Coprophagia in an older adult with Schizophrenia- A case report and brief review

Background: Coprophagia, the act of consuming one’s own feces is a rare symptom of certain neurological or psychiatric disorders including pica, mental retardation, seizure disorder, cerebral atrophy and tumors, alcoholism, depression, obsessive compulsive disorder, schizophrenia, delirium, and dementia. Coprophagia is difficult to treat and distressing for the caregiver. It can lead to complications including salivary infections, parasitic infestations, and even death. Method: A 63-year-old man with history of schizophrenia was admitted to the psychiatric unit for aggressive and disorganized behavior. He was treated with multiple psychotropics including aripiprazole, mirtazapine, quetiapine, lorazepam, and risperidone over a course of four weeks. Results: The Clinical Global Impression (CGI) severity score at baseline was markedly ill (5). Initial CGIimprovement score after a week was much worse (6). The CGI-I worsened to very much worse (7). After introduction of quetiapine in 1 weeks’ time, patient’s CGI-I improved to minimally improved (3), and at discharge after 6 weeks, to much improved (2), indicating significant improvement. Conclusion: Coprophagia is a difficult to treat and is a distressing symptom. Treatment with quetiapine appears to have helped our patient. There is paucity of published studies and future large scale studies with medication and other behavioral interventions are recommended. *Correspondence to: Subramoniam Madhusoodanan, Department of Psychiatry, St. John’s Episcopal Hospital, 327 Beach 19th Street, Far Rockaway, NY 11691, USA, E-mail: sdanan@ehs.org Received: August 29, 2019; Accepted: September 30, 2019; Published: October 04, 2019 Introduction Coprophagia is the act of consuming one’s own feces and is a relatively rare symptom associated with neurological or psychiatric disorders. This behavior can be associated with multiple psychiatric and medical conditions. Although it has been reported as a symptom primarily associated with pica [1], mental retardation [2], and new-onset psychiatric conditions [3], coprophagia can be seen in other medical disorders including seizure disorders, cerebral atrophy, and tumors [4]. Furthermore, psychiatric disorders associated with coprophagia include alcoholism, depression, obsessive-compulsive disorder, schizophrenia, fetishes, delirium, and dementia [4]. Addressing the underlying cause and treatment of coprophagia is important as it can lead to oral and salivary infections, gastrointestinal parasitic infestations, and even death. This behavior is also difficult to manage for nursing staff and other caregivers in facilities, as there is very little information about the treatment protocol. There have been few reports on coprophagia in schizophrenic patients. Distinguishing coprophagia as a symptom of an underlying comorbidity from symptoms of patient’s psychosis is important for determining the best course of treatment. The current literature describes a few strategies that have been reported to be effective. However, there is paucity of publications or research regarding this condition. We report a case of coprophagia in a patient with schizophrenia who responded to a combination of quetiapine, risperidone, and sertraline along with psychotherapeutic interventions.