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Ask the Mental Health Expert Archives 2001-2004

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Q. Currently I am working with a patient with Alzheimer's dementia. Her short-term memory is very poor. She has for the past couple of months demonstrated mood problems (sad mood, crying, etc. but unable to verbalize why). She is now engaging in eating of her own body wastes. Specifically, feces. This behavior is horrifying to her family, and the staff have thus far been unable to distract or change the behavior.

We keep her dressed in one-piece clothing, keep snacks and assistance in eating at all times, activities when she is willing, but still she manages to continue this behavior. Currently she takes Zoloft 50mg (she did not tolerate Remeron or Celexa), Seroquil 25mg AM and 50mg PM, and just this week she has been started on Depakote Sprinkles 125mg q hs in attempts to change the behavior.

What leads to this behavior and are there other nursing interventions I might try? Additionally, what is the medical term for consuming one's own body wastes?

A. The technical term for this behavior is "coprophagia"--which is classical Greek for "feces-eating". Not that that helps you much! It seems there is very little (as per my search) in the published literature on this topic, though coprophagia has been reported in both schizophrenia and dementia.

For example, Donellan & Playfer (Age Ageing 1999; 28:233-4) described a 94-year-old woman with dementia who developed this problem, and found that "...with regular toileting, this behavior ceased". This sounds too simple to me, but it might be worth trying. I would suggest working with a clinical psychologist on how to build a system of rewards (a back massage, attention, music, etc.) into a regimen of appropriate toileting--though severely demented patients may not be able to retain such conditioned learning very well. Still, it may be worth trying.

However, if this woman is significantly depressed, you may find that the best treatment for the coprophagia is vigorous treatment of the underlying depression. If there is a psychotic component to this, that, too, may need to be addressed. The current regimen of Zoloft and Seroquel is reasonable, but not all patients will respond to this.

If you don't see progress within a few weeks, ECT might be an option to consider, even though it may cause some transient worsening of the patient's mental status. Again, if you can get a consultation with a behavioral psychologist and/or a specialist in Alzheimer 's Disease management, that would be great. Good luck with this difficult case!

January 2003

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