title: Pica patient, status post gastric bypass, improves with change in medication regimen.
abstract: The causes and origins of pica remain unknown and are the source of speculation and heated debate. Bariatric surgery patients are increasingly being observed in eating disorders treatment programs. Often associated with pregnancy, iron deficiency anemia, early development and mental retardation, pica has only recently been noted in post bariatric surgery patients, all of whom presented with pagophagia (eating of ice). Although there is literature detailing the presence of bezoars in gastric bypass patients, the association of pica, bezoars and abnormal eating behavior after bariatric surgery is still not understood completely. We present the case of a patient diagnosed with pica who underwent bariatric surgery due to a specific bezoar causing obstruction, followed by a treatment plan aimed at curbing the impulses. The patient was diagnosed to have a cardboard and paper bezoar causing gastric obstruction, which was removed endoscopically. After incomplete improvement of pica symptoms with treatment including ziprasidone, lorazepam and behavioral therapy, Saphris (asenapine) was introduced resulting in significant and complete resolution.
authors: Abington Memorial Hospital, Department of Internal Medicine, 1200 Old York Road, Abington, Pennsylvania 19001, USA.
authors: Burton J
authors: BJ
authors: Tabaac
authors: Department of Clinical Sciences, American University of the Caribbean School of Medicine, Cupecoy, Sint Maarten, Netherlands Antilles.
authors: Vanessa
authors: V
authors: Tabaac
keywords: Saphris; asenapine; bariatric surgery; eating disorder; impulse control
references: CNS Spectr. 2008 Jan;13(1):19
references: 18204409
references: Obes Surg. 2005 Nov-Dec;15(10):1491-5
references: 16354533
references: Mayo Clin Proc. 2008 Aug;83(8):961
references: 18674483
references: J Am Diet Assoc. 2004 Sep;104(9):1393-7
references: 15354156
references: Am Surg. 2013 Feb;79(2):E93-5
references: 23336647
references: Surg Obes Relat Dis. 2010 May-Jun;6(3):316-8
references: 19914148
references: J Appl Behav Anal. 1998 Summer;31(2):165-89
references: 9652098
references: Surg Obes Relat Dis. 2010 May-Jun;6(3):313-5
references: 19796995
references: Surg Obes Relat Dis. 2011 Jul-Aug;7(4):e3-5
references: 20869330
references: Int J Eat Disord. 2013 Jan;46(1):89-91
references: 23034722
references: JSLS. 2010 Oct-Dec;14(4):592-5
references: 21605530