In a psychoeducation treatment approach recommended by Lourie,45 mothers are instructed about the danger of pica that could result in lead poisoning in their children. Social workers can provide a social support system for mothers by meeting the mothers' dependency needs and helping them to be more available to their children. Strategies of prohibiting pica are taught to mothers so that they can spend more time with their children and interrupt pica behavior. Furthermore, the ability to identify families at high risk for pica could function as a primary prevention.9 To prevent lead poisoning in children, renovation of substandard housing and systematic screening of children in high-risk areas are imperative.15,46

Pharmacological treatment with SSRIs and atypical neuroleptics has also been reported. On the basis of the proposition that decreased dopamine transmission resulting from both iron deficiency and the administration of neuroleptics may be a critical determinant of pica, a pharmacological approach that increases dopaminergic transmission (bromocriptine, methylphenidate) may be worthy of investigation in a subgroup of patients in whom pica is both refractory and hazardous.47

Jakab48 reported that thioridazine reduced pica as well as a number of other problematic behaviors, such as aggression in hospitalized mentally handicapped patients. However, Danford and Huber10 noted an increased pica incidence (39%) in a subgroup of institutionalized mentally handicapped patients who received neuroleptic medication, in contrast to a 25% incidence of pica in a medication-free group.

Conclusions
Pica is a complex disorder with varying prognoses among patients. Epidemiological surveys in different settings and age groups (urban, rural, youth, adults) indicate a greater prevalence of pica than expected by sporadic individual clinical reports. The adverse medical, surgical, and developmental consequences mean that early recognition and prevention are imperative.

Further research is needed to clarify the normal psychobiology and developmental progression of food selection, the intricate role of sociocultural influences, and the significance of appetite and ingestive disturbances in neuropsychiatric disorders. Special focus should be given to the high incidence of pica in the mentally handicapped and to the role of iron deficiency (the single most prevalent nutritional deficiency in world population studies) in causing and perpetuating eating disorders.

Education, prevention, and informed behavioral interventions are the mainstay of treatment. Advances in understanding the neurobiology of food selection may yield better nutritional and pharmacological approaches in the future.

Acknowledgements—The authors are grateful for the contributions to this article of Kim Jimenez, Jee Eun Kim, and Monica Salama.
 
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