Compulsive disorders Flashcards
(50 cards)
1
Q
What is a compulsive disorder?
A
- Involves abnormal, repetitive behavior resulting from anxiety or stress without an apparent inciting trigger and when other physical or behavioral causes have been ruled out
- Difficult to disrupt
- May be self-reinforcing and difficult to interrupt without physical intervention
- often disrupts daily functions due to the intensity and frequency
- The diagnosis for 2-5% of patients seen by veterinary behaviorists
- May actually be higher number as thought to be under-reported
- Owners often don’t seek help until symptoms are severe
2
Q
What are the clinical characteristics of Compulsive disorders?
A
- Categories for dogs are very diverse range of behavior
- Locomotor
- Visual/hallucinatory
- Oral
- Self-directed
-
Breed predilections
- Flank-sucking Dobermans
- Altered function in the subcortical region of the brain
- Flank-sucking Dobermans
- Affects serotonergic and dopaminergic regions
- Affected dogs have lower serotonin-receptor binding
3
Q
What are the Locomotor Compulsive Behaviors?
A
- Circling/spinning
- Tail chasing
- Pacing
4
Q
What are the visual/hallucinatory compulsive Disorders?
A
- Light or shadow-chasing
- Fly snappers
5
Q
What are the oral compulsive disorders?
A
- Pica
- Licking
6
Q
What are the self-directed or self-injurious compulsive disorders?
A
- Flank sucking
- Hind checking
- Acral like dermatitis
7
Q
What is the Pathophysiology of Compulsive Disorders?
A
- Likely multifactorial
- Learning
- can be part of the inciting cause and perpetuation of CD
- Owners may inadvertently reinforce
- Over time, the behavior becomes so engrained that it continues, even the inciting cause is no longer there
8
Q
What are the history and clinical signs of compulsive disorders?
A
- Symptoms in dogs often start prior to a year of age
- Median <1 year for tail chasing and flank sucking
- Median >1 year for acral lick dermatitis
- Owners often don’t present dogs until they are older for treatment
- Concurrent behavioral issues often present in 75% of dogs with CD
- Separation anxiety
- Aggression
- Generalized anxiety
- Attention seeking disorders
9
Q
How are compulsive disorders diagnosed?
A
- Diagnosis of exclusion
- PE and diagnostic testing may show abnormalities secondary to behaviors associated with chronic CD
-
A thorough history is needed
- Description/video of the behavior
- Initiating factors
- Situations where behavior will likely occur
- Owner response
- Attempted treatments and success
- Behavior history forms are useful
10
Q
Are all repetitive behaviors compulsive?
A
- NO
- alternative causes must be ruled out
11
Q
What is displacement behavior?
A
- Normal behavior displayed at inappropriate times, or out of context, in response to anxiety-provoking events
- EX: dog licking paw when alone
- Occurs during stressful situations
- Remains linked to the anxiety-provoking situation
- Can evolve into CD with repetition or additional stress
12
Q
What are differential diagnosis for repetitive behavior?
A
- Displacement behavior
- Redirected behavior
- Vacuum activity
- Stereotypy
- Audience-responsive behavior
13
Q
What is redirected behavior?
A
- Behavior incited by one target but directed at another
- EX:
- Pruritic dog that licks inside of an Elizabethan collar when it cannot lick itself
14
Q
What is Vacuum activity?
A
- Behavior performed in absence of normal stimuli required for that behavior
- Ex:
- Border collie that runs laps when not exercised
15
Q
What is stereotypy?
A
- Repetitive, unvarying behavior with no apparent goal or function displayed by captive animals lacking appropriate enrichment or outlets
- EX:
- Dog confined to a small kennel without toys or social contact that jumps on the door in an invariant pattern
16
Q
What is Audience-responsive behavior?
A
- Operant-conditioned behavior performed to solicit interaction with humans and in the presence of a human and has past reinforcement
- Ex:
- Light-chasing dog that stops when owner leaves and has historically been offered a toy when it chased lights
17
Q
What are the Key components of Management and Treatment of Compulsive Disorders?
A
- Client education
- Minimizing repetitive behavior
- Reinforcing alternative behaviors
- Alleviating patient stress
18
Q
How does Client education affect Compulsive disorders?
A
- Punishment based training
- Can increase aggression
- Can increase likelihood o injury
- Can increase anxiety
- Exacerbate CD
- Educated owners are less likely to use punishment-based training when they are informed that CD is due to anxiety and NOT due to dominance behavior of lack of training
19
Q
How does Minimizing Repetitive Behavior affect Compulsive Disorders?
A
- Treatment should focus on behavior prevention
- The more a dog performs the repetitive behavior, the more ingrained it becomes
- Pet owners should try to identify situations that invoke compulsive behavior and try to avoid them
- Owners need to prevent unintentional reinforcement
- Don’t provide or take away positive reinforcements while the repetitive behavior is occurring
20
Q
How dos Reinforcing Alternative Behaviors affect Compulsive Disorders?
A
- Dogs should be taught an alterative behavior that can be cued or reinforced whenever repetitive behavior is likely to occur
- Dogs that pace
- try to get them to fetch
- Shadow Chasers
- reward for lying down with chin on the floor
- Pica behavior
- feed from puzzle toys
- Owners should use cue-response-reinforcement patterns
- Give a cue
- God needs to respond
- Give a treat/toy/praise if responds appropriately
- When undesirable behavior is demonstrated
- Attention should be withdrawn
- Dogs that pace
21
Q
How does alleviating patient stress affect Compulsive Disorders?
A
- Pharmacological intervention to address anxiety
- Clomipramine
- Fluoxetine
- Higher doses of medications may be needed for CD
- Be careful of side effects
- There are no FDA approved medications for CD
- Owners should not be inconsistent with their interactions
- Can cause:
- Anxiety
- Frustration
- Confusion
- Predictable interactions help to mitigate stress
- Can cause:
22
Q
What is Cue-response-reinforcement?
A
- Give a cue
- Dog needs to respond
- Give a treat/toy/praise if responds appropriately
23
Q
What environmental modifications and physical restraint can be used for Compulsive Disorders?
A
- Opaque privacy film on reflective surfaces (light chasers)
- Walk on leash to eliminate (yard pacers)
- Barriers (baby gates, tethers, pens/crates) o prevent access to trigger environments and restrict movement
- minimize repetitive locomotor behavior
- Self-inflicted trauma
- E-collars
- Bandages
- Muzzles
24
Q
What pharmacological interventions are used to address anxiety in CD?
A
- Use drugs that affect Serotonin levels
- Clomipramine
- Common drug choice for CD
- Tail chasing in terriers
- 1-2mg/kg PO BID
- Fuoxetine
- Effective as clomipramine for tail chasing
- More effective than placebo for acral lick dermatitis
- Owners more apt to report decrease in severity of CD but not in frequency or duration
- 1-2 mg/kg PO SID
25
Are there pharmaceutical treatments for CD?
* No FDA approved medications
* Get informed consent from client, especially if higher doses are used
* Side-effects: Bradycardia and arrhythmias
26
What is the Prognosis of CD?
* Guarded to Fair
* Owners need **realistic goals and expectations**
* **_Reduction of severity and duration is the goal_**
* Treatment is unlikely going to be able to be stopped
* Focus treatment on **Quality of Life**
* Distraction from repetitive behavior
* Limit self-trauma
* Enjoyable activities and interactions with owner
* **_Preemptive intervention_** has best chances for success
27
What additional steps need to be taken to manage CD?
* **Frequent communication** with owner is necessary
* monitor patient's response to treatment
* Make adjustments to therapy, if needed
* Communicate to owners **that stressful situations may exacerbate or trigger a relapse** of CD
* Compulsive behaviors **can be managed** and quality of life can be improved for all
28
What causes Feline CD?
* Physical and environmental stressors have be implicated
29
What triggers wool-sucking?
* Stressful events
* being left alone for extended durations
* Early weaning (\<7 weeks of age)
* Increase that risk for wool-sucking and overgrooming
* Has not been associated with n increased risk for pica
* Medical issues
* cardiovascular disease, neoplasia, allergies
30
What breed predilections have been identified in Feline CD?
* Several breed predispositions have been identified
* Suggests **_Genetic factors_** may play a role
* Over-grooming: Siamese, Burmese, Oriental cats
* Wool-sucking: Siamese, Birman, Crossbreed house cats
* Pica/Oral behavior: Bengal, Burmese-type, Siamese
31
When does Feline CD start?
* Mean age ~2 years
* Breeds that are predisposed to CD may exhibit signs at a younger age
* Mean age for wool-sucking in Siamese and Birman cats was 41.6 and 67.6 weeks
32
What is Feline overgrooming?
* Tends to be directed at:
* **Abdomen**
* **Flanks**
* **Back**
* **Thorax**
* **Medial aspects of the thoracic limbs and thighs**
* In some cases, excoriation of the underlying skin may be present
* Over-grooming in these areas is **_not pathognomonic_** for psychogenic alopecia
* Physical causes of over-grooming can result in the same pattern
33
What is Feline Pica behavior?
* Cats with Pica may chew on, suck on, or ingest various objects
* Pica may be directed at _one or several objects_
* Shoelaces
* Threads
* Plastic
* Fabric
* Rubber
* Paper
* Cardboard
* Wood
* **Cats that suck on fabric are more likely to also ingest fabric**
34
How is Feline CD diagnosed?
* Diagnosed by exclusion
* There could be a medical cause for the behavior
* After presumptive medical causes have been identified and treated, the repetitive behavior may persist to the same or lessor degree
* Can indicate that the physical ailment was either not the primary inciting factor OR
* Medical and behavioral comorbidities were present
* Thorough behavior history
35
What should be gathered for history to diagnose Feline CD?
* Description (ideally including video) of the behavior
* Initiating factors situation in which the behavior is likely to occur
* Pet owner's response
* Previous treatment attempts and their degree of success
36
What are the categories of Feline CD?
* Self-directed; Self-injurious
* Oral
* Locomotor
* Vocal
* Visual; Hallucinatory
37
What are the self-directed/self-injurious Feline Compulsive Behaviors?
* Overgrooming / Psychogenic alopecia
* Hyperesthesia Syndrome
* Feline Behavioral Ulcerative dermatitis
* Chewing feet/claws
* Feline orofacial pain syndrome
38
What are the Oral Feline compulsive behaviors?
* Pica
* Wool-sucking
39
What are the Locomotor Feline Compulsive disorders?
* Pacing
* Tail-chasing
* Hyperesthesia syndrome
40
What are the Vocal Compulsive Behaviors?
* Excessive vocalization
41
What are the Visual/hallucinatory compulsive Behaviors?
* Chasing unseen prey
42
How is Feline CD treated?
* Educating owners
* Minimizing the repetitive behavior
* Reinforcing alternative behavior
* Alleviating stress
* Environmental enrichment
* Anxiolytics
43
Should Negative punishment be used to treat Feline CD?
* NEVER use negative punishment
* Verbal or physical punishment
* **Repetitive behavior often originates from stress or frustration**
* Use of harsh verbal or physical punishment that increases the cat's anxiety
* May exacerbate the disease
* Cats may **_learn to avoid punishment**_ and perform it _**out of the owner's sight_**
* **Use remote punishment** that is not associated with the owner's presence to stop CD behaviors
* Dropping a book to make a noise out of the cat's sight
* Tossing a pillow across the cat's line of sight to break its concentration
44
How can Minimizing the repetitive behavior affect Feline CD?
* _Reduces opportunities for reinforcement_ of the behavior
* _May be necessary_ for the health and welfare of the cats
* _May increase stress_ in some instances
* _Preventing situations_ that trigger the repetitive behavior _or preemptively engaging_ the cat in another activity before the CD behavior occurs is ideal
* Attempts to distract the cat with food, toys, or attention _while it is engaged_ in the repetitive behavior _may inadvertently reinforce_ the behavior
45
How can reinforcing alternative behavior affect Feline CD?
* Positive reinforcement
* Teaches alternative behavior
* Creates pleasurable associations with previously stressful situations
46
How can stress be alleviated in cats with CD?
* Environmental Enrichment
* Anxiolytics
47
How can the environment be enriched for cats with CD?
* Feline environmental enrichment provides a means to:
* Avoid stressful situations
* Mental and physical stimulation
* Opportunities to engage in normal, species-typical behavior
48
What Anxiolytics are available for cats with CD?
* Pheromones (feline facial and appeasing)
* Supplements
* a-casozepine
* L-theanine
* Pharmaceuticals - response is highly variable
* TCA - clomipramine
* SSRI - Fluoxetine
* No FDA approved drugs for Feline CD
49
What is the prognosis for Feline CD?
* **Fair** for reduction in the frequency or intensity of CD behavior
* **Poor** for complete resolution or cure
* Owners should be informed that the goals of treatment are to improve the cat's welfare and quality of life by:
* **Limiting the risk for self-injury**
* **Increasing the amount of time engaged in pleasurable activities** rather than the compulsive behavior
50
What additional considerations are there when treating Feline CD?
* **Affects the well-being of both** the cat and its owners
* May result in **Relinquishment** or **Euthanasia** of the pet if not addressed
* **_Ongoing communication_** with the owner is essential to increase the likelihood of compliance with the treatment plan
* Because treatment response depends on many factors nd may be unpredictable, **_Frequent consultation_** may be needed to adjust the treatment plan
