General info

Question 1

What are the categories of psychodermatological conditions?

Answer 1

1. Psychophysiologic
2. Primary psychiatric disorder
3. Secondary psychiatric disorder
4. Cutaneous sensory disorder

Question 2

What does psychophysiologic means?

Answer 2

skin disorder exacerbated by emotional stress (cAD, acral lick dermatitis)

Question 3

Define primary psychiatric disorder?

Answer 3

-primary behavioural problem with self-induced secondary skin manifestations

Question 4

What are tought to be primary psychiatric disorder in dogs?

Answer 4

Dogs:
1. acral lick dermatitis
2. flank sucking
3. tail chewing-chasing
4. foot-nail -chewing-licking

Question 5

What are tought to be primary psychiatric disorder in cats?

Answer 5

Cats:
1. psychogenic alopecia
2. hyperesthesia syndrome
3. tail sucking
4. feet-nail chewing

Question 6

What are tought to be primary psychiatric disorder in dogs and cats?

Answer 6

D&C
1.self-directed attention- seeking behaviour
2. psychogenic pruritus?

Question 7

Define secondary psychiatric disorders?

Answer 7

when skin diseases adversely affect the normal behavioural patterns and social functions

Question 8

Name cutaneous sensory disorders:

Answer 8

1. Allodynia
2. Hyperalgesia
3. dysesthesia

Question 9

What is allodynia?

Answer 9

experience of pain from non-noxious stimuli

Question 10

What is hyperalgesia?

Answer 10

exaggerated response to painful stimuli

Question 11

What is dysesthesia?

Answer 11

behaviours in response to or to avoid unpleasnt stimuli
-feline hyperesthesia syndrome

Question 12

What are self-injurious behaviours?

Answer 12

-volitional behaviour resulting in self-damage that appears repeatedly, consistently in the absence of any dermatological or physiologic condition

Question 13

What are obessions?

Answer 13

persistent ideas, impulses or images
-inaapropriate and causing anxiety
-cannot be confirmed in animals

Question 14

What are compulsions?

Answer 14

-repetitive behaviours with the goal to prevet or reduce anxiety
-stereotypic behaviours that interfere with normal function

Question 15

What are stereotypic behaviours?

Answer 15

-sequence of movements
-serve no obvious purpose
-occur repetitively or with excessive duration
-usually they derive from behaviours that are part of normal behavioural repertoire
-most are not compulsive

Question 16

What are etiopathogenesis of OCDs?

Answer 16

1. Breed predisposition
2. Lifestyle
3. Individual animal

Question 17

Name psychogenic skin disease in dogs?

Answer 17

1. Acral lick dermtaitis
2. Tail bitting, chewing, chasing
3. Tail dock neuroma
4. Flank sucking
5. Self-nursing
6. Anal licking
7. Foot licking, nail licking
8. Preputial licking

Question 18

What are psychogenic skin diseases in cats

Answer 18

1. Psychogenic alopecia-dermatitis
2. Tail sucking
3. Self-nursing
4. Nail biting, foot chewing, nail chewing
5. Head and neck excoriations (idiopathic ulcerative dermatitis)
6. Indolent ulcer-like lesions, erosions on the nasal planum
7. Feline hyperesthesia syndrome

Question 19

What are psychogenic skin diseases in horses

Answer 19

1. Psychogenic self-mutilation
2. Neurological self-mutilation

Question 20

Name trcyclic antidepressants

Answer 20

amitryptiline, imipramin, doxepin, chlomipramine
cADi or ICAD

Question 21

What is MOA of tricyclic antidepressants

Answer 21

incerased serotonine and norepinephrine

Question 22

Name recommended psychological drug therapy

Answer 22

1. Trcyclic antidepressants
2. SSRI (fluoxetine)
3. Opiate antagonists (naloxone, naltrexone)
4. Anxiolytics (benzodiazepines)

Question 23

Treatment of psychogenic itch (Olivry, 2019)

Answer 23

single drug at recommended dose → escalate dose until side-effects → combine drugs → escalate doses
1) Treat dermatologic (inflammatory itch): glucocorticoids (oral ± topical), oclacitinib, perhaps lokivetmab
2) Add or replace with gabapentin (C: 5-10 mg/kg BID or TID; 50-100 mg/cat BID)
3) Add or replace with antidepressants: amitriptyline, clomipramine, fluoxetine, perhaps mirtazapine, perhaps carbamazepine
4) Add or replace with mu-opioid antagonist: naloxone, naltrexone

Question 24

What are ddx for canine psychogenic dermatoses

Answer 24

1. Psychomotor (partial complex) seizures (e.g. tail biting in dogs)
2. Abnormal movements: myoclonus

Question 25

Causes of acral lick dermatitis

Answer 25

1. Phychogenic causes: always or almost always even if there is an underlying organic disease 2. Allergic causes: it can be the only manifestation of adverse food reaction 3. Neurologic causes

Question 26

What neurologic causes can cause acral lick dermatitis

Answer 26

1. Distal sensory axonal neuropathy 2. Lesions in ventral spinal cord motor nerve roots 3. Peripheral nerve sheath tumors: type I are characterized by hyperesthesia (nerve irritation) without neurologic deficits; usually in front legs 4. Cauda equina syndrome, sciatic nerve inflammation

Question 27

What is the most common place for acral lick dermatitis and rare locations

Answer 27

Rare location: tail, stifle, hip, lateral elbow Site preference: left forelimb

Question 28

How dg of acral lick dermatitis can be made

Answer 28

1. Owner may be unaware of self-traumatic behaviour 2. Dx from normal self-grooming: in normal grooming licking pauses and breaks and there are changes in the posture and the area groomed. 3. Dx from pain or irritation: in cases with pain or irritation there is also chewing 4. Clue in favour of psychogenic component: newly licked area when the original lesions has been covered by a bandage or wrap 5. Biopsy selection: non-ulcerated area 6. Histopathology

Question 29

Histo changes of acral lick dermatitsi

Answer 29

follicular elongation, plasmacytic periadnexal inflammation, vertical streaking fibrosis, traumatic furunculosis; dilatation, hypertrophy, inflammation and occasional rupture of sweat glands

Question 30

What is the atb treatemnt for acral lick dermatitis

Answer 30

Antibiotic treatment: 1. Frequency: bacteria isolated in 97% of the cases 2. Selection: based on deep tissue culture due to frequent isolation of multiple drug resistant organisms and to differences from the results of superficial cultures 3. Empirical treatment: enrofloxacin or potentiated sulfonamides (based on deep cultures)

Question 31

What is the psychogenic treatment for acral lick dermatitis

Answer 31

1. Desensitization, counterconditioning 2. Drugs: tryciclic antidepressants, SSRI, benzodiazepines, phenobarbital, hydroxyzine, endorphin blockers, endorphin agonists, progestins. -Trial periods of 5 weeks which drug is more effective. -Selegiline= treatment of choice for chronic lesions

Question 32

What are recommended treatments for the lesion of acral lick dermatitis

Answer 32

1. Mechanical prevention of licking 2. Repellents 3. Topical glucocorticoids, DMSO, inj glucocorticoids 4. Surgery 5. laser 6. cryosurgery 7. Radiation 8. Acupuncture 9. Oclacitinib

Question 33

What are causes to tail biting or tail chasing and spinning

Answer 33

1. Genetics: autosomal recessive in bull terrier 2. Psychogenic: excessive endorphin release 3. Association with lethal acrodermatitis-Zn 4. Psychomotor seizures: abnormal EEC in all dogs examined 5. Lipids: increased serum cholesterol, HDL and LDL

Question 33

What dog breed are predisposed to tail biting or tail chasing and spinning

Answer 33

1. bull terrtier, GSD

Question 34

DDX to tail biting or tail chasing and spinning

Answer 34

1) infection-trauma, 2) lumbosarcal stenosis-cauda equina syndrome, 3) tail dock neuroma, 4) anal sac disease

Question 35

Causes of flank sucking

Answer 35

1. Trichuriasis (not confirmed) 2. Psychomotor epilepsy: treatment with phenobarbital or primidone 3. Bacterial folliculitis 4. cAD, food allergy 6. Psychogenic (compulsive)

Question 36

What age of onset, triggers and associtaed behaviours are seen with flank sucking

Answer 36

-Age of onset: median 8.5 months -Triggers: inactivity > increased arousal -Associated behaviors: fabric sucking, acral lick dermatitis, pica

Question 36

Name recommended tretamemnt for self- nursing

Answer 36

1. Spaying 2. Sedation, psychological training

Question 37

What causes anal licking

Answer 37

1. Anorectal disease: inflammatory bowel disease, proctitis 2. Anal sack disease, Malassezia anal sacculitis 3. Malassezia dermatitis 4. cAD, food allergy

Question 38

DDX for psychogenic alopecia and dermatitis

Answer 38

1. FLUTD, 2. nephritis, 3. anal sac diseases, 4. internal parasites

Question 38

Clinical DDX for psychogenic alopecia and dermatitsi

Answer 38

-based on distribution 1. FAD: caudal abdomen, medial-caudal thighs 2. fAD, AFR: more generalized, less symmetrical. AFR was the most common cause of the syndrome (at least for cats referred to a behaviorist)

Question 39

Treatment for psychogenic alopecia and dermatits

Answer 39

1. Glucocorticoids: for short-term (2-4 weeks) in case of neurodermatitis 2. Flea control: always 3. Expression of anal sacs: always 4. Clomipramine: not effective 5. Haloperidol

Question 40

MOA and side effects of haloperidol

Answer 40

=dopamine antagonist -may desensitize a-noradrenergic receptors; -initial dose 1mg/kg BID and 1 week hospitalization; -evaluation of response at 2 months; side effects: hallucinations, ataxia, limb twitches.

Question 41

Causes of feline hyperesteshia syndrome

Answer 41

1. Dermatologic: FAD, atopic, food, skin infection, pansteatitis 2. Neuromuscular: epilepsy, brain tumor, spinal cord disease, myopathy, toxoplasmosis 3. Abnormal sensation: hyperesthesia, allodynia, alloknesis 4. Behavioral: stress; compulsive, displacement behavior

Question 42

What are clinical manifestations of feline hyperesthesia syndrome

Answer 42

1. Estrus behavior: increased activity, rolling, elevation of perineum, vocalization 2. Excessive licking, plucking, biting or chewing: flank, lumbar, anal, tail 3. Self-mutilation: inflicted over a short period of time; tail, flanks, forelegs, paws 4. Rippling of the skin, muscle spasms or twitches: dorsally 5. Hard to distract the cat to stop the behavior or only temporal disruption