Pica is an eating disorder typically characterized by the continual eating of nonnutritive substances for a period of at least 4 weeks at an age in which this behavior is developmentally inappropriate (e.g., >18-24 mo). Today, the definition of PICA has been expanded to include eating of nonnutritive substances.
Individuals who are diagnosed with pica have been reported to mouth and/or gulp down a wide variety of nonfood materials, including, but not limited to, clay, dirt, sand, stones, pebbles, hair, feces, lead, laundry starch, vinyl gloves, plastic, pencil erasers, ice, fingernails, paper, paint chips, coal, chalk, wood, plaster, light bulbs, needles, string, cigarette butts, wire, and burnt matches.
In the majority of cases of children who have been diagnosed with PICA, natural recovery occurs with time. Most children who have no mental problems simply grow out of the disorder. However, some children may need a multidisciplinary approach involving psychologists or social workers. The role of physician in early treatment stage is that of reassurance.
When spontaneous recovery does not take place, some type of treatment must be offered. Expansion of management plan must take into relation symptoms of pica and causative factors, as well as treatment of potential complications of the disorder.
The variety of behavioral strategies that have been proven to be effective in treating PICA include
- Antecedent treatment
- Distinction guidance between edible and
non-edible items
- Self-protection equipment that prevent
insertion of objects in the mouth
(mouth guards)
- Sensory strengthening of proper foods
- Differential strengthening of other or
unrelated behaviors, such as screening
(covering eyes briefly), or performing
exercise (or watching TV) is encouraged
- Conditional aversive oral taste (silver
acetate, lemon)
- Conditional aversive smell consciousness
(sulfur or ammonia),
- Conditional aversive physical awareness
(water spray, mild static shock therapy),
- Brief time out with physical restraint of
arms
- Correction of the environment
- Administer appropriate responses to
reinforce positive behavior
Thursday, April 16, 2009
Tuesday, April 14, 2009
How can I improve my libido while taking an antidepressant? part 3
Some individuals prefer to use only an SSRI. However, almost all SSRI have the ability to induce sexual dysfunction. Recently Fluvoxamine (luvox) has been speculated to help individuals with sexual dysfunction. At present Luxol is used to treat OCD and does work well. The drug does maintain sexual function but it has two side effects of concern. When the drug is abruptly discontinued, it can cause withdrawal symptoms of dizziness, fatigue, nausea, vivid dreams, irritability, and headaches. The other problem is that luvox may increase the risk of suicide in young adults and children. Individuals who are depressed have been found to have worsening of depression and suicidal thoughts when taking Luvox. Therefore, at the moment, the drug is rarely prescribed without close supervision.
Some physicians do try an add a psychostimulant to the patient’s regimen to counter the sexual dysfunction. Addition of drugs like Ritalin or methyl phenidate have been shown to work, but often the side effects of anxiety and insomnia also dominate. Further, these drugs have ability to cause physical dependence and cause withdrawal reactions when the drugs are abruptly stopped.
The latest and perhaps the one with the least controversy are Viagra and Tadalafil. Since the availability of Viagra and related drugs, there have been a few studies to see if the sexual dysfunction can be reversed. There have been a few studies which showed that both tadalafil and sildenfail both slightly improved sexual function in individuals who took anti depressants. However, most of the studies included small numbers and long-term data are not available. Anecdotal reports indicate that while Viagra does work, the effects are not sustained in the long run. In any case, Viagra is perhaps the best option for individuals with sexual dysfunction which occurs with anti depressants. The few negatives about viagra are that it is expensive and fake/counterfeit products are common.
Some physicians do try an add a psychostimulant to the patient’s regimen to counter the sexual dysfunction. Addition of drugs like Ritalin or methyl phenidate have been shown to work, but often the side effects of anxiety and insomnia also dominate. Further, these drugs have ability to cause physical dependence and cause withdrawal reactions when the drugs are abruptly stopped.
The latest and perhaps the one with the least controversy are Viagra and Tadalafil. Since the availability of Viagra and related drugs, there have been a few studies to see if the sexual dysfunction can be reversed. There have been a few studies which showed that both tadalafil and sildenfail both slightly improved sexual function in individuals who took anti depressants. However, most of the studies included small numbers and long-term data are not available. Anecdotal reports indicate that while Viagra does work, the effects are not sustained in the long run. In any case, Viagra is perhaps the best option for individuals with sexual dysfunction which occurs with anti depressants. The few negatives about viagra are that it is expensive and fake/counterfeit products are common.
How can I improve my libido while taking an antidepressant? part 2
The other option for treatment of sexual dysfunction includes lowering dose of the anti depressant. This is often a tricky option as most antidepressants have a fine line between effectiveness and no effect. Lowering the dose may reduce sexual dysfunction but may also decrease effectiveness of the drug- most patients are reluctant to try this option.
The other option includes adding another medication to counter the sexual dysfunction or one can switch to another anti depressant with a lower incidence of side effects.
One of the alternative drugs, which has often been prescribed to counter sexual dysfunction is bupropion. Bupropion is an effective anti depressant and does not cause a change in sex drive or weight gain. Bupropion, also sold as Wellbutrin, is an atypical antidepressant that does work well. There are several studies which have shown that bupropion can reverse sexual dysfunction in normal healthy individuals. The improvements were observed in terms of arousal, orgasm, and overall sexual satisfaction. However, it was observed that sexual benefits usually were more prominent at a higher dose (300 mg). A lower dose (150 mg) was not much different compared to placebo
However, at high doses, bupropion often has many side effects including inability to sleep, anxiety, and intense headaches. Most people stop taking the drug because of headaches and mouth dryness.
Another drug recommended to counter the sexual dysfunction is to use selegeline. This anti parkinsonian drug when applied as a patch (6 mg) does work as an antidepressant and has minimal sexual side effects.
The other option includes adding another medication to counter the sexual dysfunction or one can switch to another anti depressant with a lower incidence of side effects.
One of the alternative drugs, which has often been prescribed to counter sexual dysfunction is bupropion. Bupropion is an effective anti depressant and does not cause a change in sex drive or weight gain. Bupropion, also sold as Wellbutrin, is an atypical antidepressant that does work well. There are several studies which have shown that bupropion can reverse sexual dysfunction in normal healthy individuals. The improvements were observed in terms of arousal, orgasm, and overall sexual satisfaction. However, it was observed that sexual benefits usually were more prominent at a higher dose (300 mg). A lower dose (150 mg) was not much different compared to placebo
However, at high doses, bupropion often has many side effects including inability to sleep, anxiety, and intense headaches. Most people stop taking the drug because of headaches and mouth dryness.
Another drug recommended to counter the sexual dysfunction is to use selegeline. This anti parkinsonian drug when applied as a patch (6 mg) does work as an antidepressant and has minimal sexual side effects.
How can I improve my libido while taking an antidepressant?
A fairly high number of individuals who take anti depressant medications complain that they have decreased libido, lack of sexual desire, failure to achieve an erection or inability to ejaculate. The exact numbers of people who have sexual dysfunction from anti depressant medications is not known, but anecdotal reports suggest that the numbers are high.
The sexual dysfunction that occurs with anti depressants has been known for decades and is somewhat difficult to resolve. Almost every class of anti depressant drugs has been associated with sexual dysfunction and lowered sexual excitement. The sexual dysfunction generally occurs after the patient has been on the drug for a few months. In some cases, the sexual dysfunction improves with time, but in many cases, the problem only gets worse. These sexual side effects while not life threatening, seriously affect an individual’s lifestyle. Often the patients solve the problem by refusing to take their medication. This lack of compliance then leads to worsening of the mental health problem.
So how can this problem be resolved?
When an individual first complains of sexual dysfunction, a wait and see approach may be appropriate because some individuals will improve with time. The wait and see period should not be more than 2-4 months. If the patient has not improved by then, he/she is unlikely to improve.
The sexual dysfunction that occurs with anti depressants has been known for decades and is somewhat difficult to resolve. Almost every class of anti depressant drugs has been associated with sexual dysfunction and lowered sexual excitement. The sexual dysfunction generally occurs after the patient has been on the drug for a few months. In some cases, the sexual dysfunction improves with time, but in many cases, the problem only gets worse. These sexual side effects while not life threatening, seriously affect an individual’s lifestyle. Often the patients solve the problem by refusing to take their medication. This lack of compliance then leads to worsening of the mental health problem.
So how can this problem be resolved?
When an individual first complains of sexual dysfunction, a wait and see approach may be appropriate because some individuals will improve with time. The wait and see period should not be more than 2-4 months. If the patient has not improved by then, he/she is unlikely to improve.
Thursday, April 9, 2009
PICA- eating crap part 2
Once the patient has recovered from surgery, a consultation is made with a psychiatrist to evaluate the individual. Close monitoring of the patient is necessary. Many individuals continue to persist with this bizarre eating habit even after surgery.
While pica is common in childhood and occasionally there may be just one episode, there are developmentally delayed children who do persist with this eating habit. The treatment of pica is behavior management.
Close supervision is required of children known to put things in their mouth. Unfortunately developmentally disturbed children fare well with psychotherapy and many require medications. Healthy adults generally recover spontaneously or with some type of behavior management.
While pica is common in childhood and occasionally there may be just one episode, there are developmentally delayed children who do persist with this eating habit. The treatment of pica is behavior management.
Close supervision is required of children known to put things in their mouth. Unfortunately developmentally disturbed children fare well with psychotherapy and many require medications. Healthy adults generally recover spontaneously or with some type of behavior management.
PICA- eating crap
Pica is an exotic name for a mental disorder which is characterized by persistent eating of non food substances such as hair, paint, paper, soil, pencils, metal pins, etc. However, some individuals may eat foods like raw rice, excess salt or sugar, flour, etc. The disorder is quite common and is estimated to occur in 4-25% of the population. A fascinating observation is that the majority will continue to eat only one these non nutritive items during the course of the disorder. Of course, there are others who will eat multiple items.
Pica is most commonly observed in the 1st-3rd decade of life. It may occur early in children but is often mistaken for just children being foolish. To make a diagnosis of Pica, one must persist with these eating habits for more than one month at an age where such a habit would be considered developmentally unsuitable.
Most individuals who develop Pica are healthy individuals. Pica has often been reported during pregnancy where females suddenly develop a taste for bizarre items. The disorder is also seen in wide variety of mental disturbed individuals, esp. those with dementia and some types of schizophrenia.
The majority of healthy individuals eat the non nutritive substances secretly and often are brought to hospital with symptoms of bowel obstruction. Some children eat plaster from the walls and in the past, lead poisoning was a common emergency admission. A number of individuals require surgery because the foreign material may have either blocked the bowel or caused a perforation in the stomach. At surgery, the diagnosis of pica is usually made by the findings of hair, soil or plastic straws, etc.
Pica is most commonly observed in the 1st-3rd decade of life. It may occur early in children but is often mistaken for just children being foolish. To make a diagnosis of Pica, one must persist with these eating habits for more than one month at an age where such a habit would be considered developmentally unsuitable.
Most individuals who develop Pica are healthy individuals. Pica has often been reported during pregnancy where females suddenly develop a taste for bizarre items. The disorder is also seen in wide variety of mental disturbed individuals, esp. those with dementia and some types of schizophrenia.
The majority of healthy individuals eat the non nutritive substances secretly and often are brought to hospital with symptoms of bowel obstruction. Some children eat plaster from the walls and in the past, lead poisoning was a common emergency admission. A number of individuals require surgery because the foreign material may have either blocked the bowel or caused a perforation in the stomach. At surgery, the diagnosis of pica is usually made by the findings of hair, soil or plastic straws, etc.
Wednesday, April 8, 2009
Emsam; An Anti depressant which is applied as a patch. Part 2
Emsam patch is changed once daily at the same time. The patch does tend to get stick to the skin rather firmly and most people need to apply an adhesive remover or mineral oil to get it off. The new patch should always be rotated a new skin site. Once the patch is applied firm pressure with the palm should be applied for a few seconds to ensure proper contact with skin. Emsam comes in various doses and it is recommended that depressed patients start with the 6mg/24 hr formula. At this does level there are no dietary restrictions. However, if the higher doses of 9 and 12 mg are used every 24 hrs, dietary restrictions do apply.
So does Emsam work?
Several studies have shown that compared to placebo, Emsam is a superior anti depressant. At present Emsam is used to treat clinical depression and has even been found to be useful in patients who have failed to respond to other SSRI and tricyclic anti depressants. The most common side effect is at the application site and is redness caused by the adhesive tape. Other rare side effects include headache, lack of sleep, diarrhea dry mouth, and gastric upset. These side effects occur in less than 5-10 percent of individuals. There are a whole list of drugs which cannot be taken while taking Emsam and the list is no different when one takes the other anti depressants.
Emsam has been on the market for only 2 years to treat depression but the results indicate that it does help some individuals who have failed to respond to other anti depressants. So far it has remained a decent drug with not as many side effects as the tricyclics. Furthermore, weight gain has not been a problem with this agent. How long it will continue to work in depressed patients remains to be seen.
So does Emsam work?
Several studies have shown that compared to placebo, Emsam is a superior anti depressant. At present Emsam is used to treat clinical depression and has even been found to be useful in patients who have failed to respond to other SSRI and tricyclic anti depressants. The most common side effect is at the application site and is redness caused by the adhesive tape. Other rare side effects include headache, lack of sleep, diarrhea dry mouth, and gastric upset. These side effects occur in less than 5-10 percent of individuals. There are a whole list of drugs which cannot be taken while taking Emsam and the list is no different when one takes the other anti depressants.
Emsam has been on the market for only 2 years to treat depression but the results indicate that it does help some individuals who have failed to respond to other anti depressants. So far it has remained a decent drug with not as many side effects as the tricyclics. Furthermore, weight gain has not been a problem with this agent. How long it will continue to work in depressed patients remains to be seen.
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