P.4.f.002 Pica ongoing for 36 years comorbid with obsessive–compulsive disorder: a case report

The assessment and management of pica in people with intellectual disability

“…• Environmental enrichment (Matson 2013) • Response blocking with redirection (Liu 2015) • Occupational therapy input if pica might be due to a sensory issue (Liu 2015) • Exposure and response prevention if part of obsessive-compulsive disorder (Aksoy 2014) As mentioned above, the existing studies into behavioural interventions for pica have small samples (Hagopian 2011;Call 2015), but it is often thought that behavioural interventions can be very effective (McNaughten 2017). One review paper found that 80.7% of identified studies reduced pica by more than 90% relative to baseline (Hagopian 2011).…”

“…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 pica Intellectual 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.

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“… Intellectual 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.…”

“…Therefore, the information in this section is provided to inform clinicians of possible interventions rather than to recommend any particular approach.

Behavioural interventions for pica Physical interventions (Matson 2013) Positive reinforcement (Matson 2013) Pica exchange (Carter 2009) Discrimination training (McNaughten 2017) Environmental enrichment (Matson 2013) Response blocking with redirection (Liu 2015) Occupational therapy input if pica might be due to a sensory issue (Liu 2015) Exposure and response prevention if part of obsessive–compulsive disorder (Aksoy 2014)

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