavior therapy and have not improved. There are no approved drug regimens for PICA. In the literature, all drug therapy treatment for PICA is anecdotal and only isolated case reports exist. No one really knows what the ideal drugs are and how long to treat PICA.

However, based on case reports and effectiveness, the drugs with the best benefit for PICA are the atypical anti psychotics. Drugs like olanzapine, risperidone, or clozapine have shown to be more easily tolerated and produce relief in many cases.

Isolated reports do indicate that with time PICA does diminish and the drugs can be stopped. Some individuals required drug therapy for 3-9 months. The principal brain target of all antipsychotic drugs is the dopamine D2 receptor. One should be aware that a few mentally handicapped individuals who have been treated with anti psychotics have gone on to develop worsening of PICA. This may be due to ineffective dose, improper diagnosis or a combination of other emotional problems.

It is highly recommended that one follow up with a psychiatrist when using these drugs. The lowest dose of drug should be used. The effects of anti psychotics are not immediate and can take anywhere from 2-4 weeks to manifest. Other drugs which have been tried for treatment of PICA with some benefit include bromocriptine and methylphenidate.

At low dose, these drugs are fairly well tolerated and to avoid side effects one should not practice polypharmacy. Careful titration of dose with gradual increases can have a major impact on PICA

(http://www.psychiatrictimes.com/display/article/10168/1159376?pageNumber=4)