Decoding a case of pica: The path to a difficult diagnosis

Pica, a disorder characterized by the ingestion of non-food substances, is typically associated with psychiatric conditions but can also indicate underlying neurological disorders.

This report, details the case of a 61-year-old woman with a history of histrionic personality disorder and generalized anxiety disorder who developed severe pica, ingesting objects such as screws and jewelry. Initial psychiatric evaluations did not reveal a clear explanation for her behavior. However, further investigation identified significant cognitive decline, gait disturbances, and urinary incontinence—symptoms indicative of adult chronic hydrocephalus (ACH). A cranial CT scan confirmed ventricular dilation, leading to an ACH diagnosis. Pica disorder is often linked to frontal lobe dysfunction, common in ACH.

This case emphasizes the necessity of interdisciplinary collaboration between psychiatry and neurology to ensure accurate diagnosis and effective treatment, improving outcomes for patients whose psychiatric symptoms may mask an underlying neurological condition.