Effective treatment of pica and coprophagia in a patient with schizoaffective disorder with Ziprasidone – Case Report


Mohamed I Ramadan M.D. M.S.

Medical director

Mohave Mental Health Clinic

1741 Sycamore Ave

Kingman AZ 86409

To my knowledge this is the first case report of a patient with schizoaffective disorder who suffered from medication-refractory pica and coprophagia responding to ziprasidone. Coprophagia or the ingestion of feces has long been associated with psychiatric illness and it is considered to be a variant of pica (1). Coporophagia has been described in patients with schizophrenia, obsessive compulsive disorder, kluver-Bucy syndrome and dementia. Coprophagia is an uncommonly reported symptom and there were few cases in which psychotropic medication was effective against coprophagia (2, 3). Complications of coprophagia include poor oral hygiene, chronic gingival infection and chronic lesions on the mucosa and sialadenitis (3). 

“Ms A” is a 33- year -old attractive woman with a 17- year history of schizoaffective disorder bipolar type. Over the years patient was treated with several antipsychotics including therapeutic doses of risperidone, olanzepine and haloperidol. “Ms A” has also been treated with several antidepressants and mood stabilizers.  Patient symptoms were stable with the use of olanzepine, lithium and zolpidem.

“Ms A” mentioned that she noted some weight gain and that her “secret habit” is becoming more frequent. Ms A stated that she has been suffering of pica and coprophagia since childhood and her habit did not get better even when she has no psychotic symptoms. To minimize weight gain “Ms A” was prescribed ziprasidone and was tapered off olanzepine. After using ziprasidone 60 mg twice a day with food “Ms A” habit was gone.

Few months later  “Ms A” she thought that she does not needs her medications. Few weeks after she discontinued her medications Ms A became psychotic and her pica and coprophagia recurred. “Ms A” came to the clinic and she was restarted on ziprasidone and her psychiatric symptoms were gone again.

The patient in this case has schizoaffective disorder bipolar type and her coprophagia did not respond to treatment with several atypical antipsychotics or antidepressants but her symptoms rapidly disappeared after treatment with ziprasidone. Among atypical antipsychotics available in the United States ziprasidone has a uniquely higher affinity for serotonin-1A receptors and seretonion-1D combined with the serotonin-dopamine antagonist (4). Anther atypical antipsychotic with similar profile is perospirone which is a recently developed atypical antipsychotic with potent serotonin 5-HT(2) and dopamine D(2) antagonist activity and high affinity for serotonin-1A receptor. Perospirone was found to be effective in the treatment of anther case of treatment refractory coprophagia (2).  These two cases may suggest that atypical antipsychotic with this unique mechanism of action may be more effective in treating pica and coprophagia.

References:

1-Beck DA, Frohberg NR. Coprophagia in an elderly man: a case report and review of the literature. Int J Psychiatry Med. 2005;35(4):417-27. Review.

2-Sukemori S, Kurosawa A, Ikeda S, Kurihara Y. Effective treatment of coprophagia in a patient with schizophrenia with the novel atypical antipsychotic drug perospirone.
Pharmacopsychiatry. 2006 May;39(3):113.

3-Donnellan CA, Playfer JR. A case of coprophagia presenting with sialadenitis. Age Ageing. 1999 Mar;28(2):233-4.

4. Physicians’ Desk Reference. 61th ed. Montvale, NJ: Thomson PDR; 2007.

 

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