Pagophagia – A Common but Rarely Reported Form of Pica

Pagophagia is a particular form of pica characterized by ingestion of ice, freezer frost or iced drinks often associated with iron or calcium deficiency. It occurs due to a complex interplay in between behavioural components. Only few cases of pagophagia have been reported from India.We report a case, a married lady, who presented with pagophagia and responded to fluoxetine.

We report , a married lady, who presented with pagophagia and responded to fluoxetine.

A 42-year-old married lady, working in a jewelery shop came to the psychiatry outpatient department with complaints of eating ice and freezer frost. The patient was normal about ten months back when she developed the habit of eating 10 to 12 ice cubes and freezer frost per day, which gradually increased to about 25 to 30 ice cubes per day. The patient was prescribed tablet venlafaxine 50 mg along with capsule B-complex by a physician for two to six weeks. There was no improvement in her habit. On detailed psychological evaluation in three sessions, it was found that the patient started the habit just before the ninth standard annual examinations of her son and she was the main tutor for him, who was a mediocre. After developing the habit, she remained preoccupied with eating ice cubes, freezer frost and iced drinks even during winters. She did not took it as a problem. It was only when the habit increased and she searched on the internet, she realized that it is a disorder which can be treated. There was no past or family history of any chronic physical or psychiatric disorder. Her blood investigations including hemoglobin, serum calcium and stool examination were normal.

The patient was started on fluoxetine 20 mg daily and tablet venlafaxine was tapered off. The dose was increased to 30 mg after three weeks and she was also given suggestion, distraction and explanation of the nature of symptoms. The husband was counseled about the nature of illness, its etiology and perpetuation. There was a gradual decrease in the frequency of pagophagia followed by gradual remission. On following her up four months, she did not develop the habit.

Pica is defined as persistent eating of non-nutritive substances for at least one month [1]. The behavior must be developmentally inappropriate, not culturally sanctioned, sufficiently severe to merit clinical attention, and not occurring during the course of another mental disorder. Pagophagia is a particular form often characterized by an ingestion of ice, freezer frost or iced drinks often associated with iron [1-4] or calcium deficiency [5]. It is commonly associated with other pica cravings [4-6], and has been mostly reported with iron and/or calcium deficiency [7-11] and thus, responds to treatment of underlying deficiency without any other intervention.In the present case, there was no other pica craving or iron and calcium deficiency. There was stressor in the onset in the form of her son’s annual examinations. A number of published studies have demonstrated that pica behavior can be decreased substantially with behavioral treatment (positive and negative reinforcements) and counseling [12-13], We used counseling in the present case Pica has been considered as an obsessive compulsive spectrum disorder as there is compulsion to take non-nutritive substances [3,6,7] and also, there are previous reports of Selective Serotonin Reuptake Inhibitors (SSRI’s), citalopram [2] and escitalopram [3] effective in its treatment. The present case also responded to an SSRI, fluoxetine.

Further investigations of pica seems warranted to find out its prevalence, etiology and effective methods of treatment. The condition needs to be timely recognized and appropriately treated to avoid any future complications.

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