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Desire for poop

ROCHESTER. Disgust is a deeply rooted protection program designed to protect us from health threats. If something smells or tastes disgusting, it can hardly be healthy.

If the feeling of disgust is switched off, an essential part of the brain must already be defective. This is what appears to be the case with people who are not afraid to eat their own feces.

A medial temporal lobe atrophy or lesion can usually be found here, reports neurologists from the Mayo Clinic in Rochester.

A team led by Dr. Keith Josephs scoured the clinic's database for patients who had coprophagia noted. Overall, this problem occurred in twelve adults over the course of 20 years, six of whom were men (J Neurol 2016; 263 (5): 1008-1014).

Half of them have dementia

Half of those affected had a diagnosis of dementia. A frontal brain tumor had previously been removed from a 20-year-old and the complication was an anterior cerebral artery infarction.

In another brain tumor patient, steroid psychosis may have contributed to the behavior, another patient had developed severe epileptic seizures after multiple infarctions, and one suffered from tuberous sclerosis.

Cerebral imaging showed no abnormalities in only two of those affected - they did, however, have intellectual disabilities, epilepsies and / or psychoses.

Coprophagia was often accompanied by smeared stool, aggressive behavior, sexual hyperactivity, or the desire to devour any kind of object. One patient said he wanted to kill himself with his feces.

The imaging of the dementia patients consistently showed moderate to severe medial temporal lobe atrophy, and the frontal lobe had also shrunk, albeit significantly less. The American scientists had diagnosed three of them with frontotemporal dementia, the rest showed symptoms of Alzheimer's disease.

The neurologists working with Josephs assume that the amygdala was also damaged in the dementia patients as a result of the medial temporal lobe atrophy. This may mean that there is no feeling of disgust or fear that normally prevents coprophagia. Primate experiments point in this direction: coprophagia can be induced by targeted amygdala lesions.

Extreme stress

The lack of fear in many of the patients also speaks in favor of damage to the almond kernel. A patient with a brain tumor wanted to jump out of a moving car, a woman suffering from dementia threw herself out of the wheelchair again and again.

During the therapy, the doctors hardly left out any psychotropic drugs: They tried benzodiazepines, various classes of antidepressants and anticonvulsants, but they could only end the coprophagia with haloperidol (1-3 mg / d).

The antipsychotic was administered to four of the patients; all four had responded to this treatment. However, the doctors had no success with quetiapine, nor with any of the other preparations.

In the steroidal psychotic patient, appetite for his own feces decreased after the dexamethasone dose was lowered. With another, the therapists tried it by tucking him into a one-piece suit and mittens. However, the patient bit his mittens and continued with his behavior.

Rapid therapy success is important

According to the so far rather meager knowledge, haloperidol is most likely to be suggested as a therapeutic agent, write the US neurologists. However, rapid therapeutic success is extremely important, as coprophagia causes extreme stress among the caregivers.

Josephs and co-workers also point out the dangers for patients: deaths after consuming their own excrement have been described.