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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 kind of eating disorder well-known as pica. Pica is an unexplained craving because that ingestion of one of two people edible or inedible substances. Inhalants are volatile substances, which develop chemical vapors that deserve to be inhaled to induce a psycho-active or mind transforming effect. Although, pica is not linked to solvent abuse, right here we report one adolescent instance of paper-eating through solvent dependence.


Xylophagia is a condition involving the consumption of file and type of eat disorder well-known as pica. People who endure from this eating disorder commonly consume substances favor paper, pencils, tree barks or other items made of wood. The many popular kind of xylophagia is the usage of paper, however rare form of pica may be explained in the literature. Pica is an unusual craving for and ingestion of one of two people edible or inedible substances. The problem has been defined in medical journals because that centuries.<1,2,3> Incidence of pica has also been attached to steel deficiency, zinc deficiency and specific co-morbid problems like Kleine-Levin syndrome, mental retardation and also schizophrenia. It has been it was observed in men and women of every ages and ethnicity, however is much more prevalent amongst the lower socioeconomic classes.<4,5> World-wide 25-33% of every pica situations involve tiny children, 20% are pregnant women, and also 10-15% are people with finding out disabilities. Solvents room volatile substances which produce chemical vapors that can be inhaled to induce a psycho-active or mind changing effect. They include a broad selection of chemicals that may have various pharmacological effects and are uncovered in numerous different commodities such together fuels, solvents, glue, propellants, adhesives and also paint thinners. Although pica is not connected to solvent abuse here, we report an adolescent case of paper-eating through solvent dependence.


CASE REPORT

Ms. B, a 16-year-old unmarried girl, a student of 1st psychiatric urgent care, belonging come a Hindu reduced socioeconomic strata family, v no previous or family history of any type of psychiatric condition or substance abuse, was brought with a history of eating document and inhaling substances like kerosene for 3 years. Her family members would chew betel nut, and also she also started chewing betel nut consistently without she parents’ knowledge. When her family involved know around this, she was minimal and to be advised against it.

At the very same time when alone at college 1-day, she felt favor eating notebook paper and obtained immense satisfied after it. An hour later she had another piece of document and passed the entirety day without having any adverse impact. Following day also without the understanding of she classmates she ate three pieces the paper. In ~ a month, she emerged a habit of eating 4-5 A4 size documents daily during school time. She had actually never tried to cut down ~ above eating file until she was brought to the hospital. Meanwhile, while transporting kerosene to an additional container she accidentally skilled the odor of kerosene and was inclined towards that smell. She feel good, and that led she to smell kerosene daily without her family"s knowledge. She supplied to feel relaxed and detached native the next site after inhaling the kerosene for around 3-4 h. After 6 months of this exercise she realized the if she misses inhaling the kerosene for even 1 or 2 job she will feel restless, having low mood in ~ school, not interested in doing any kind of household work and also craving come inhale kerosene. In that frustration, she supplied to eat roughly 10 files daily and also run behind autos and other vehicles come inhale the smell. Her household noticed the she had scholastic problems, had poor concentration and was no helping in household works. She was commonly angry, argumentative, throwing points at parents and also trying to injury herself.

After about 3 years family members noticed her addiction practices and also brought she for evaluation.

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

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

Patient and family members to be psycho-educated about the nature that the illness and harmful aftermath of addiction. Cognitive habits therapy (CBT) to be employed for stress and anxiety reduction, coping skills, challenge distressing thoughts and preventing damaging behaviors. After ~ 6 sessions that CBT she began showing innovation in her an inspiration levels, compulsive behavior and duty of psycho-therapy. Throughout the 12 job of hospital stay she stayed abstinent from eating document and inhaling the kerosene, and was thought about fit because that discharge with an advice because that follow-up and continued medications with CBT.


DISCUSSION

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

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

The onset of inhalant usage disorder is a significant concern in adolescence as missed in program enquiry. Many epidemiological studies do not incorporate questions for eliciting solvent abuse, causing bad recognition of the magnitude of problem.<7> Inhalant abuse is ending up being a publicly health difficulty in India because of lack the awareness amongst the general populace as well as wellness professionals.<8> Inhalants are cheap, easily available, and not prohibited for procurement. They are capable of creating a rapid euphoria and use cannot be detected after a couple of hours because of their volatile nature, make it less complicated for the user to conceal.

The bulk of the users avoid using inhalants after ~ a brief period of experimentation and also only 4% go on to construct dependence. Therapy is typically supportive, and there room no standardized medication regimens or psycho-therapeutic recommendations till day for the therapy of xylophagia and pica. Residential care in a drug-free setting with household support, boosting existing personal, social and environmental strengths might help.

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Pica, in the context of other eating disorders, has received little attention in the past, and also this is the an initial case the adult onset pica, without mental retardation, in the context of volatile solvent dependency reported in the literature.