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Releases · fanyuecheng/Pica · GitHub
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Releases: fanyuecheng/Pica
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Releases · fanyuecheng/Pica
Pica version 1.4.0 release
28 Mar 02:41
fanyuecheng
v1.4.0
9874e70
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Pica version 1.4.0 release
Latest
Latest
feat:
新版聊天室
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5
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Pica version 1.3.4 release
09 Jan 09:47
fanyuecheng
v1.3.4
577c7f7
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Pica version 1.3.4 release
update:
会话设置页-头像装饰 url 更新
本子详情页新增cover预览,本子名/作者/翻译长按复制
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3
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Pica version 1.3.3 release
20 Oct 04:35
fanyuecheng
v1.3.3
97b62e9
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Pica version 1.3.3 release
feat:
添加网页版分类
三方更新
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3
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Pica version 1.3.2 release
14 Sep 02:38
fanyuecheng
v1.3.2
f2b071e
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Pica version 1.3.2 release
优化&bug fix
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3
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Pica version 1.3.0 release
15 Apr 03:51
fanyuecheng
1.3.0
9e159ca
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Pica version 1.3.0 release
feat:
聊天室增加了和官方类似的消息语音播放功能
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Pica version 1.2.5 release
01 Apr 06:04
fanyuecheng
v1.2.5
6c437af
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Pica version 1.2.5 release
修复了从 tag/上传这/发布者/作者搜索漫画时,列表上拉加载更多页数不增加的bug
修复了漫画列表排序的bug
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3
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Pica version 1.2.4 release
21 Mar 03:58
fanyuecheng
v1.2.4
c729f57
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Pica version 1.2.4 release
简单适配iPad
iPad相较于iPhone有了分屏,所以一般iPad布局和iPhone并不相同,有自己独特的App架构,所以一般会有某App HD 版本来专门为iPad使用。
这里仅简单适配,所以会有文字过小,或者某一部分过大的现象,因为大部分是根据屏幕宽度适配的,字体也更适合iPhone,不再细致区分。
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Pica version 1.2.3 release
04 Mar 07:13
fanyuecheng
v1.2.3
dd343b8
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Pica version 1.2.3 release
feat:
增加版本更新检查
请求使用动态uuid,避免请求失败。自然是服务端做了什么。
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3
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Pica version 1.2.2 release
03 Mar 02:41
fanyuecheng
v1.2.2
c83c885
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Pica version 1.2.2 release
feat:
本子详情增加看了这个本子的人也在看功能
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3
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Pica version 1.2.1 release
23 Feb 03:05
fanyuecheng
v1.2.1
d19d5ad
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Pica version 1.2.1 release
feat:
增加庇护所网页分类
图片详情页支持导出单话本子为html
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3
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Releases · wgh136/PicaComic · GitHub
Releases · wgh136/PicaComic · GitHub
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v2.3.5
02 Feb 02:44
wgh136
v2.3.5
2dccd51
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v2.3.5
Latest
Latest
更新内容
现在可以设置eh的settings profile
优化图片预加载
阅读器内固定横屏(仅限Android)
改进webdav
修复哔咔打卡问题
修复v2.3.4中对旧数据的错误处理导致历史记录无法工作进而导致无法进入阅读器的问题
修复阅读极长漫画的性能问题
其他的一些错误修复
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2 reactions
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v2.3.4
25 Jan 08:50
wgh136
v2.3.4
60daf99
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v2.3.4
临时错误修复
遇到以下问题, 请再次下载并安装:
修复已下载页面和图片收藏页面读取eh相关数据出现的问题
修复错误更改eh显示模式设置的问题
修复一个eh图片加载问题
更新内容
本地收藏同步网络收藏功能 (由@luckyray-fan 完成)
在漫画块上显示收藏状态和上次阅读位置
修复本地收藏搜索时中文输入法问题
优化触控板手势识别
图片收藏功能
修复禁漫分类中没有排序选项的问题
改进ui
一些错误修复
注意: 更新至此版本后, 数据将不再与旧版本兼容(使用旧版本app读取新版本的数据将会无法显示本地收藏)
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luckyray-fan
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v2.3.3
12 Jan 14:43
wgh136
v2.3.3
cb296b5
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v2.3.3
功能更新
合并本地收藏与网络收藏
显示eh画廊的页数信息
自动添加语言筛选功能
反转点按翻页功能
eh收藏夹内取消收藏功能
picacg探索页面调整为随机漫画+最新漫画
搜索栏中可以输入nhentai ID跳转
性能改进与ui优化
错误修复
修复历史记录占用空间异常的问题
修复jm搜索中切换排序模式无效的问题
修复了一个eh图片加载问题
修复禁漫收藏夹问题
修复eh未登录时无法查看带有警告的画廊的问题
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13 reactions
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v2.3.2-patch
15 Dec 10:34
wgh136
v2.3.2
ef41cf3
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v2.3.2-patch
v2.3.2-patch
修复图片加载错误
图片加载失败将会重试两次
新功能和改进
UI修改: 将本地收藏从"我"页面分离, 合并排行榜和分类(hitomi被合并至探索页面)
增加检查本地收藏中的漫画是否有效的功能
windows上阅读器全屏功能
可以自由调整漫画块大小
增加默认搜索源的设置
向本地收藏的多选菜单中添加"加入到本地收藏"选项
增加翻页栏位置的设置
向漫画的长按菜单和右键菜单中加入添加至本地收藏选项
默认收藏夹设置将会影响本地收藏页面初始打开的收藏夹
增加显示本地收藏数量的设置
移动端本地收藏页面将会显示滚动条
bug修复
修复无法打开文件的问题
修复Android 10-无法设置下载目录的问题
修复移动端初始化页面布局错误的问题
修复阅读器内缩放设置相关问题
修复一些网络请求和数据读取问题
修复绅士漫画缩略图加载问题, 禁漫头像加载问题
Assets
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2 reactions
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v2.3.1-hotfix
10 Dec 02:46
wgh136
v2.3.1-hotfix
edb419a
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v2.3.1-hotfix
修复webdav
改进eh图片加载
修复nhentai的一些链接识别错误的问题
如果使用了webdav功能, 出于数据安全考虑, 请尽快更新至此版本
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4 reactions
4 people reacted
v2.3.1
09 Dec 05:01
wgh136
v2.3.1
83c82c7
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v2.3.1
1.更改了hosts功能实现方式
2.改进网络请求
3.webdav功能改进: 现在会每隔一天创建一次历史记录; 当进入app时如果下载数据失败将会禁用同步功能
4.修复禁漫的收藏问题和使用id查看漫画时的问题
5.增加自定义漫画信息页面右上角工具栏的功能
6.搜索框现在有搜索, 打开链接, 禁漫id 3个功能
7.修复了部分设备上的长按缩放的手势识别问题
8.优化ui
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v2.3.0-hotfix
02 Dec 02:04
wgh136
v2.3.0-hotfix
3f74bc6
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v2.3.0-hotfix
修复eh缩略图加载问题
修复使用hosts后的错误的网络请求
修复eh不能加载原图的问题
修复错误的数据读取问题
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5 reactions
5 people reacted
v2.3.0
01 Dec 08:45
wgh136
v2.3.0
8cd7993
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v2.3.0
v2.3.0
警告: 由于更改了部分数据的储存方式, v2.3.0之前的app将无法读取v2.3.0及之后的版本的app数据
新功能和改进
改进了数据储存
增加隐藏阅读器中章节信息的设置
网络收藏转换为本地收藏的功能
漫画源顺序自定义
允许更改点击本地收藏时的行为
本地收藏搜索
hosts设置
错误修复
禁漫长篇的加载缺页问题
禁漫最新只加载一页的问题
一些禁漫网络请求问题
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2 reactions
2 people reacted
v2.2.8
24 Nov 06:58
wgh136
v2.2.8
b947eaa
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v2.2.8
重构了禁漫的网络请求
调整了阅读器内双击和长按的缩放效果
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v2.2.7
19 Nov 03:26
wgh136
v2.2.7
316c546
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v2.2.7
更新内容
eh和nh的搜索改进
本地收藏的增强
阅读器中增加长按缩放
优化ui
导出已下载的漫画时, 将会使各个章节的文件夹重命名为章节名称
修复一些错误
eh和nh的搜索改进
eh的搜索选项被加入到了app中, 同时向eh和nh的搜索选项中加入了语言
本地收藏的增强
在"我"页面中添加了隐藏和显示本地收藏的按钮
长按或右键本地收藏的漫画将会显示"复制到"选项
长按或右键本地收藏夹后弹出的菜单中将会显示"生成文本并复制"选项和"导出"选项
新建本地收藏时增加从文件导入选项
长按缩放
长按缩放现在在阅读器中默认启用, 同时也修正了之前的一些错误的手势识别
video_2023-11-19_11-24-59.mp4
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异食癖 - 精神健康障碍 - 《默沙东诊疗手册大众版》
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异食癖是一种 进食障碍 进食障碍概述 进食障碍是指进食或进食相关行为的紊乱,通常涉及 进食种类或进食量的改变 采取措施防止食物的吸收(例如自我催吐或服用泻药) 异常进食行为在达到以下标准时可视为进食障碍:持续一定时间且严重损害患者的身体健康和/或工作学习,或对患者的人际交往产生不良影响。... 阅读更多 ,特征是经常吃一些非食物的东西。 通常,异食癖患者吃的东西不会对他们造成伤害,但有时他们进食的东西会引起并发症,如消化道梗阻或铅中毒。 当年龄超过 2 岁的人进食非食物的东西达一个月或以上时,医生通常会诊断异食癖。 行为矫正疗法可能有帮助,但目前尚无专门针对异食癖的治疗方法。 营养不良和其他并发症可按需治疗。 异食癖者经常吃一些不能吃的东西(如纸、陶土、泥土或头发)。此行为如果发生在 2 岁以下儿童,则视为正常发育现象。年幼儿童经常将各种东西放入口中,有时会吃他们。异食癖也可能发生在妊娠期。 在世界某些地区,进食不属于食物的东西是传统文化(如民间医药、宗教仪式或惯常做法等)的一部分。例如,佐治亚州皮德蒙特地区的有些人定期吃陶土。 通常而言,异食癖者所吃的东西不会对其造成伤害。通常而言,异食癖者所吃的东西不会对其造成伤害。但是,他们吃的东西有时会导致并发症,如 便秘 成人便秘 便秘是排便次数减少或排便困难,大便坚硬或大便后直肠有未排净感(不完全排净)。(也可参见 儿童便秘。) 便秘有急性和慢性。急性便秘往往出现的很明显且突然。慢性便秘常缓慢出现,有时持续数月或数年。 很多人认为如果一天不排便,就是便秘。然而,不是每个人每天都会有排便的。每天1至3次排便到每周2至3次排便都属正常现象。排便减少并不一定表明就是存在便秘,除非和以前的排便习惯相比,近期发生了显著的变化。如果大便的颜色和性状没有太显著的变化,人们通常... 阅读更多 、 消化道梗阻 肠梗阻 肠梗阻是指肠道完全阻塞或严重阻碍食物、液体、消化道分泌物和气体通过肠道。 成人患者的最常见病因是既往腹部手术后形成的瘢痕组织、疝和肿瘤。 常见症状是疼痛、腹胀和食欲不振。 体格检查和X线检查可诊断。 常需手术解除梗阻。 阅读更多 、由吃油漆屑导致的 铅中毒 铅中毒 铅中毒影响身体的很多部位,包括大脑、神经、肾、肝和血液。儿童对铅特别敏感,因为他们的神经系统仍在发育。 铅中毒的一些原因包括摄入了含铅油漆,使用某些进口、不当处理的铅釉陶瓷饮食而摄入铅。 血中铅水平非常高可能引起性格改变、头痛、丧失知觉、乏力、口腔内金属味、行走不协调、消化系疾病和贫血。 根据症状和血液检查得出诊断。 检测家用用水、陶瓷和涂料的铅含量可有助于识别潜在的铅中毒来源。 阅读更多 ,以及吃土导致的 寄生虫感染 寄生虫感染概述 寄生虫是一种生活在另一种生物(宿主)表面或内部,并从宿主那里受益(例如,通过获取营养)的生物。虽然这一定义实际上适用于许多微生物,包括细菌、真菌和病毒,但术语“寄生虫”用来指 仅由一个细胞构成的原虫(如 阿米巴) 由更大的及多个细胞构成并拥有内部脏器的蠕虫(肠虫)... 阅读更多 。 异食癖本身很少影响社会功能,但它常常合并其他精神疾病,这些障碍可影响社会功能。这些障碍包括 孤独症 自闭症谱系障碍 孤独症谱系障碍是指人们难以发展正常社交关系,使用语言异常或根本不使用语言,并表现出受限或重复行为。 患者很难与他人沟通和建立关系。 孤独症谱系障碍患者的行为、兴趣和/或活动模式也受限制,并且经常遵循严格的常规模式。 诊断基于观察、父母和其他照护者的报告以及标准化孤独症特异性筛查测试。 大多数人对高度组织化的行为干预反应最佳。 阅读更多 、 智障 智力障碍 智力障碍是指出生时或婴儿早期智力功能远远低于平均水平,从而限制正常日常生活活动的能力。 智力障碍可能是遗传性,也可能是干扰大脑发育的疾病导致的结果。 大多数智力障碍儿童直到上学才出现明显的症状。 诊断基于正式测试的结果。 适当的产前护理可以降低生下智力障碍儿童的风险。 阅读更多 和 精神分裂症 精神分裂症 精神分裂症是一种以脱离现实(精神错乱)、各种幻觉(通常为幻听)、坚定的虚假信念(妄想)、异常思维和行为、情感表达减少、动机消失以及日常功能(包括工作、社交和自理能力)受损为特征的精神疾病。 精神分裂症的病因和机制均不清楚。 本病患者症状多样,包括行为怪异、言语瓦解、情感平淡、寡言少语、无法集中注意力或进行回忆。 医生在做检查排除其他可能的精神病因之后,根据症状作出精神分裂症的诊断。... 阅读更多 异食癖的诊断 医师的评估 各项辅助检查,以排查可能的并发症 通常,医生通过判定患者在吃什么东西来诊断异食癖。 患者持续吃一些不属于食物的东西,持续 1 个月或更长时间,即可诊断为异食癖。两岁以下的儿童出现这种行为不诊断为异食癖,因为在那个年龄时,吃这些东西不会被认为是异常的。如果异食行为是文化的一部分,也不诊断为异食癖。 如果医生怀疑本病,他们会评估患者的 营养状况 营养状况评估 营养是消化、吸收和利用营养素的过程,这些营养素是人体生长、发育以及维持生命所必需的。 为了得到足够以及合适的营养,人体需要进食健康的食物,这些食物由各种不同的营养素(食物中能够营养人体的物质)组成。健康的饮食能使人们保持理想的体重和身体成分(体内脂肪与肌肉的百分比),维持日常体力和脑力活动,并最大限... 阅读更多 ,确认是否存在体重减轻和营养不良。 有些时候,异食癖是在儿童出现消化道梗阻症状(比如重度痉挛或便秘)或铅中毒并被带到急诊科或门诊就诊时确诊的。 要确认消化道梗阻,可能需要做 X 线检查。 医生可能会做血液检查,以检查铅中毒或寄生虫感染。 异食癖的治疗 有时需采取行为矫正治疗 治疗营养不良和其他并发症 行为矫正疗法可能有帮助,但目前尚无专门针对本病的治疗方法 行为矫正疗法可帮助人们消除不理想的行为,同时学习更好的行为。 对营养不良和其他并发症进行治疗。消化道梗阻可能需要手术。 异食癖可在持续数月后自行消失,特别是在儿童中。 了解更多信息 以下是一些可能有帮助的英文资料。请注意,本手册对该资料中的内容不承担责任。 美国进食障碍帮助协会 (NEDA):大型非营利组织,提供在线筛选工具、帮助热线、论坛和各种支持团体(部分为虚拟团体) 美国国家神经性厌食症和相关疾病协会 (ANAD):为医疗卫生专业人士提供课程和培训,并为饮食障碍患者及其家人提供同伴支持团体、自我帮助和其他服务
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README
MIT
pica - high quality image resize in browser
Resize images in browser without pixelation and reasonably fast.
Autoselect the best of available technologies: webworkers,
webassembly, createImageBitmap, pure JS.
demo
With pica you can:
Reduce upload size for large images, saving upload time.
Saves server resources on image processing.
Generate thumbnails in browser.
...
Note. If you need File/Blob resize (from form's file input), consider use
image-blob-reduce. It has
additional machinery to process orientation, keep EXIF metadata and so on.
Migration from pica v6 to pica v7
Multiply unsharpAmount by 2, divide unsharpThreshold by 2, example:
pica@6: pica.resize(a, b, { unsharpAmount: 80, unsharpThreshold: 2 })
pica@7: pica.resize(a, b, { unsharpAmount: 160, unsharpThreshold: 1 })
Prior to use
Here is a short list of problems you can face:
Loading image:
Due to JS security restrictions, you can process images
from the same domain or local files only. If you load images from
remote domain use proper Access-Control-Allow-Origin header.
iOS has a memory limits for canvas elements, that may cause
problems in some cases, more details.
If your source data is jpeg image, it can be rotated. Consider use
image-blob-reduce.
Saving image:
Some ancient browsers do not support canvas.toBlob() method.
Use pica.toBlob(), it includes required shim.
For jpeg source, it's a good idea to keep exif data. Consider use
image-blob-reduce.
Quality
JS canvas does not support access to info about gamma correction.
Bitmaps have 8 bits per channel. That causes some quality loss,
because with gamma correction precision could be 12 bits per
channel.
Precision loss will not be noticeable for ordinary images like
kittens, selfies and so on. But we don't recommend this library
for resizing professional quality images.
Install
npm install pica
Use
const pica = require('pica')();
// Resize from Canvas/Image to another Canvas
pica.resize(from, to)
.then(result => console.log('resize done!'));
// Resize & convert to blob
pica.resize(from, to)
.then(result => pica.toBlob(result, 'image/jpeg', 0.90))
.then(blob => console.log('resized to canvas & created blob!'));
API
new Pica(config)
Create resizer instance with given config (optional):
tile - tile width/height. Images are processed by regions,
to restrict peak memory use. Default 1024.
features - list of features to use. Default is
[ 'js', 'wasm', 'ww' ]. Can be [ 'js', 'wasm', 'cib', 'ww' ]
or [ 'all' ]. Note, cib is buggy in Chrome and not supports default
mks2013 filter.
idle - cache timeout, ms. Webworkers create is not fast.
This option allow reuse webworkers effectively. Default 2000.
concurrency - max webworkers pool size. Default is autodetected
CPU count, but not more than 4.
createCanvas - function which returns a new canvas, used internally
by pica.
Default returns a
but this function could return an OffscreenCanvas
instead (to run pica in a Service Worker). Function signature: createCanvas(width: number, height: number): Canvas
Important! Latest browsers may support resize via createImageBitmap.
This feature is supported (cib) but disabled by default and not recommended
for use. So:
createImageBitmap() is used for non-blocking image decode (when available,
without downscale).
It's resize feature is blocked by default pica config. Enable it only on your
own risk. Result with enabled cib will depend on your browser. Result
without cib will be predictable and good.
.resize(from, to, options) -> Promise
Resize image from one canvas (or image) to another. Sizes are
taken from source and destination objects.
from - source, can be Canvas, Image or ImageBitmap.
to - destination canvas, its size is supposed to be non-zero.
options - quality (number) or object:
quality (deprecated, use .filter instead) - 0..3.
filter - filter name (Default - mks2013). See resize_filter_info.js for details. mks2013 does both resize and sharpening, it's optimal and not recommended to change.
unsharpAmount - >=0. Default = 0 (off). Usually
value between 100 to 200 is good. Note, mks2013 filter already does
optimal sharpening.
unsharpRadius - 0.5..2.0. By default it's not set. Radius of Gaussian
blur. If it is less than 0.5, Unsharp Mask is off. Big values are clamped
to 2.0.
unsharpThreshold - 0..255. Default = 0. Threshold for
applying unsharp mask.
cancelToken - Promise instance. If defined, current
operation will be terminated on rejection.
Result is Promise, resolved with to on success.
(!) If you need to process multiple images, do it
sequentially to optimize CPU & memory use. Pica already knows
how to use multiple cores (if browser allows).
.toBlob(canvas, mimeType [, quality]) -> Promise
Convenience method, similar to canvas.toBlob(), but with
promise interface & polyfill for old browsers.
.resizeBuffer(options) -> Promise
Supplementary method, not recommended for direct use. Resize
Uint8Array with raw RGBA bitmap (don't confuse with
jpeg / png / ... binaries). It does not use tiles & webworkers.
Left for special cases when you really need to process raw
binary data (for example, if you decode jpeg files "manually").
options:
src - Uint8Array with source data.
width - src image width.
height - src image height.
toWidth - output width, >=0, in pixels.
toHeight - output height, >=0, in pixels.
quality (deprecated, use .filter instead) - 0..3.
filter - filter name (Default - mks2013). See resize_filter_info.js for details. mks2013 does both resize and sharpening, it's optimal and not recommended to change.
unsharpAmount - >=0. Default = 0 (off). Usually
value between 100 to 200 is good. Note, mks2013 filter already does
optimal sharpening.
unsharpRadius - 0.5..2.0. Radius of Gaussian blur.
If it is less than 0.5, Unsharp Mask is off. Big values are
clamped to 2.0.
unsharpThreshold - 0..255. Default = 0. Threshold
for applying unsharp mask.
dest - Optional. Output buffer to write data,
if you don't wish pica to create new one.
Result is Promise, resolved with resized rgba buffer.
What is "quality"
Pica has presets to adjust speed/quality ratio.
Simply use quality option param:
0 - Box filter, window 0.5px
1 - Hamming filter, window 1.0px
2 - Lanczos filter, window 2.0px
3 - Lanczos filter, window 3.0px
In real world you will never need to change default (max)
quality. All this variations were implemented to better
understand resize math :)
Unsharp mask
After scale down image can look a bit blured. It's good idea to sharpen it
a bit. Pica has built-in "unsharp mask" filter (off by default).
Set unsharpAmount to positive number to activate the filter.
Filter's parameters are similar to ones from Photoshop.
We recommend to start with unsharpAmount = 160,
unsharpRadius = 0.6 and unsharpThreshold = 1.
There is a correspondence between UnsharpMask parameters
in popular graphics software.
Browser support
We didn't have time to test all possible combinations, but in general:
Top level API should work in all browsers,
supporting canvas
and typed arrays.
Webworkers,
WebAssembly and
createImageBitmap
are not required, but they will be used if available.
If you plan to use only pure math core,
then typed arrays support will be enough.
Note. Though you can run this package on node.js, browsers
are the main target platform. On server side we recommend to use
sharp.
References
You can find these links useful:
discussions on stackoverflow:
1,
2,
3.
chromium skia sources:
image_operations.cc,
convolver.cc.
pica for enterprise
Available as part of the Tidelift Subscription.
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Pica | 什么是异食癖? - 知乎
Pica | 什么是异食癖? - 知乎切换模式写文章登录/注册Pica | 什么是异食癖?通心粉家园心理科普由心而治,遇见更好的自己。异食癖是指反复食用不可食用的食物。这是一种进食障碍。它可能很严重,并可能危及生命。食用的物品差别很大,可能包括纸张、塑料、布、污垢、粘土、油漆、岩石、肥皂、烟头、头发和硬币等金属碎片。 Pica诊断根据《精神障碍诊断和统计手册》(DSM-5),pica的诊断需要四个标准:反复食用非食品物质至少持续一个月。食用非食物物质不适合个人的发育水平。(2岁以下的儿童不能诊断异食癖,因为在较年轻的年龄,咀嚼不同种类的物体被视为正常发育。)饮食行为不是社会文化的一部分。如果进食行为发生在另一种精神障碍(例如智力残疾、自闭症谱系障碍、精神分裂症)或医疗状况(包括怀孕)的情况下,其严重程度足以引起额外的临床注意。在之前版本的DSM中,异食癖属于“通常在婴儿期、儿童期或青春期首次诊断的疾病”在当前版本中,它被移至新的合并部分“喂养和饮食障碍”这种变化反映了异食癖可以发生在成年人和儿童身上。如果食用非营养物质来抑制神经性厌食症患者的食欲,则不会诊断为异食癖。一些患有回避/限制性食物摄入障碍(ARFID)的人,尤其是那些根据食物的感官选择饮食的人,也可能患有异食癖。这些个体对质地非常敏感,可能会寻找具有首选质地的非营养物质。在吞食异物的情况下,非自杀性自残也会发生异食癖。虽然异食癖可以在任何年龄发生,但最常见的是在儿童时期。异食癖在孕妇和发育和智力残疾儿童中更为常见。它通常与其他疾病一起发生,如自闭症谱系障碍、强迫症和注意力缺陷/多动障碍。关于异食癖的研究有限。据信,这在美国健康儿童中很少见。12岁以上的美国儿童中,只有不到10%符合异食癖的诊断标准。一项研究报告称,镰状细胞贫血治疗儿童中异食癖患病率较高,另一项研究表明,非洲学龄儿童中异食癖患病率较高。在一些非洲国家,吃泥土的习俗在文化上是受认可的,并且可能在非裔美国人中继续作为一种基于其传统的文化规范做法。数据显示,异食癖在怀孕的非洲和非裔美国女性中更为普遍。非裔美国女性吃泥土可能被视为一种文化习俗。这可能是一种后天习得的行为,对社会和心理都有好处。当异食癖行为是一种文化支持的行为时,它不会被诊断为精神障碍。理论原因由于对异食癖的研究极其有限,对其危险因素的了解还不够。一种流行的理论是,矿物质缺乏,尤其是缺铁,会导致异食癖。许多证据来自病例报告,这些报告显示,在补充足够的物质含量后,行为停止了。有人提出,异食癖可能是在饮食不足的基础上,对压力作出反应而发展起来的。医疗风险异食癖可能与重大医疗风险有关,具体取决于摄入的物质和行为的严重程度。铅、汞(来自纸张)、锌和铜等重金属可能有毒。异食癖会导致胃和胃肠道大量消耗物质,肠阻塞,以及需要手术的眼泪。异食癖还会导致体内寄生虫、中毒、窒息、呼吸道问题和死亡等问题。治疗方法对于异食癖尚无公认的治疗方法。目前针对异食癖的干预措施包括手术以及营养、药理和行为治疗。当摄入的物品对身体造成损害时,可能需要进行手术干预,但不能解决潜在症状。关于异食癖行为干预的研究有限。现阶段最有可能成功治疗儿童异食癖的干预措施是联合治疗,包括强化程序,如偶然强化和歧视训练。对于患有异食癖的成年人来说,认知行为疗法(CBT)可能是一种有用的技术。这种治疗可能侧重于帮助患者改变他们对吃非食品的想法,改变行为,并用另一种应对策略来代替。发布于 2022-06-21 20:05异食癖心理健康赞同添加评论分享喜欢收藏申请
Pica: What It Is, Causes, Symptoms & Treatment
: What It Is, Causes, Symptoms & Treatment800.223.2273100 Years of Cleveland ClinicMyChartNeed Help?GivingCareersSearchClevelandClinic.orgFind A DoctorLocations & DirectionsPatients & VisitorsHealth LibraryInstitutes & DepartmentsAppointmentsHome/Health Library/Diseases & Conditions/PicaAdvertisementAdvertisementAdvertisementPicaPica is a mental health condition where a person compulsively swallows non-food items. It’s especially common in children and with certain conditions. While it’s often harmless, swallowing certain items can make pica very hazardous. Fortunately, it’s often treatable with therapy and modification to lifestyle and circumstances.ContentsArrow DownOverviewSymptoms and CausesDiagnosis and TestsManagement and TreatmentPreventionOutlook / PrognosisLiving WithContentsArrow DownOverviewSymptoms and CausesDiagnosis and TestsManagement and TreatmentPreventionOutlook / PrognosisLiving WithOverviewWhat is pica?Pica is an eating disorder where a person compulsively eats things that aren’t food and don’t have any nutritional value or purpose. Depending on when and why a person does this, pica can be normal, expected and harmless. However, it can cause major problems if a person with this condition eats something toxic or dangerous.Pronounced “PIKE-ah,” pica gets its name from a bird species, the Eurasian magpie (the formal Latin name for that species is Pica pica). This bird has a reputation for eating unusual objects.AdvertisementCleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. PolicyWho does pica affect?Pica can happen to anyone at any age but tends to happen in three specific groups of people:Young children, especially those under 6 years old.People who are pregnant.People with certain mental health conditions, especially autism spectrum disorder, intellectual disabilities or schizophrenia.How common is pica?Pica is a relatively common condition, but experts aren’t sure exactly how common it is. That’s partly because research studies often don’t use the same definition for this condition.It’s also common for healthcare providers to miss the condition entirely. This can happen when people don’t tell their doctor about it or don’t report signs of it in their children.Yet another reason is that infants and young children often put things in their mouths, which is part of their normal development. This kind of pica usually goes away on its own very quickly.AdvertisementHow does this condition affect my body?Pica is a condition where a person compulsively eats things that aren’t food and don’t have any nutritional value. Because it’s compulsive, people with this condition have a very hard time controlling the urge on their own.Pica can have a wide range of effects depending on what non-food item(s) a person eats. For people who eat things like ice — a common behavior for someone who is pregnant — pica is harmless. For others, it can lead to eating dangerous or toxic items.Depending on what you eat, pica can damage your teeth. It can also lead to dangerous problems even when you eat things that aren’t toxic. An example is when people eat hair (known as trichophagia), which can get stuck in their digestive tract, causing blockages, tearing or other damage.Parasites that live in the soil can also infect people who eat dirt or clay (geophagia). People can also contract illnesses from eating feces (poop), especially pet feces that might contain parasites or other germs.Mental health effectsPeople with pica often feel embarrassed or ashamed about this condition. Because of this, people with this condition often don’t seek treatment or are afraid to open up about it to their healthcare provider.Symptoms and CausesWhat are the symptoms of pica?The sole symptom of pica is compulsively eating things that aren’t food or have no nutritional value or benefit. Most people with this condition prefer a single type of non-food item they eat.However, pica can cause other conditions or issues, which have their own sets of symptoms. Other conditions that can happen because of pica include:Anemia (low iron).Ascariasis (roundworm infection).Constipation.Electrolyte imbalance.Irregular heart rhythms (arrhythmias).Lead poisoning.Small intestine and large intestine obstruction/blockage.Common non-food items eatenPeople with pica often eat the following:Ash.Baby or talcum powder.Chalk.Charcoal.Clay, dirt or soil.Coffee grounds.Eggshells.Feces (poop) of any kind.Hair, string or thread.Ice.Laundry starch.Paint chips.Paper.Pebbles.Pet food.Soap.Wool or cloth.AdvertisementWhat causes pica?Experts don’t know exactly why pica happens. However, researchers know certain factors increase the risk of developing it.Cultural or learned behaviors. Certain types of pica are common, socially accepted behaviors in certain cultures and religions. A religious example of this is the practice of eating dirt at El Santuario de Chimayó, a Roman Catholic shrine in New Mexico, USA. A cultural example of this commonly happens in cities in the country of South Africa, where it’s a common practice among young women.Stress or anxiety. Pica might be an outlet or coping mechanism for people with these issues.Negative conditions during childhood. Pica is more common in children living in low socioeconomic situations (such as poverty), but why this happens is unknown. Some possible explanations include that pica is a coping mechanism for children to deal with situations of abuse or neglect. It also might be attention-seeking behavior, especially when one or both parents are absent for any reason.Nutritional deficiencies. People who show signs of pica often have mineral or other deficiencies in their diet. Iron (anemia), calcium and zinc deficiencies are some of the most common reasons people show these signs.Mental health conditions. These include conditions that a person might develop spontaneously, conditions they had at birth because of disruptions in how they developed in the womb and genetic disorders they inherited from their parents.Medical conditions. Pregnancy and sickle cell anemia are two conditions that have connections to pica.Certain medications increase the risk of someone developing pica or similar behaviors. But it’s unknown if these medications actually cause people to develop pica.Diagnosis and TestsHow is pica diagnosed?Diagnosing pica requires four criteria (with the mentioned exceptions explained after the list):Time. The diagnosis requires persistent eating items or substances with no food or nutrition value for at least one month.Mental development. This means a person has developed past a certain point mentally and should know not to eat things that aren’t food or have no nutritional value.No social and cultural factors. This means the person doesn’t have social or cultural background reasons to explain the behavior.No medical or mental health conditions. This means pica isn’t happening because of any other conditions.Reasons to not diagnose picaWhile pica is an extremely common behavior for several reasons, many of those also disqualify diagnosing it. These include:Cultural or social practices. True pica is a compulsive behavior that you can’t control. People with pica behaviors for cultural or social reasons have control of their actions.Nutritional deficiencies. People who have low iron or calcium deficiencies often try to compensate for these by eating non-food items. This is actually why pica is acceptable behavior in some cultures. People in certain places around the world eat clay or soil to make up for a lack of iron, calcium or other vitamins and minerals in their diet.Other medical or mental health conditions. The criteria for diagnosing pica make exceptions for when it happens because of medical and mental health conditions. The only reason to diagnose pica in those circumstances is when it’s severe enough to cause health problems or need specific care.What tests will be done to diagnose pica?Most of the tests for pica are looking for problems that happen because of this condition. These can include a variety of lab, diagnostic and imaging tests, such as:Blood, urine (pee) and stool (poop) tests. These look for signs of infections, poisoning and electrolyte imbalances.Imaging tests. These are looking for any signs of blockage or internal damage from this condition. These can include X-rays, computerized tomography (CT) scans, magnetic resonance imaging (MRI), ultrasound and more.Diagnostic tests. These tests look for indications of serious health problems that can happen with pica. An example of one of these tests is an electrocardiogram (ECG or EKG), which looks for problems with your heart’s electrical rhythm that can happen with certain electrolyte imbalances or parasitic infections.Management and TreatmentHow is pica treated, and is there a cure?Pica in people who are pregnant usually goes away on its own. Children also usually grow out of pica, especially as someone teaches them the difference between edible and non-edible items and objects. For children with intellectual disabilities (or other problems that interfere with learning), removing problematic items and supervision are both very important.The main form of treatment for pica is therapy, with different therapy methods available depending on the situation and individual needs. A few therapy methods that are possible include:Mild aversive therapy. This method involves teaching people to avoid pica behaviors using mild aversions (consequences) to teach people to avoid non-food items and positively reinforcing (rewarding) healthy eating behaviors.Behavioral therapy. This therapy method involves teaching a person coping mechanisms and strategies to help them change their behavior.Differential reinforcement. In this method, people learn to avoid pica behaviors by focusing on other behaviors and activities.What medications are used?There are very few medications that are likely to help with pica. Antipsychotic medications might help, but the possible side effects usually keep these medications from seeing widespread use.Complications/side effects of the treatmentThere are very few complications that are possible with treatments for pica. If medications are part of the treatment, the possible side effects depend entirely on the medications themselves. Your healthcare provider is the best person to talk to about possible side effects, what to watch for and what you can do to help minimize their impact on your life.How to take care of myself or manage symptoms?Pica is a condition that’s usually benign but can become harmful depending on what a person eats. If you have pica, it’s important to have an honest discussion with your healthcare provider about it. They can offer guidance and resources to help you or refer you to a healthcare provider who has special training in this condition.How soon after treatment will I feel better?The recovery time for pica depends on the treatment and how well you do with it. Your healthcare provider is the person to ask for information about how long it’ll likely take for you to recover and what you can do to help the process happen smoothly.Care at Cleveland ClinicMental Health CareMake an AppointmentPreventionHow can I prevent pica or reduce my risk of developing it?Pica happens unpredictably, so there’s no way to prevent developing it. There’s also no way to reduce your risk of developing this condition.The only thing you can do that relates to pica is to make sure you eat a balanced diet and don’t have any deficiencies in essential vitamins or minerals. While this isn’t exactly prevention or reducing risk, because nutritional deficiencies don’t count toward a pica diagnosis, this is still important overall.Outlook / PrognosisWhat can I expect if I have this condition?Pica is a condition that’s sometimes dangerous on its own, depending on what non-food items a person eats. The main risks with this condition are when people eat items that are:Toxic.Sharp-edged.A risk for blocking your digestive tract.That can cause infections, especially fungi, parasites, bacteria and viruses.How long does this condition last?Pica is technically a life-long condition because it’s not considered curable. People who stop the behavior, either through treatment or who stop on their own, are considered “in remission” as long as they don’t resume the behavior.What’s the outlook for pica?Pica very commonly goes away on its own in children and in people who are pregnant. The condition is usually benign (harmless) for people in these circumstances. The condition itself isn’t dangerous, but it can lead to people eating dangerous items. With treatment, this condition can go into remission, and people can live their lives without difficulty from it.Living WithHow do I take care of myself?If you have pica, talking to your healthcare provider is an important first step in getting help for it. Their job is to help you while also making sure you feel safe and not judged. They can also help by offering you guidance directly or suggesting an expert who can.If you have pica and it’s causing issues that affect your life, it’s important to keep the following in mind:Be honest with your healthcare provider. Pica can be a source of embarrassment or shame for many people. That can make it hard for them to talk about how this condition affects their lives. But pica is a mental health condition, meaning it’s a medical concern, just like a broken arm or a sinus infection. And, like those conditions, it’s good to ask for help and get treatment for this condition.See your healthcare provider as recommended. Your healthcare provider can set up a schedule of visits as needed. As you progress in treatment, you’ll likely need to see them less and less. If this condition starts affecting your life again and you resume pica behaviors, you should return to your healthcare provider and resume treatment.Try to take away items or objects you commonly eat or make it inconvenient to get to them. One way to prevent or reduce pica behaviors is to remove problematic items or objects as much as possible. If removing them isn’t possible, try to make it inconvenient for you to return to pica behaviors.When should I go to the ER?Your healthcare provider can guide you in situations where you might need emergency medical care. Overall, you should seek medical attention if you have symptoms of more dangerous conditions, including the following:Ascariasis (roundworm infection).Electrolyte imbalance.Irregular heart rhythms (arrhythmias).Lead poisoning or other signs of toxic effects.Small intestine and large intestine obstruction/blockage.You should also seek medical attention for children who swallow any potentially toxic or dangerous items. One example of this is any toy that involves small, magnetic objects, which can easily stick together in the digestive tract and cause life-threatening blockages.A note from Cleveland ClinicPica is a very common condition around the world, especially in some circumstances. While it’s usually a condition that people grow out of or stop on their own, for some, it can be a serious problem. The greatest risk is for people who consume items that are toxic, sharp or that can block their digestive tract. Fortunately, mental healthcare treatments and techniques can help this condition go into remission. If you have pica, it’s normal to feel embarrassed about it. But your healthcare provider isn’t there to judge you. Their job is to help you get the care and resources you need to overcome this condition. That way, you can move on with your life and focus on the things that are most important or that you most enjoy.Medically ReviewedLast reviewed by a Cleveland Clinic medical professional on 05/06/2022.Learn more about our editorial process.ReferencesAdvertisementCleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. 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All Rights Reserved.Pica - StatPearls - NCBI Bookshelf
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NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. StatPearls [Internet].Show detailsTreasure Island (FL): StatPearls Publishing; 2024 Jan-.Search term
PicaYasser Al Nasser; Erind Muco; Ali J. Alsaad.Author Information and AffiliationsAuthorsYasser Al Nasser; Erind Muco1; Ali J. Alsaad2.Affiliations1 Campbell University School of Osteopathic Medicine2 King Faisal universityLast Update: June 26, 2023.Continuing Education ActivityThe American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines pica as eating non-nutritive, non-food substances over a period of at least one month. Additionally, the behavior must not be in keeping with the child's developmental stage and must not be socially normative or culturally acceptable behavior. The nature of ingested items is variable, including but not limited to earth (geophagy), raw starches (amylophagy), ice (pagophagia), charcoal, ash, paper, chalk, cloth, baby powder, coffee grounds, and eggshells. This activity describes the risk factors, evaluation, and management of pica and highlights the role of the interprofessional team in enhancing care delivery for affected patients.
Objectives:
Explain how cultural and social norms can influence the diagnosis of pica.Explain when the diagnosis of pica can be made.List other conditions that can mimic pica.Examine the role of collaboration amongst interprofessional team members to improve care coordination and minimize oversight, leading to earlier diagnosis and treatment and better outcomes for patients with pica.
Access free multiple choice questions on this topic.
IntroductionThe American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines pica as eating nonnutritive, nonfood substances over a period of at least one month. The term is derived from "pica-pica," the Latin word for the magpie bird, because of the bird's indiscriminate gathering and eating a variety of objects for the sake of curiosity.[1] For diagnosis, the behavior must persist for at least one month, not be in keeping with the child's developmental stage (and age cut off of 24 months or more is suggested by DSM V), and not be socially normative or culturally acceptable behavior. The nature of ingested items is variable, including but not limited to earth (geophagy), raw starches (amylophagy), ice (pagophagia), charcoal, ash, paper, chalk, cloth, baby powder, coffee grounds, and eggshells.[2]Although pica is seen in children, it is also a common eating disorder in patients who are intellectually impaired. In women, it is most often seen during pregnancy. In some parts of the world, the consumption of non-nutritive substances is culturally accepted. Pica usually occurs as an isolated disorder but there are instances when it may co-exist with schizophrenia, OCD, and trichotillomania.It is important to understand that in order to diagnose pica, the individual must be at least 2 years of age. It is not unusual to notice that younger children are frequently eating nonnutritive substances.EtiologyMany factors have been implicated in the etiology of pica; however, no direct causality has been established. Studies of psychological factors have reported an association between pica and stress, child neglect and abuse, and maternal deprivation.[3]. Iron deficiency anemia has also been implicated.[4] Many population-based studies have found a low level of serum iron/ferritin (and other micronutrients) among patients with pica.[5][6][7]. Despite this, studies conducted on substances consumed by pica patients failed to show increased iron bioavailability among these substances. This suggests that the idea that these cravings stem from a need for serum iron is an inadequate pathophysiological explanation for this phenomenon.[8] Another proposed hypothesis that is gaining more attention is that pica for non-nutritive substances offers protection from harmful toxins during the most vulnerable stages of human cell replication and embryogenesis (childhood and pregnancy).[9][10][11] The proposed mechanism of protection is binding to toxins and decreasing their intestinal absorption.[12][13][14] In pagophagia, a Japanese study hypothesized that when a patient with anemia chews ice, it increases perfusion thus improving brain function. They contributed that to the activation of the dive reflex which would lead to peripheral vasoconstriction and an increase in central perfusion. Another explanation would be sympathetic activation which would also increase blood flow to the brain.[15]While the causes of Pica remain unknown, some of the risk factors for developing the disorder include the following:StressCultural factorsLearned behaviorLow socioeconomic statusUnderlying mental health disorderNutritional deficiencyChild neglectPregnancyEpilepsyFamilial psychopathologyEpidemiologyA variety of reasons make it challenging to estimate the exact prevalence of pica; for example, studies use variable definitions of pica, under-reporting is common among affected subjects, and a strong cultural and social influence adds further difficulty to detection.[16] For the most part, the condition seems to affect women who are pregnant and young children.[17] A German prevalence study of 804 children found that 99 children (12.3%) have engaged with a pica behavior at some point in their lives.[18] A meta-analysis of studies of the prevalence of pica during pregnancy estimated that 27.8% of pregnant women reported experiencing pica. The study also stated that the sample was heterogeneous throughout the world, with a higher prevalence in Africa compared to other continents.[19] A high prevalence of pica seems to be reported in patients with mental retardation (approximately 10%); it correlates with the severity of mental retardation.[20]History and PhysicalA comprehensive history should be pursued along with caregiver interviews. The details of the exposure should be sought, including the type of substance, amount, duration of exposure, settings where behavior usually happens, the source of the substance, any co-ingestions, and symptoms of toxicity.[21]While, in most cases, the physical exam will be normal,[22] one should look for signs of poisoning or complications. Bezoar ingestion could lead to obstruction and, possibly, ulceration and perforation. Lead poisoning manifests with neurological signs such as lethargy, headache, seizure, encephalopathy, cranial nerve palsy, and papilledema. Infectious agents that could present in clay include Toxocara and Ascaris. Signs of such parasitic infections include fever, cough, myocarditis and encephalitis, hepatomegaly, and visual disturbance.[21][23][24]EvaluationLaboratory evaluation should be tailored according to the suspected substances ingested. Iron studies in patients with pica should be performed, especially in women who are pregnant, and children. Lead (in pica for paint and chalk) and zinc levels should be checked where appropriate.[25] A basic metabolic panel should be obtained, especially in clay ingestion which can cause metabolic disturbances such as hypokalemia.[26]Imaging studies are usually required when patients have abdominal symptoms. This may include plain abdominal x-rays, barium studies, and endoscopy. In many cases, serial studies are needed to ensure that the substance has passed.Treatment / ManagementPrimary prevention should be utilized to identify at-risk patients such as children who live in old homes with lead paint and woman who are pregnant. This could be achieved by screening for the condition among such populations.[27][28][29] Strategies should be utilized to decrease exposure to the craved substance, such as reducing access or providing an appropriate substitute with a similar texture.[30] Iron, zinc, and other nutrient supplementation should be provided when a deficiency is identified.[31][32][33] Behavioral and aversive treatment might be effective in patients with mental disabilities.[34] Differential reinforcement is a commonly used strategy to induce different patient responses to pica by redirecting the undesired behavior to other activities.[35]There are no medications specifically for the treatment of pica. While there are anecdotal reports about antipsychotic use to reduce pica behaviors, these drugs also cause constipation and other adverse effects.Besides the removal of the substance from the environment, it is important to assess the cultural traditions and beliefs that promote pica behavior.Differential DiagnosisCareful screening should be performed for mental health problems in the setting of pica. Several psychiatric illnesses should be considered in the differential diagnosis including other eating disorders, schizophrenia and psychosis, autism and developmental delay in children, substance abuse, and addiction.[36][37]PrognosisPica is usually a benign disorder if it is short-term. In pregnant women and children, the condition spontaneously disappears without any sequelae. However, in individuals with intellectual impairment, it may persist for years. When Pica is long term it can result in bowel obstruction, bezoars, and even toxicity. Ingestion of dirt and paint can lead to infections and heavy metal toxicity. Many reports exist of people who have had to undergo surgery to relieve bowel obstruction, perforation, and ulcers.ComplicationsThe complications of pica can be categorized according to the type of substance ingested:Geophagia: Clay ingestion is a very common form of pica. It can lead to constipation, hypokalemia with myopathy, and nutritional deficiencies.[38][26][39] Clay can also be a source of many infectious agents such as parasites. Lead poisoning can be a serious complication with clay ingestion.Pagophagia: Ice ingestion could lead to iron deficiency, especially during pregnancy.[36] Other complications include tooth decay and sensitivity.[40]Amylophagia: Excessive starch consumption has been associated with iron deficiency. It also can cause high blood sugar and obesity due to its high carbohydrate content.[41]Other substances: Ingested materials can contain a wide variety of toxic contaminants such as lead, mercury, arsenic, fluoride, and many others. Exposure to such items can lead to a wide range of toxic effects such as lead poisoning.[42] Lead poisoning could have dire consequences, particularly among women who are pregnant, and high levels can result in seizures.[43]
Fetal Toxicity
Pica during pregnancy can have dire consequences on the growing fetus. There are case reports of intrauterine toxicity due to maternal pica. Lead poisoning has been implicated in long-term neurological disability.[44] Maternal geophagy has been associated with childhood motor function delay.[45]Enhancing Healthcare Team Outcomes Treatment of patients with pica should utilize an interprofessional team approach. A team consisting of a physician, psychiatrist/psychologist, behavioral therapist, social worker, and dietitian. Patients should be treated in a nonjudgmental manner, with particular attention to their cultural and social background.[46]Patient education is vital. Failure to educate patients on healthy eating habits is a common reason why pica can be prevalent in some populations. Parents need to be educated about the harms of ingesting nonnutritive substances by their children and the need for limiting such exposure. In some jurisdictions, landlords have to ensure that lead-based painting is removed. A dietary consult may benefit some families. Close follow-up by the nurse practitioner may be required to ensure that the pica behavior is not continuing.Clinicians should communicate with each other so that the same message is sent to the parent or caregiver. Review Questions
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[PubMed: 17883773]17.Young SL, Sherman PW, Lucks JB, Pelto GH. Why on earth?: Evaluating hypotheses about the physiological functions of human geophagy. Q Rev Biol. 2011 Jun;86(2):97-120. [PubMed: 21800636]18.Murray HB, Thomas JJ, Hinz A, Munsch S, Hilbert A. Prevalence in primary school youth of pica and rumination behavior: The understudied feeding disorders. Int J Eat Disord. 2018 Aug;51(8):994-998. [PubMed: 30175409]19.Fawcett EJ, Fawcett JM, Mazmanian D. A meta-analysis of the worldwide prevalence of pica during pregnancy and the postpartum period. Int J Gynaecol Obstet. 2016 Jun;133(3):277-83. [PubMed: 26892693]20.McAlpine C, Singh NN. Pica in institutionalized mentally retarded persons. J Ment Defic Res. 1986 Jun;30 ( Pt 2):171-8. [PubMed: 3735412]21.McNaughten B, Bourke T, Thompson A. Fifteen-minute consultation: the child with pica. Arch Dis Child Educ Pract Ed. 2017 Oct;102(5):226-229. [PubMed: 28487433]22.Screening for elevated blood lead levels. American Academy of Pediatrics Committee on Environmental Health. Pediatrics. 1998 Jun;101(6):1072-8. [PubMed: 9614424]23.Woodhall DM, Garcia AP, Shapiro CA, Wray SL, Shane AL, Mani CS, Stimpert KK, Fox LM, Montgomery SP. Assessment of U.S. Pediatrician Knowledge of Toxocariasis. Am J Trop Med Hyg. 2017 Oct;97(4):1243-1246. [PMC free article: PMC5637614] [PubMed: 28820703]24.Dold C, Holland CV. Ascaris and ascariasis. Microbes Infect. 2011 Jul;13(7):632-7. [PubMed: 20934531]25.Poy MS, Weisstaub A, Iglesias C, Fernández S, Portela ML, López LB. [Pica diagnosis during pregnancy and micronutrient dificiency in Argentine women]. Nutr Hosp. 2012 May-Jun;27(3):922-8. [PubMed: 23114955]26.Ukaonu C, Hill DA, Christensen F. Hypokalemic myopathy in pregnancy caused by clay ingestion. Obstet Gynecol. 2003 Nov;102(5 Pt 2):1169-71. [PubMed: 14607045]27.Roberts JW, Dickey P. Exposure of children to pollutants in house dust and indoor air. Rev Environ Contam Toxicol. 1995;143:59-78. [PubMed: 7501867]28.Hauptman M, Bruccoleri R, Woolf AD. An Update on Childhood Lead Poisoning. Clin Pediatr Emerg Med. 2017 Sep;18(3):181-192. [PMC free article: PMC5645046] [PubMed: 29056870]29.Ezzeddin N, Zavoshy R, Noroozi M, Jahanihashemi H, Riseh SH. Prevalence and risk factors for pica during pregnancy in Tehran, Iran. Eat Weight Disord. 2015 Dec;20(4):457-63. [PubMed: 26143570]30.Matson JL, Hattier MA, Belva B, Matson ML. Pica in persons with developmental disabilities: approaches to treatment. Res Dev Disabil. 2013 Sep;34(9):2564-71. [PubMed: 23747942]31.Roy A, Fuentes-Afflick E, Fernald LCH, Young SL. Pica is prevalent and strongly associated with iron deficiency among Hispanic pregnant women living in the United States. Appetite. 2018 Jan 01;120:163-170. [PubMed: 28864256]32.Sadeghzadeh M, Khoshnevisasl P, Sadeghzadeh S. The relation between pica and iron deficiency in children in Zanjan, Islamic Republic of Iran: a case-control study. East Mediterr Health J. 2017 Aug 20;23(6):404-407. [PubMed: 28836652]33.Kelkitli E, Ozturk N, Aslan NA, Kilic-Baygutalp N, Bayraktutan Z, Kurt N, Bakan N, Bakan E. Serum zinc levels in patients with iron deficiency anemia and its association with symptoms of iron deficiency anemia. Ann Hematol. 2016 Apr;95(5):751-6. [PubMed: 26931116]34.Albin JB. The treatment of pica (scavenging) behavior in the retarded: a critical analysis and implications for research. Ment Retard. 1977 Aug;15(4):14-7. [PubMed: 895511]35.Call NA, Simmons CA, Mevers JE, Alvarez JP. Clinical Outcomes of Behavioral Treatments for Pica in Children with Developmental Disabilities. J Autism Dev Disord. 2015 Jul;45(7):2105-14. [PubMed: 25636679]36.Rabel A, Leitman SF, Miller JL. Ask about ice, then consider iron. J Am Assoc Nurse Pract. 2016 Feb;28(2):116-20. [PMC free article: PMC4635104] [PubMed: 25943566]37.Kar SK, Kamboj A, Kumar R. Pica and psychosis - clinical attributes and correlations: a case report. J Family Med Prim Care. 2015 Jan-Mar;4(1):149-50. [PMC free article: PMC4366992] [PubMed: 25811011]38.McKenna D. Myopathy, hypokalaemia and pica (geophagia) in pregnancy. Ulster Med J. 2006 May;75(2):159-60. [PMC free article: PMC1891740] [PubMed: 16755950]39.Setime MA, Sesay S, Cainelli F, Vento S. A case of severe hypokalemic myopathy due to clay ingestion. Isr Med Assoc J. 2013 Sep;15(9):524-5. [PubMed: 24340849]40.Johnson CD, Koh SH, Shynett B, Koh J, Johnson C. An uncommon dental presentation during pregnancy resulting from multiple eating disorders: pica and bulimia: case report. Gen Dent. 2006 May-Jun;54(3):198-200. [PubMed: 16776414]41.Edwards CH, Johnson AA, Knight EM, Oyemade UJ, Cole OJ, Westney OE, Jones S, Laryea H, Westney LS. Pica in an urban environment. J Nutr. 1994 Jun;124(6 Suppl):954S-962S. [PubMed: 8201446]42.Diawara MM, Litt JS, Unis D, Alfonso N, Martinez L, Crock JG, Smith DB, Carsella J. Arsenic, cadmium, lead, and mercury in surface soils, Pueblo, Colorado: implications for population health risk. Environ Geochem Health. 2006 Aug;28(4):297-315. [PubMed: 16752202]43.Shannon M. Severe lead poisoning in pregnancy. Ambul Pediatr. 2003 Jan-Feb;3(1):37-9. [PubMed: 12540252]44.Mycyk MB, Leikin JB. Combined exchange transfusion and chelation therapy for neonatal lead poisoning. Ann Pharmacother. 2004 May;38(5):821-4. [PubMed: 15026564]45.Mireku MO, Davidson LL, Zoumenou R, Massougbodji A, Cot M, Bodeau-Livinec F. Consequences of prenatal geophagy for maternal prenatal health, risk of childhood geophagy and child psychomotor development. Trop Med Int Health. 2018 Aug;23(8):841-849. [PMC free article: PMC6103800] [PubMed: 29876999]46.Williams DE, McAdam D. Assessment, behavioral treatment, and prevention of pica: clinical guidelines and recommendations for practitioners. Res Dev Disabil. 2012 Nov-Dec;33(6):2050-7. [PubMed: 22750361]Disclosure: Yasser Al Nasser declares no relevant financial relationships with ineligible companies.Disclosure: Erind Muco declares no relevant financial relationships with ineligible companies.Disclosure: Ali Alsaad declares no relevant financial relationships with ineligible companies.
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ViewsPubReaderPrint ViewCite this PageAl Nasser Y, Muco E, Alsaad AJ. Pica. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. In this PageContinuing Education ActivityIntroductionEtiologyEpidemiologyHistory and PhysicalEvaluationTreatment / ManagementDifferential DiagnosisPrognosisComplicationsEnhancing Healthcare Team Outcomes Review QuestionsReferencesBulk DownloadBulk download StatPearls data from FTPRelated informationPMCPubMed Central citationsPubMedLinks to PubMedSimilar articles in PubMedReview Pica Disorder among African American Women: A Call for Action and Further Research.[Soc Work Public Health. 2020]Review Pica Disorder among African American Women: A Call for Action and Further Research.Jackson MS, Adedoyin AC, Winnick SN. Soc Work Public Health. 2020 Jun 1; 35(5):261-270. Epub 2020 Jul 13.Characteristics of Pica Behavior among Mothers around Lake Victoria, Kenya: A Cross-Sectional Study.[Int J Environ Res Public Healt...]Characteristics of Pica Behavior among Mothers around Lake Victoria, Kenya: A Cross-Sectional Study.Chung EO, Mattah B, Hickey MD, Salmen CR, Milner EM, Bukusi EA, Brashares JS, Young SL, Fernald LCH, Fiorella KJ. Int J Environ Res Public Health. 2019 Jul 14; 16(14). Epub 2019 Jul 14.PICA.[Indian J Dent Res. 2012]PICA.Aparna PV, Austin RD, Mathew P. Indian J Dent Res. 2012 May-Jun; 23(3):426-7. Pica and amylophagy are common among Malagasy men, women and children.[PLoS One. 2012]Pica and amylophagy are common among Malagasy men, women and children.Golden CD, Rasolofoniaina BJ, Benjamin R, Young SL. PLoS One. 2012; 7(10):e47129. Epub 2012 Oct 17.Review The Neurology and Psychopathology of Pica.[Curr Neurol Neurosci Rep. 2022]Review The Neurology and Psychopathology of Pica.Schnitzler E. Curr Neurol Neurosci Rep. 2022 Aug; 22(8):531-536. Epub 2022 Jun 8.See reviews...See all...Recent ActivityClearTurn OffTurn OnPica - StatPearlsPica - StatPearlsYour browsing activity is empty.Activity recording is turned off.Turn recording back onSee more...
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Mental Health
Eating Disorders
Pica: Symptoms, Causes, and Treatment
People with a pica disorder eat non-food items like dirt, paint chips, and feces
By
Sherry Christiansen
Updated on December 07, 2023
Medically reviewed by
Jamie Johnson, RDN
Table of Contents
View All
Table of Contents
What Do People With Pica Eat?
Causes
Diagnosis
Complications
Treatment
Outlook
Coping
Pica is an eating disorder that causes someone to crave and compulsively eat things that are not food, such as paint chips, dirt, paper, or hair. The disorder can lead to intestinal blockages, toxic side effects, and other health issues.
Pica is usually temporary and can affect pregnant people and others with iron-deficiency anemia or other nutrient deficiencies who may crave certain minerals found in dirt, or eat earthy material like clay. Pica disorder is also seen in people living with an autism spectrum disorder.
Pica in kids is not uncommon and is more prevalent in autistic kids and those with developmental or intellectual disabilities (pica is not diagnosed in those under age 2).
This article explains pica symptoms and health issues that may follow the ingestion of non-food material. It explains common types of pica and their causes, as well as pica treatment.
Verywell / Laura Porter
What Do People With Pica Eat?
Pica types have different names, based on describing the type of non-food items that people eat. Pica disorder examples include pagophagia, which refers to eating ice, and geophagia, which refers to eating dirt and clay.
Common items ingested by people (children and adults) with pica include:
DirtPaperClayAnimal fecesIcePaint chipsSandHairChalkPlants or grassCigarette buttsRocksToys (such as Lego bricks)Rubber bandsShampooClothStringWoolTalcum powderGum
What Are the Causes of Pica?
Although the exact cause of pica is unknown, experts know that some conditions cause a person to be more at risk for developing pica. These include:
Developmental disorders
Intellectual disabilities
Autism spectrum disorder
Mental health conditions, such as schizophrenia or obsessive-compulsive disorder
Those with malnutrition or who suffer from hunger, resulting in low levels of nutrients such as iron and zinc, which can trigger specific types of cravings
Stress, such as in kids who have been abused or neglected or those living in severe poverty
During pregnancy when, rarely, people crave dirt (which may be related to an iron deficiency)
Pica in Pregnancy
People who are pregnant are known to have a form of pica that may be caused by a craving for certain nutrients (such as minerals found in dirt). Iron and zinc deficiencies can trigger pica cravings. Another type of pica thought to be associated with nutrient cravings is called geophagy, which involves eating earthy substances such as clay.
Other Risk Factors
Pica can be linked with several other conditions, including:
Hair pulling (a disorder called trichotillomania)Skin picking (a disorder called excoriation)
The overall number of people with pica is not clear, but it is thought to be more prevalent in developing countries than in the United States.
Pica in Autistic Children
Several factors have been linked with pica in autistic kids. The reasons these kids often crave nonfoods may include the following.
Sensory feedback (also referred to as automatic reinforcement): This is the desire to eat nonfoods for a pleasurable feeling.An inability to decipher between foods and nonfoods: Some children eat nonfood items because they believe they are edible foods.Nutrient deficiency: This includes a lack of adequate levels of iron or zinc.
Pica Disorder and Autism
Pica disorders are more common in autistic people and in people with certain intellectual disabilities and mental health diagnoses. In one study, 23.2%, of autistic kids had pica disorders, while 8.4% of kids with a developmental disability and 3.5% of kids in the general population had pica disorders.
How Is Pica Diagnosed?
Pica is not diagnosed based on specific lab tests. A healthcare provider begins the diagnosis by taking a person's medical history and the reports from family members, particularly for children.
Other tests may then follow based on symptoms and what the person may be eating.
Diagnostic Tests
Pica disorders may be diagnosed based on tests that include:
Blood tests to evaluate the possibility of anemia or low zinc or iron levels
Stool samples to test for intestinal bleeding
X-rays or other imaging tests to check for intestinal blockage
Lead levels, to evaluate for lead poisoning if paint chips are ingested
Tests to check for parasites or bacteria from eating dirt or other items
Weight loss evaluation
Testing for nutritional deficiencies
Qualifying Factors for a Pica Diagnosis
The criteria of symptoms that qualify a person to be diagnosed with pica include:
Persistent eating of nonfood substances for one month or longer, even if the foods cause illness or discomfort such as nauseaIngesting a nonfood substance when it's not part of a culturally or socially supported practice, as is true in cultures that commonly eat clay for medicinal purposes.Eating nonfood items when it is developmentally inappropriate. For example, children ages 2 years and under commonly put items in their mouths and would not yet be diagnosed with pica.
The type of nonfood substances that are ingested often change according to a person's age and the availability of nonfood items.
What Are the Complications of Pica?
Most people with pica eat regular nutrient-filled foods in addition to ingesting nonfood items. But in many instances, those who are affected by pica are nutritionally malnourished. Pica disorders lead to symptoms that have a broad range, but they are all linked with the impact of nonfood items that are ingested.
Symptoms of pica occur as a result of the toxic or poisonous content as well as the bacteria in nonfood items that are ingested. The symptoms may include:
NauseaPain or abdominal cramping in the stomachConstipationDiarrheaFatigueBehavior problemsSchool problems
Because pica symptoms are linked to the substances ingested, some of these symptoms may lead to more serious complications.
These symptoms and conditions need to be evaluated more urgently by a healthcare provider. They include:
Intestinal blockage, when stomach pain does not resolve
Stomach ulcers, which may cause blood in the stools
Symptoms of lead poisoning if paint chips that contain lead are ingested
Electrolyte imbalances, in rare cases leading to seizure
Injuries to teeth, such as broken or fractured teeth from chewing on hard nonfood items
Infections caused by germs, and/or parasites that enter the body from the nonfood item that is swallowed
Call 911 if you witness signs of choking or severe pain in someone with pica or experience them yourself.
How Is Pica Treated?
Pica disorder treatment varies depending on the underlying factors linked with the condition. It's important for healthcare providers to address the symptoms that often result from pica.
These symptoms differ depending on which nonfood items are ingested. Common pica treatments include:
Medications for constipation or diarrheaTreatment of stomach ulcersAntibiotic treatment for infectionsNutritional supplements for nutrient deficienciesAddressing other medical problems, such as lead poisoning
Behavioral Treatment for Pica
Pica disorder behaviors have similar features to symptoms and patterns of other conditions, such as bulimia or obsessive-compulsive disorder. It's been seen in people with bipolar disorder.
Treatments that address the pica behavior itself may include:
A referral to a mental health/behavioral health specialistBehavior modification programs to redirect a person's attention away from the nonfood object and reward the choice of appropriate food itemsMedication to help reduce the urges and impulses to eat nonfood items
Is Pica a Form of OCD?
Obessive-compulsive disorder (OCD) behavior patterns don't explain all types and cases of pica disorder. However, OCD has been associated with pica symptoms, sometimes leading to an OCD diagnosis.
Professionals
Professionals trained in treating pica may include:
A behavior analyst, with experience in functional behavioral assessment and implementation of behavioral intervention
A psychologist with experience in applied behavior analysis, which is a type of therapy aimed at improving specific behaviors
A pediatrician who specializes in the treatment of behavioral issues
Outlook (Prognosis)
Pica disorder treatment may be successful, but it varies quite a bit depending on the underlying causes and any related factors. In kids, pica usually improves as they grow up. But for those with mental illness or developmental disorders, it commonly continues into the teenage years or even into adulthood.
Pica treatment has been found to be more successful in children who have undergone a medical assessment and behavioral evaluation by a mental health or medical professional. Behavioral assessments help to identify and treat associated problem behaviors, such as aggression.
A thorough medical evaluation can result in the effective treatment of underlying problems, such as nutritional deficiencies, which may end up resolving pica.
Pregnant people with pica will often experience a resolution of symptoms when the pregnancy ends. Many kids with pica outgrow it, however, autistic kids or those with developmental or intellectual disabilities might experience pica symptoms for most or all of their lives.
Coping With Pica
Pica disorder can be very challenging. It’s important to reach out and find experienced local professionals trained in treating compulsive behavior conditions such as pica.
There are many strategies to help empower people with pica and, in turn, lower stress and build positive coping skills while dealing with specific issues. Specific strategies, such as chewing gum, avoiding non-food items that you crave, and keeping stress at bay can all be helpful coping strategies.
Some examples for parents of autistic children include the following:
Blocking, or placing your hand on top of the child’s hand can prevent the child from putting the nonfood item into their mouth. This strategy helps to reduce pica for some kids.Snacking at frequent, regular time intervals (such as every 30 or 60 minutes) can provide options to the child other than eating nonfood items.Rewards, such as stickers, can be given when children refrain from pica behaviors. Positive reinforcement is a proven strategy to help parents change a child's unwanted behaviors.
Summary
Pica is a condition in which people consume non-food items, such as dirt, clay, paint chips, cloth, string, cigarette butts, or rubber bands. It occurs more commonly in autistic kids or with developmental or intellectual disabilities, pregnant people, as well as some non-pregnant adults. Nutritional deficiencies may be at the root of some types of pica. Treatment includes supplementing deficient nutrients, behavioral therapy, and medication. If you are concerned about yourself or a loved one consuming non-food items, speak to a healthcare professional to get help.
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
National Eating Disorders. (NEDA). Pica.
Papini NM, Bulik CM, Chawner SJ, Micali N. Prevalence and recurrence of pica behaviors in early childhood: findings from the ALSPAC birth cohort. medRxiv. 2023.06.04.23290951. doi:10.1101/2023.06.04.23290951
American Academy of Family Physicians. What is pica.
Fields VL, Soke GN, Reynolds A, Tian LH, Wiggins L, Maenner M, et al. Pica, Autism, and Other Disabilities. Pediatrics. 2021 Feb;147(2):e20200462. doi:10.1542/peds.2020-0462.
Bedanie G, Tikue A, Thongtan T, Zitun M, Nugent K. Pica/Pagophagia-Associated Hyponatremia: Patient Presenting With Seizure. Cureus. 2020 Jul 21;12(7):e9330. doi:10.7759/cureus.9330.
Bharti A, Mishra AK, Sinha V, Anwar Z, Kumar V, Mitra S. Paper eating: An unusual obsessive-compulsive disorder dimension. Ind Psychiatry J. 2015 Jul-Dec;24(2):189-91. doi:10.4103/0972-6748.181713.
Kids Health from Nemours. Pica.
Call NA, Simmons CA, Mevers JE, Alvarez JP. Clinical Outcomes of Behavioral Treatments for Pica in Children with Developmental Disabilities. J Autism Dev Disord. 2015;45(7):2105-2114. doi:10.1007/s10803-015-2375-z
By Sherry Christiansen
Sherry Christiansen is a medical writer with a healthcare background. She has worked in the hospital setting and collaborated on Alzheimer's research.
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PICA在剑桥英语词典中的解释及翻译
PICA在剑桥英语词典中的解释及翻译
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pica 在英语中的意思
picanoun [ U ]
psychology
specialized uk/ˈpaɪ.kə/ us/ˈpaɪ.kə/
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a condition that makes a person or an animal want to eat things that are not food, for example paper or soap, in a way that is not normal: Pica is a compulsive tendency to eat substances other than normal food. Some children have eating problems such as food refusal, selective eating, pica, and overeating.
更多范例减少例句For years before her paper pica appeared, the patient recalled eating a special type of mud which contained a distinctive smell.Geophagia is commonly called clay-eating pica.Pica in dogs may be a sign of immune-mediated haemolytic anaemia.
“SMART 词汇”:相关单词和短语
Mental illnesses
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adjustment disorder
age-associated memory impairment
anhedonia
anorexia nervosa
anorexic
health anxiety
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hoarder
hoarding
Hyde
manic depression
mental handicap
obsessive-compulsive disorder
psychopathy
psychosis
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(pica在剑桥高级学习词典和同义词词典中的解释 © Cambridge University Press)
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/ˈvedʒ.i ˌbɜː.ɡər/
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a type of food similar to a hamburger but made without meat, by pressing together small pieces of vegetables, seeds, etc. into a flat, round shape
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