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Address because that correspondence: Dr. Bhavin M. Patel, department of Psychiatry, Spandana nursing Home, 549/46, sixth Main, 4th Block, Rajajinagar, Bengaluru - 560 010, Karnataka, India. E-mail: moc.liamg
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Xylophagia is a problem involving the intake of file and kind of eat disorder well-known as pica. Pica is an inexplicable craving for ingestion of either edible or inedible substances. Inhalants are volatile substances, which produce chemical vapors that have the right to be inhaled come induce a psycho-active or mind transforming effect. Although, pica is not linked to solvent abuse, here we report one adolescent situation of paper-eating with solvent dependence.


Xylophagia is a problem involving the usage of file and form of eating disorder recognized as pica. People who experience from this eat disorder typically consume substances favor paper, pencils, tree barks or various other items made of wood. The most popular form of xylophagia is the consumption of paper, however rare type of pica might be defined in the literature. Pica is an inexplicable craving for and also ingestion of one of two people edible or inedible substances. The problem has been defined in medical journals for centuries.<1,2,3> Incidence of pica has also been linked to stole deficiency, zinc deficiency and specific co-morbid problems like Kleine-Levin syndrome, psychological retardation and schizophrenia. It has actually been observed in men and women of every ages and also ethnicity, yet is much more prevalent among the lower socioeconomic classes.<4,5> World-wide 25-33% of all pica instances involve little children, 20% room pregnant women, and 10-15% are people with finding out disabilities. Solvents are volatile building material which produce chemical vapors that deserve to be inhaled come induce a psycho-active or mind transforming effect. They encompass a broad selection of chemistry that may have different pharmacological effects and are discovered in thousands of different assets such together fuels, solvents, glue, propellants, adhesives and paint thinners. Return pica is not linked to solvent abuse here, us report an adolescent situation of paper-eating through solvent dependence.


CASE REPORT

Ms. B, a 16-year-old unmarried girl, a student of first psychiatric urgent care, belonging come a Hindu reduced socioeconomic strata family, through no previous or family history of any type of psychiatric illness or substance abuse, was carried with a history of eating record and inhaling substances choose kerosene for 3 years. Her family members members would chew betel nut, and also she also started chewing betel nut routinely without her parents’ knowledge. As soon as her family pertained to know about this, she was limited and was advised against it.

At the exact same time once alone at institution 1-day, she felt prefer eating notebook paper and gained immense satisfied after it. An hour later on she had an additional piece of file and passed the whole day there is no having any type of adverse impact. Following day likewise without the expertise of her classmates she ate 3 pieces the paper. In ~ a month, she arisen a habit of eating 4-5 A4 size papers daily during school time. She had never make the efforts to cut down on eating file until she was lugged to the hospital. Meanwhile, while delivering kerosene to another container she accidentally knowledgeable the odor of kerosene and was inclined towards that smell. She felt good, and also that led she to odor kerosene day-to-day without she family"s knowledge. She used to feel relaxed and also detached native the surroundings after inhaling the kerosene for around 3-4 h. After ~ 6 months of this practice she realized the if she misses inhaling the kerosene for even 1 or 2 job she will feel restless, having actually low mood at school, no interested in doing any type of household work and craving come inhale kerosene. In that frustration, she offered to eat roughly 10 files daily and also run behind autos and also other vehicles come inhale that smell. Her family members noticed that she had scholastic problems, had bad concentration and also was not helping in family members works. She was generally angry, argumentative, throwing things at parents and also trying to harm herself.

After about 3 years household noticed her seeks practices and brought she for evaluation.

On examination she was well kempt, cooperative and rapport could be established. There to be no mood, believed or late abnormality. She had partial insight and was willing because that the treatment. Cognitive functions, physical examination, investigations together as finish blood picture, urine routine and X-ray abdomen, liver role and serum electrolytes to be normal. Possibility of lead poisoning was additionally excluded after ~ peripheral blood smear examination.

She to be diagnosed to have actually pica (xylophagia) through mental and also behavior disorder due to use of volatile solvents. She was admitted and started with paroxetine 25 mg in 2 divided doses. To control her withdrawal symptom clonazepam 0.5 mg was added. ~ 2 days her withdrawal symptoms were under control, baclofen 20 mg was added for manage of craving and also supplemental multi-vitamin injectable preparations.

Patient and also family members to be psycho-educated about the nature the the illness and also harmful aftermath of addiction. Cognitive habits therapy (CBT) was employed for tension reduction, transaction skills, difficulty distressing thoughts and also preventing damaging behaviors. After 6 sessions of CBT she began showing advancement in her an inspiration levels, compulsive actions and function of psycho-therapy. Throughout the 12 work of hospital stay she remained abstinent native eating paper and inhaling the kerosene, and also was considered fit for discharge v an advice for follow-up and continued drugs with CBT.


DISCUSSION

Pica is sometimes a culturally sanctioned practice and may no be pathological. Return pica is the most usual eating disorder in individuals with developmental disabilities and also children, in this case there to be no history of childhood developmental disabilities.

Although the etiology the pica is unknown, more recent cases of pica have actually been tied come the obsession – obsession spectrum disorder. Many hypotheses prefer psychosocial, biochemical, cultural, socioeconomic and also psychodynamic factors describe this phenomenon.<6> Deficiencies in iron, calcium, zinc and also nutrients (thiamine, niacin, vitamins B and C) have been linked with pica in some youngsters with malnutrition. Pica may be benign, or it might be associated with life-threatening complications.

The start of inhalant usage disorder is a significant concern in adolescence together missed in regime enquiry. Many epidemiological studies perform not include questions for eliciting solvent abuse, causing poor recognition that the size of problem.<7> Inhalant abuse is ending up being a windy health trouble in India because of lack of awareness among the general populace as well as health professionals.<8> Inhalants are cheap, conveniently available, and also not prohibited because that procurement. They are capable of creating a rapid euphoria and also use cannot be detected ~ a couple of hours as result of their volatile nature, do it easier for the user to conceal.

The bulk of the users avoid using inhalants after a brief duration of experimentation and also only 4% go on to develop dependence. Treatment is usually supportive, and also there are no standardized medication regimens or psycho-therapeutic references till date for the treatment of xylophagia and pica. Residential care in a drug-free setting with family members support, enhancing existing personal, social and also environmental strengths may help.

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Pica, in the paper definition of other eating disorders, has actually received small attention in the past, and also this is the first case that adult beginning pica, without mental retardation, in the context of volatile solvent dependence reported in the literature.