Pica and coprophagia in schizophrenia: A case report

Little research has addressed maladaptive eating behaviors among patients with schizophrenia. Pica, the eating of nonfood items, and coprophagia, the consumption of feces, occur at higher rates in the early stages of schizophrenia; however, etiology of pica is poorly understood. Understanding primary precipitants of pica among patients with schizophrenia is integral for providing effective treatment. We present a case study on an interprofessional collaboration to ascertain primary diagnosis of a patient exhibiting symptoms of psychosis and pica/coprophagia. A 22-year-old Hispanic male involuntarily presented to an inpatient facility. His-family reported that for 6 months prior to admission, he did not attend to self-care tasks, began consuming nonfood items, and appeared internally preoccupied. While hospitalized, he maintained similar behavior. He frequently went to the bathroom to consume his feces and urine. If disrupted, he sometimes became physically aggressive and persisted in his behavior. He reported odd beliefs related to nutrition. At times, he rubbed hand sanitizer on his face and body. He was trialed on olanzapine, haloperidol, lorazepam, and paliperidone to address agitation and psychosis. Medical rule-outs for his behavior included cognitive impairment, seizure, central nervous system (CNS) lesion, and substance/alcohol use. He was referred to psychology for an evaluation to determine his primary diagnosis. Findings indicated absence of mood episodes and OCD. His history revealed several risk factors for schizophrenia, and progression of illness was typical of schizophrenia. His pica behaviors declined following implementation of a consistent regimen of paliperidone per court ordered medication petition. This case report presents a patient with co-occurring pica, coprophagia, and first episode psychosis, a rare and understudied combination of symptoms. He evidenced delusional beliefs related to nutrition, which precipitated maladaptive eating behaviors. The case is relevant for providers observing maladaptive eating behaviors in patients with symptoms of psychosis, suggesting that treating pica with antipsychotic medications may be efficacious. The case study also illustrates the importance of accurate diagnostics and the power of interprofessional collaboration in providing psychiatric care.