Introduction
Coprophagia,
defined as the compulsive consumption of feces, is a rare and distressing
disorder. While coprophagia is commonly observed in puppies which usually
resolves by adulthood, persistent coprophagia in adult patients often indicates
an underlying psychiatric or medical condition. This article aims to provide a
comprehensive review of coprophagia by exploring etiology, symptoms, commonly
associated psychiatric comorbidities, case studies from literature, treatment
approaches and implications based on available literature on the subject.
Etiology of Coprophagia
The exact etiology
or root cause of coprophagia is still not fully understood. However, literature
suggests that coprophagia could have medical, behavioral or psychiatric causes.
1.
Medical Causes
Any medical
condition affecting nutrient absorption like gastrointestinal disorders,
digestive enzyme deficiencies, parasites infection etc. could lead to
nutritional deficiencies inducing coprophagia. Conditions causing changes in
appetite or taste like diabetes, Cushing's disease, thyroid disorders may also increase
risk of coprophagia. Dogs on calorie-restricted diets or fed poorly balanced
diets are also prone.
2.
Behavioral Causes
In puppies,
coprophagia may begin as investigatory, play or learning behavior from their
mother and develop into habit if rewarded with attention. Sensory appeals of
feces like odor, texture could overcome natural aversions in some dogs.
3.
Psychiatric Causes
Coprophagia has
been associated with psychiatric disorders like dementia, autism,
schizophrenia, obsessive-compulsive disorder, cognitive impairment indicating a
possible psychiatric pathogenesis.
Symptoms
The hallmark symptom is compulsive consumption of feces. However, psychiatric evaluation of patients with coprophagia commonly finds thought disturbances including:
·
Command auditory hallucinations
·
Guilt, desire for punishment
·
Delusional beliefs linking coprophagia to
avoid severe consequences
·
Depressive symptomatology
·
Incongruent affect
·
Laboratory and neuroimaging findings vary
based on underlying comorbidities.
Psychiatric Comorbidities
Coprophagia occurs
in context of following psychiatric disorders as case reports and series have documented:
·
Affective disorders (bipolar disorder,
depression)
·
Schizophrenia spectrum disorders
·
Dementia
·
Autism
·
Cognitive disorders
·
Epilepsy
·
Brain tumors
Co-occurring
symptoms may include incontinence, aggression, hypersexuality depending on the
comorbid condition.
Case Studies
A literature review
summarized two case studies of patients with persistent coprophagia:
Case 1: 59M with bipolar
disorder exhibited coprophagia due to command auditory hallucinations and guilt
over criminal history. Symptoms resolved within 19 days with
risperidone-clozapine trial.
Case 2: 32M with bipolar
disorder continued coprophagia attributed to delusional guilt despite 26-day
treatment with risperidone-divalproex.
Notably, time to
recovery was shorter in case 1 associated with resolution of psychiatric
symptoms with a cognitive behavioral intervention.
Treatment
Treatment involves
addressing any underlying medical issues and psychiatric treatment of comorbid
conditions:
1.
Antipsychotics like risperidone,
aripiprazole, quetiapine, ziprasidone shown to improve coprophagia secondary to
psychoses.
2.
Clozapine, with its broad receptor
profile, showed faster improvement in refractory cases compared to other
antipsychotics.
3.
Mood stabilizers, antidepressants help if
affective disorders coexist.
4.
Additional aids include behavioral
therapy, environmental modifications, taste deterrents.
5.
Multimodal approach usually works better
than monotherapy for complex coprophagia.
Medications
As mentioned
earlier, several classes of medications have shown effectiveness in treating
coprophagia associated with psychiatric disorders:
1.
Antipsychotics like risperidone,
quetiapine, olanzapine has shown to reduce symptoms by blocking psychosis and
thought disturbances. Risperidone in particular has evidence from case reports.
2.
Mood stabilizers like lithium, valproate,
lamotrigine helps if there are underlying affective disorders by controlling
mood fluctuations.
3.
SSRIs/SNRIs may be useful if
obsessive-compulsive or anxiety components are involved.
4.
Clozapine, an atypical antipsychotic,
appears superior to others likely due to its broad receptor binding profile
targeting symptoms from multiple angles.
5.
Dosages need to be individualized and
higher than usual may be required in refractory cases. Monotherapy versus
multidrug approaches need evaluation.
Behavioral Therapies
Some behavioralmethods shown to aid treatment include:
1.
Cognitive behavioral therapy to identify
and modify irrational thoughts and behaviors related to coprophagia.
2.
Contingency management using positive
reinforcement of alternative behaviors to discourage coprophagia.
3.
Habit reversal training involving
awareness training and competing response techniques.
4.
Desensitization through systematic and
gradual exposure to simulate coprophagic urges in controlled settings.
Environmental Modifications
Making following
changes to patient's surroundings have helped reduction of coprophagia:
1.
Immediate cleanup and safe disposal of
feces to remove triggers and rewards.
2.
Use of plastic wraps, barriers or diapers
if incontinence is present.
3.
Close supervision during periods of risk
through monitoring devices or caretakers.
4.
Altering diet or using deterrent sprays
to make feces less appealing can assist other treatments.
FAQs
Q1. Is coprophagia common
in dogs?
A1. While seen
commonly in puppies, persistent coprophagia in adult dogs is rather rare and
needs medical/psychiatric evaluation.
Q2. What causes coprophagia
in dogs?
A2. Possible causes
include medical issues affecting nutrition, behavioral factors like attention-seeking,
psychiatric disorders in human patients.
Q3. How is coprophagia
treated?
A3. Treatment
involves identifying and treating any underlying cause, psychotherapy,
medications, taste deterrents, environment modifications based on individual
case.
Q4. When should I be
concerned about my dog's coprophagia?
A4. If coprophagia
persists beyond 6 months of age, interferes with daily activities or training,
or if dog seems stressed, medical advice should be sought.
Conclusion
In summary,
coprophagia is a complex disorder with varied etiologies. While typically
self-limiting in puppies, persistent coprophagia in adults likely stems from
medical, psychiatric or behavioral issues. Evaluation and management require a
multidisciplinary approach focusing on associated conditions. Further research
on pathophysiology, effective long-term treatment modalities and standardized
guidelines will help optimize care of these challenging patients.
References
Azizi, H., et al.
(2018). The Pathophysiology and Management of Coprophagia: A Report of Two
Cases and Literature Review. Hindawi. https://www.hindawi.com/journals/crips/2018/5157879/
Horwitz, D. and
Landsberg, G. (n.d.). Dog Behavior Problems - Coprophagia. VCA Animal Hospital.
https://vcahospitals.com/know-your-pet/dog-behavior-problems-coprophagia
American Kennel
Club. (n.d.). Why Does My Dog Eat Poop?. https://www.akc.org/expert-advice/health/why-dogs-eat-poop/
Four Paws. (n.d.).
How to Prevent Coprophagia in Dogs. https://www.fourpaws.com/pets-101/potty-time-and-training/how-to-prevent-coprophagia-in-dogs
Gazit, R., et al.
(2003). Coprophagia as an obsessive–compulsive spectrum disorder: a case
report. The Israel Medical Association journal, 5(12), 953-954.
Kang, J. W., et al.
(2019). A case of chronic coprophagia associated with schizoaffective disorder.
Psychiatry investigation, 16(4), 328.
Peckham, R. K.,
& Bakker, H. D. (1980). Behavioral treatment of chronic coprophagia in a
psychotic retardate. Behavior Therapy, 11(5), 670-675.
Young, R. L.
(2018). Assessment and management of inappropriate elimination, rapid eating,
and coprophagia in dogs with non–verbal developmental disabilities. Frontiers
in veterinary science, 5, 58.
Watanabe H., et al
(2016) Coprophagia successfully treated with risperidone augmentation: a case
report. Psychiatry and clinical neurosciences. 70(10):429-430.
Vermeer, K. A.,
Grossman, C. J., & Gibbons, R. D. (2014). Coprophagia in a patient with
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