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Pica in an Adolescent with Autism Spectrum

Disorder Responsive to Aripiprazole
Article in Journal of Child and Adolescent Psychopharmacology · December 2015
DOI: 10.1089/cap.2015.0184

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JOURNAL OF CHILD AND ADOLESCENT PSYCHOPHARMACOLOGY
Volume 26, Number x, 2016
ª Mary Ann Liebert, Inc.
Pp. 1–2
DOI: 10.1089/cap.2015.0184
Pica in an Adolescent with Autism Spectrum
Disorder Responsive to Aripiprazole
1 2
Arzu Hergu¨ ner, MD, and Sabri Hergu¨ ner, MD
To The Editor:
P ica is defined as the persistent eating of nonfood sub-stances (e.g.,
soap, paper) in a developmentally inappropriate and culturally
unacceptable manner. Although its etiology is un-clear, intellectual
disability, autism, schizophrenia, male gender, nutritional (e.g., iron
and zinc) deficiencies, and younger age are among the most common
factors associated with pica (Stiegler
2005).
In this report, we describe an adolescent girl with autism spec-
trum disorder (ASD) who had pica responsive to aripiprazole.
Case Report
A 17-year-old female with a diagnosis of ASD was referred to
our outpatient clinic by her parents with complaints of irritability,
physical aggression toward her parents, self-injurious behaviors,
and coprophagia. According to her mother, she had been eating
leaves, soap, detergent, toothpaste, and deodorant since her
childhood. She had started eating her feces 6 months before. She
had her bowel control when she was 10 years old, and currently
did not have any defecation problems, such as constipation or
diarrhea. Her mother reported that she engaged in compulsive
behaviors including excessive hand washing, changing her clothes
frequently (10–15 times a day), and ordering. In her family
history, her mother and grandmother both had had a diagnosis of
obsessive-compulsive disorder (OCD). Her mother had pica
(geophagia) during her childhood. The patient’s routine
biochemical workup, including complete blood count, ferritin,
and iron was within normal limits.
She had been on risperidone 1 mg/day for 15 months for her
disruptive behaviors, with partial response. We decided to change
risperidone to aripiprazole and increase the dose to 7.5 mg/day
over a 3 week-period. In her second visit to the clinic 4 weeks
later, her mother reported that her disruptive and compulsive
behaviors had decreased, and that her pica resolved completely.
During 6 months of treatment with aripiprazole, she did not
engage in any pica be-havior or experience any side effects.
Discussion
We described an adolescent with pica, which resolved after
aripiprazole administration. In the literature, there is only one re-
ported case (a 29-year-old male with ASD) with pica (coprophagia)
that improved rapidly with aripiprazole (Pardini et al. 2010).
1
Child and Adolescent Psychiatry Clinic, Konya Training and Research Hospital, Konya, Turkey.
2
Department of Child and Adolescent Psychiatry, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey.
1
Letter to the Editor
Exacerbation of pica during antidopaminergic (thioridazine)
treatment, and improvement with a dopamine agonist (methyl-
phenidate) have been reported (Singh et al. 1994; Hergu¨ner and
Hergu¨ner 2010). Aripiprazole is a partial agonist at dopamine
D2, and is described as a dopamine system stabilizer. It acts like
an antagonist in hyperdopaminergic states, and like an agonist in
hy-podopaminergic states (Muscatello et al. 2011). We suggest
that aripiprazole may have stopped the pica behavior in this
reported case by stabilizing dopaminergic transmission.
Several reports described pica as an obsessive compulsive
spectrum disorder (OCSD) (Beck and Frohberg 2005; Hergu¨ner
et al. 2008). The compulsive behaviors of the patient, and the
OCD and pica in her family history support that pica may be
related to OCSD. Treatment with selective serotonin reuptake
inhibitors (SSRIs) has been shown to reduce pica, which was
attributed to their anti-obsessive properties. In our case, both pica
and com-pulsive behaviors improved with aripiprazole, which
might be the result of aripiprazole’s antianxiety and anti-OCD
effects (Musca-tello et al. 2011).
This report suggests that aripiprazole may be an alternative in
the treatment of pica. However, further studies are needed to in-
vestigate the efficacy of aripiprazole in pica.
Disclosures
No competing financial interests exist.
References
Beck DA, Frohberg NR: Coprophagia in an elderly man: A case
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Hergu¨ner S, Hergu¨ner AS: Pica in a child with attention deficit hy-
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Hergu¨ner S, Ozyıldırım I, Tanıdır C: Is Pica an eating disorder or an
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Muscatello MR, Bruno A, Pandolfo G, Mico` U, Scimeca G, Romeo
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 ¨ ¨
2 HERGUNER AND HERGUNER

Pardini M, Guida S, Gialloreti LE: Aripiprazole treatment for co- Address correspondence to:
prophagia in autistic disorder. J Neuropsychiatry Clin Neurosci 22: Sabri Hergu¨ner
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