![]() Although he cited us,3 he overlooked the evidence we provided indicating that the Bacloville article4 was published without acknowledging major changes to the initial protocol, affecting the primary outcome. Second, Dr Andrade should have warned readers that Bacloville’s results are most questionable, lacking robustness. To the Editor: Dr Andrade’s analysis of the Bacloville trial in a recent Clinical and Practical Psychopharmacology column, in which he concluded that “individualized treatment with high-dose baclofen (30-300 mg/d) may be a useful second-line approach in heavy drinkers” and that “baclofen may be particularly useful in patients with liver disease,” deserves comment.1įirst, Andrade failed to recall that the first pivotal trial of baclofen, ALPADIR (NCT01738282 320 patients, as with Bacloville), was negative (see Braillon et al2). 11īaclofen, a French Exception, Seriously Harms Alcohol Use Disorder Patients Without Benefit 10 The differential effects of methylphenidate and atypical antipsychotics on appetite might be contributory. 9 Pica was also reported to be responsive to aripiprazole (partial dopamine agonist). 8 Pica was reported following commencement of the atypical antipsychotics risperidone and olanzapine in 2 cases. These subjects showed improvement in pica after methylphenidate (mechanistically a DA agonist). In a double-blind randomized placebo-controlled trial 8 evaluating the hypothesis that pica may be exacerbated by the use of antipsychotics, when compared to placebo, all 3 subjects engaged in higher levels of pica during the thioridazine phase. Pica might be related to dopamine dysregulation. 3Īlthough ADHD has been associated with comorbid eating disorders, especially bulimia nervosa, 4 association with pica as in this case is limited to only case reports. 2 The differential diagnosis for pica is provided in Table 1. The eating behavior should not be culturally sanctioned. The developmental age for pica is ≥ 2 years. Methylphenidate response was achieved with great tolerability. Twelve weeks have elapsed at the time of this writing, and he continues to do well with no evidence of pica. A remarkable behavioral response was reported, but, most importantly, the pica dramatically improved. He was switched to methylphenidate immediate release 2.5 mg once daily, which was titrated to 3 times daily over 1 week (weight: 19 kg/42 lb). The boy’s parents requested to discontinue risperidone, as his serum prolactin level was elevated at follow-up. Risperidone 0.75 mL/d over 2 weeks resulted in tangible behavioral improvement, but paradoxical exacerbation of pica was also reported along with increased appetite. Given the safety concerns, a trial of risperidone was suggested. Autism spectrum disorder and obsessive-compulsive disorder were ruled out on clinical grounds. Review of parental reports as well as kindergarten records demonstrated attention-deficit/hyperactivity disorder (ADHD)–like disruptive behaviors including risk-taking behaviors (eg, dashing out into the road, throwing severe tantrums, repeated minor head trauma). Applied behavioral analysis was suggested but was not helpful. Electroencephalogram showed generalized epileptiform discharges. Blood film, lead levels, and erythrocyte protoporphrin were unrevealing. Baseline laboratory workup including iron studies, vitamin D level, and thyroid function tests were all within normal limits. ![]() Developmental assessment using the Wechsler Preschool and Primary Scale of Intelligence 1 revealed the following results: full scale intelligence quotient: 88 (in the low average range), verbal comprehension: 81, visual spatial: 91, fluid reasoning: 85, working memory: 84, and processing speed: 92. This behavior was only recently discovered after multiple emergency department visits for unexplained recurrent abdominal pain. ![]() He had the habit of eating burnt matchsticks (cautopyreiophagia), paper (xylophagia), and geophagia of a few months duration. Case ReportĪ 4-year-old Kuwaiti boy was referred from the developmental pediatrics outpatient department as an unusual case of pica. Here, the case of a 4-year-old boy with behaviors consistent with pica is presented. The DSM-5 defines pica as the consumption of non-nutritive, nonfood substances for a period > 1 month. ![]()
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