Abstract:The ingestion of one's own feces is referred to as coprophagia. In this report, the author discusses a case of coprophagia-associated death in a 36-year-old woman. The woman had a history of intellectual disability, bipolar disorder, and schizoaffective disorder and was living in a group home. At autopsy, examination of the upper airway revealed 4 distinct spherical boli of impacted fecal matter in the oral cavity and pharynx. Death was attributed to asphyxia due to aspiration of stool bolus during an episode … Show more
“…It has been suggested that the link between attention-deficit hyperactivity disorder (ADHD) and pica could be due to poor impulse control or dysfunctions in the dopaminergic system (Herguner 2010). • Dental pain (Ayanouglou 2011) • Increased appetite due to medication (Erickson 2017) • Dialysis (Katsoufis 2012) • Sickle cell anaemia (El-Mekkawy 2014)…”
Section: Mental Disordersmentioning
confidence: 99%
“…The role of nutritional deficiencies in pica and whether they are cause or consequence is therefore unclear. Physical and neurobiological conditions associated with pica Physical Conditions leading to malabsorption, poor nutritional status or anaemia, including gastric bypass surgery and coeliac disease (Gupta 2007)Micronutrient deficiencies (iron/zinc/calcium) (Erickson 2017)Malnutrition (Lerner 2008)Dental pain (Ayanouglou 2011)Increased appetite due to medication (Erickson 2017)Dialysis (Katsoufis 2012)Sickle cell anaemia (El-Mekkawy 2014)Neurobiological Diminished dopaminergic transmission (Barrett 2008)Elevated serotonin levels (Barrett 2008)Decreased/increased endogenous opiate (Barrett 2008)…”
Section: Associations With Picamentioning
confidence: 99%
“…In terms of medication being linked to pica, there has been one case report of coprophagic asphyxiation in a woman with severe intellectual disability (Erickson 2017). She had high blood olanzapine levels at autopsy and it was postulated that her antipsychotic was a driver of pica.…”
Section: Associations With Picamentioning
confidence: 99%
“…In one study, pica in adults with intellectual disability was associated with severely impaired expressive communication abilities, younger age, autism, poorer cognitive performance, greater aggression and male gender; it was found to be less common in those who had Down syndrome and who did not have impaired self-care skills (Ashworth 2009). Mental/developmental disorders that may be associated with picaIntellectual disability (Aksoy 2014)Autism (Aksoy 2014)Fetal alcohol spectrum disorder (Wygant 2019)Attention-deficit hyperactivity disorder (Herguner 2010)Obsessive–compulsive disorder (Aksoy 2014)Depression (Erickson 2017)Anorexia nervosa (Yalug 2007)Psychosis (Aksoy 2014)Behavioural phenotype of some genetic syndromes, e.g. hyperphagia in Prader–Willi syndrome (Barrett 2008)Neurodegenerative disease (e.g.…”
Section: Associations With Picamentioning
confidence: 99%
“…Conditions leading to malabsorption, poor nutritional status or anaemia, including gastric bypass surgery and coeliac disease(Gupta 2007) • Micronutrient deficiencies (iron/zinc/calcium)(Erickson 2017) • Malnutrition(Lerner 2008) …”
SUMMARY
Pica is a condition associated with a number of physical and mental health diagnoses. The potentially fatal consequences of pica and the links with significant physical health problems are not always recognised. Pica is like other forms of behaviour that can challenge: clinicians must seek the underlying cause and treat this first, before primarily pursuing a behavioural form of treatment. In this article, we discuss the associations, consequences, assessment and management options available for pica to guide professionals. Pica often presents in a way individual to the particular patient, so tailoring of assessment and treatment is important.
“…It has been suggested that the link between attention-deficit hyperactivity disorder (ADHD) and pica could be due to poor impulse control or dysfunctions in the dopaminergic system (Herguner 2010). • Dental pain (Ayanouglou 2011) • Increased appetite due to medication (Erickson 2017) • Dialysis (Katsoufis 2012) • Sickle cell anaemia (El-Mekkawy 2014)…”
Section: Mental Disordersmentioning
confidence: 99%
“…The role of nutritional deficiencies in pica and whether they are cause or consequence is therefore unclear. Physical and neurobiological conditions associated with pica Physical Conditions leading to malabsorption, poor nutritional status or anaemia, including gastric bypass surgery and coeliac disease (Gupta 2007)Micronutrient deficiencies (iron/zinc/calcium) (Erickson 2017)Malnutrition (Lerner 2008)Dental pain (Ayanouglou 2011)Increased appetite due to medication (Erickson 2017)Dialysis (Katsoufis 2012)Sickle cell anaemia (El-Mekkawy 2014)Neurobiological Diminished dopaminergic transmission (Barrett 2008)Elevated serotonin levels (Barrett 2008)Decreased/increased endogenous opiate (Barrett 2008)…”
Section: Associations With Picamentioning
confidence: 99%
“…In terms of medication being linked to pica, there has been one case report of coprophagic asphyxiation in a woman with severe intellectual disability (Erickson 2017). She had high blood olanzapine levels at autopsy and it was postulated that her antipsychotic was a driver of pica.…”
Section: Associations With Picamentioning
confidence: 99%
“…In one study, pica in adults with intellectual disability was associated with severely impaired expressive communication abilities, younger age, autism, poorer cognitive performance, greater aggression and male gender; it was found to be less common in those who had Down syndrome and who did not have impaired self-care skills (Ashworth 2009). Mental/developmental disorders that may be associated with picaIntellectual disability (Aksoy 2014)Autism (Aksoy 2014)Fetal alcohol spectrum disorder (Wygant 2019)Attention-deficit hyperactivity disorder (Herguner 2010)Obsessive–compulsive disorder (Aksoy 2014)Depression (Erickson 2017)Anorexia nervosa (Yalug 2007)Psychosis (Aksoy 2014)Behavioural phenotype of some genetic syndromes, e.g. hyperphagia in Prader–Willi syndrome (Barrett 2008)Neurodegenerative disease (e.g.…”
Section: Associations With Picamentioning
confidence: 99%
“…Conditions leading to malabsorption, poor nutritional status or anaemia, including gastric bypass surgery and coeliac disease(Gupta 2007) • Micronutrient deficiencies (iron/zinc/calcium)(Erickson 2017) • Malnutrition(Lerner 2008) …”
SUMMARY
Pica is a condition associated with a number of physical and mental health diagnoses. The potentially fatal consequences of pica and the links with significant physical health problems are not always recognised. Pica is like other forms of behaviour that can challenge: clinicians must seek the underlying cause and treat this first, before primarily pursuing a behavioural form of treatment. In this article, we discuss the associations, consequences, assessment and management options available for pica to guide professionals. Pica often presents in a way individual to the particular patient, so tailoring of assessment and treatment is important.
Coprophagia is a rare and distressing disorder characterized by symptoms of compulsive consumption of feces. Several attempts have been made in literature to explore the pathophysiology, management, and outcomes of this disorder. However, critical questions remain, related to characterizing effective management, features of associated comorbidities, time to recovery of symptoms, sustainability of recovery, and the determinants of outcomes. Unfortunately, there is a dearth of available literature addressing these questions. We present two cases of patients with coprophagia in seeking to address these questions. Common symptoms of thought content disorder related to coprophagic behavior are noted in both cases. A shorter time to resolution of coprophagia is noted in one of the patients compared to previously reported studies. Recent and pertinent literature was reviewed and the implications for diagnosis and management of coprophagia are discussed.
BACKGROUND: Coprophilia and coprophagia are distinct paraphilias that fall under the category of other specified paraphilic disorders in the current edition of the Diagnostic and Statistical Manual of Mental Disorders. Coprophilia refers to sexual excitement from viewing, smelling, or handling feces, as well as fantasizing about another person engaging in these activities. Coprophagia, or eating one’s own or another person’s excrement, has also been observed in some patients with coprophilia. AIMS: The purposes of this review are to examine the current literature on the etiology, symptoms, interviewing techniques, pharmacotherapy, and psychotherapy used for each disorder and to elicit best practice guidelines in the treatment of patients with coprophila and coprophagia. METHODS: Electronic and hand searches were initiated using CINAHL, EBSCOhost, SAGEpub, and MEDLINE databases between 1990 and 2022 using the terms “coprophilia,” “coprophagia,” “paraphilia NOS,” and “other specified paraphilic disorder” restricted to English. RESULTS: Individual case reports and limited studies were found in this literature. Reported treatment protocols included individual and tandem use of pharmacotherapy and psychotherapy, with mixed outcomes. Future studies are needed to explore the factors that mitigate the paraphilias, therapeutic management, and treatment outcomes, to produce evidence-based practice treatment guidelines. CONCLUSIONS: Understanding the psychological and biological factors that may contribute to these disorders’ manifestations may portend a greater understanding and insight into the genesis of the paraphilias. Having specific evidence-based treatment protocols will afford the psychiatric nurse practitioner to render patient-centered, safe, and culturally competent care and effect better patient outcomes among this understudied population.
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