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Address for correspondence: Dr. Bhavin M. Patel, department of Psychiatry, Spandana education Home, 549/46, 6th Main, fourth Block, Rajajinagar, Bengaluru - 560 010, Karnataka, India. E-mail: moc.liamg
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Xylophagia is a problem involving the usage of paper and form of eating disorder recognized as pica. Pica is an unexplained craving for ingestion of either edible or inedible substances. Inhalants room volatile substances, which create chemical vapors that deserve to be inhaled to induce a psycho-active or mind transforming effect. Although, pica is not attached to solvent abuse, here we report one adolescent situation of paper-eating v 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 normally consume substances like paper, pencils, tree barks or other items do of wood. The many popular type of xylophagia is the intake of paper, yet rare form of pica may be explained 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 described in medical journals because that centuries.<1,2,3> Incidence that pica has additionally been linked to iron deficiency, zinc deficiency and certain 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 amongst the lower socioeconomic classes.<4,5> World-wide 25-33% of every pica instances involve small children, 20% are pregnant women, and also 10-15% are people with discovering disabilities. Solvents room volatile building material which develop chemical vapors that deserve to be inhaled come induce a psycho-active or mind transforming effect. They encompass a broad variety of chemistry that might have various pharmacological effects and also are discovered in thousands of different assets such as fuels, solvents, glue, propellants, adhesives and paint thinners. Although pica is not attached to solvent abuse here, we report an adolescent instance of paper-eating through solvent dependence.


CASE REPORT

Ms. B, a 16-year-old unmarried girl, a college student of first psychiatric urgent care, belonging to a Hindu reduced socioeconomic strata family, through no past or family background of any type of psychiatric illness or substance abuse, was brought with a history of eating file and inhaling substances favor kerosene for 3 years. Her family members members would certainly chew betel nut, and also she likewise started chewing betel nut consistently without she parents’ knowledge. Once her family involved know around this, she was minimal and was advised against it.

At the exact same time as soon as alone at college 1-day, she felt choose eating notebook file and acquired immense pleasure after it. An hour later she had one more piece of document and passed the totality day there is no having any type of adverse impact. Next day also without the expertise of she classmates she ate 3 pieces of paper. In ~ a month, she developed a habit of eating 4-5 A4 size files daily throughout school time. She had actually never tried to reduced down ~ above eating document until she was lugged to the hospital. Meanwhile, while carrying kerosene to another container she accidentally competent the odor of kerosene and also was inclined towards that smell. She feeling good, and also that led her to odor kerosene daily without she family"s knowledge. She offered to feeling relaxed and also detached from the surroundings after inhaling the kerosene for around 3-4 h. After ~ 6 months of this practice she realized that if she misses inhaling the kerosene for even 1 or 2 days she will certainly feel restless, having actually low mood in ~ school, no interested in doing any household work and also craving come inhale kerosene. In that frustration, she offered to eat approximately 10 records daily and also run behind autos and also other vehicles to inhale the smell. Her family members noticed the she had scholastic problems, had poor concentration and also was no helping in family members works. She was frequently angry, argumentative, throwing things at parents and also trying to injury herself.

After around 3 years household noticed her addiction practices and also brought her for evaluation.

On check she to be well kempt, cooperative and rapport might be established. There to be no mood, thought or tardy abnormality. She had partial insight and was willing because that the treatment. Cognitive functions, physics examination, investigations together as complete blood picture, pee routine and also X-ray abdomen, liver function and serum electrolytes to be normal. Possibility of command poisoning was likewise excluded after ~ peripheral blood smear examination.

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

Patient and family members were psycho-educated around the nature of the illness and also harmful after-effects of addiction. Cognitive actions therapy (CBT) to be employed for stress and anxiety reduction, transaction skills, difficulty distressing thoughts and also preventing damaging behaviors. ~ 6 sessions that CBT she began showing development in her an ideas levels, compulsive behavior and role of psycho-therapy. Throughout the 12 days of hospital remain she continued to be abstinent native eating document and inhaling the kerosene, and also was thought about fit for discharge v an advice for follow-up and also continued medications with CBT.


DISCUSSION

Pica is occasionally a culturally sanctioned practice and may not be pathological. Back pica is the most typical 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, an ext recent instances of pica have actually been tied to the obsession – obsession spectrum disorder. Many hypotheses choose psychosocial, biochemical, cultural, socioeconomic and also psychodynamic factors explain this phenomenon.<6> Deficiencies in iron, calcium, zinc and nutrients (thiamine, niacin, vitamin B and C) have actually been linked with pica in some youngsters with malnutrition. Pica might be benign, or it may be linked with life-threatening complications.

The beginning of inhalant use disorder is a significant concern in adolescence as missed in regimen enquiry. Most epidemiological studies perform not encompass questions for eliciting solvent abuse, causing negative recognition that the size of problem.<7> Inhalant abuse is becoming a public health trouble in India because of lack that awareness amongst the general populace as well as health and wellness professionals.<8> Inhalants room cheap, conveniently available, and not prohibited for procurement. They are qualified of creating a quick euphoria and also use cannot be detected after a few hours as result of their volatile nature, do it less complicated for the user come conceal.

The majority of the users prevent using inhalants after a brief duration of experimentation and also only 4% go on to develop dependence. Therapy is typically supportive, and also there are no standardized medicine regimens or psycho-therapeutic referrals till date for the treatment of xylophagia and also pica. Residential treatment in a drug-free setting with family members support, improving existing personal, social and environmental strengths may help.

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Pica, in the context of various other eating disorders, has received little attention in the past, and this is the first case that adult start pica, without psychological retardation, in the context of volatile solvent dependency reported in the literature.