Phobias Flashcards

1
Q

What are the origins of Noise and Storm Aversion?

A
  • Developmental
    • _Lack of exposur_e in the first few months of life
    • Sensitized exposure chronically to arousing noises
  • Learned
    • Traumatic experience associated with a sound
    • Socially mediated exposure to another individual with noise aversion
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2
Q

What are the statistics of Noise and Storm aversion?

A
  • 49% of dogs show aversion to noise
  • Most common triggers:
    • Fireworks
    • Gunshots
    • Thunder
  • ⅓ of owners with dogs with noise phobia seek medical advice
  • Exposure to fireworks, vehicle noise, banging, vacuum cleaners & loud voices in dog prior to 6 months of age may reduce noise phobia
  • >75% of dogs with noise phobia also have storm phobia & vice versa
  • >85% of dogs with storm & noise phobias have separation anxiety
  • Motion sickness is common comorbid condition with noise phobia
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3
Q

What is noise reactivity?

A
  • An over-reaction to a noise
  • Begins in the locus coeruleus of the amygdala
  • Pathway is triggered easier & faster in a noise reactive patient
    • takes less stimulus over time
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4
Q

What is Anxiety?

A
  • Reaction to an anticipated threat
  • Something is not there
  • Physiologic and behavioral manifestations may be displayed
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5
Q

What is Fear?

A
  • Real and present danger
    • “Something is there” with response influenced by learning
  • Physiologic & behavioral manifestations may be displayed varying proximity of stimulus
    • Example: fast heart-rate & respiration & escape with tornado moving toward vehicle & can shake it off/recover… this is expected fear
  • Simple fears: specific stimulus triggers response with avoidance & exploration following exposure
  • Complex Fears: A variety of triggers generate a fear response
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6
Q

What is a Phobia?

A
  • Excessive (panic, hysteria, catatonia) & maladaptive fear
  • Usually involves short or ineffective avoidance & escape response + autonomic signs
  • No purpose / no beneficial
    • Ex: fast hear rate, fast respirations, & trying to escape when the sky gets cloudy
  • More resistant to treatment
  • Not able to recover spontaneously
    • may take hours, days, weeks
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7
Q

What are the symptoms of Noise Aversion?

A
  • Escape attempts-digging & chewing
  • Vocalization
  • Inappropriate elimination & salivation
  • Hiding / immobile & avoidance (retreating)
    • less likely to seek veterinary care
  • Self-trauma
  • Aggression
  • Owner-seeking behavior
  • Not eating
  • Ignoring commands
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8
Q

How is Noise Aversion diagnosed?

A
  • History:
    • Reactivity with any component of a noise or storm (wind, noise, lightening, altered barometric pressure, atmospheric ionization, rain, clouds / darkening)
  • Behavior History:
    • What is the trigger
    • How long to recovery
    • Symptom frequency & severity
    • Owners response
  • Physical Examination
  • CBC, Serum, Chemistry profile & urine testing, +/- thyroid evaluation
  • Rule out medical/behavioral causes
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9
Q

What Comorbidities are common with Noise Aversion?

A
  • Older dogs with noise phobia frequently had musculoskeletal pain
  • Consider pain in dogs diagnosed with noise phobia especially older dogs with no prior history of noise phobia
  • Treatment:
    • analgesia
    • possible anxiolytics
    • desensitization & counter-conditioning
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10
Q

How can the environment be changed to help with Noise Phobias?

A
  • Provide a secure & safe retreat where stimulus is minimized & support a location the pet selects (Sanctuary Space)
  • White noise
  • Ceiling fan
  • Music
  • Sound-proofing
  • room darkening
  • Kennel/blankets
  • Mat training
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11
Q

What behavioral management can be implement to help with noise phobias?

A
  • Fear conditioning isn’t gone - positive has to outweigh the negative
  • Plenty of enrichment
  • Manage other anxieties
  • Work with head harness & drag line training “sit” & “down”
  • Teach & reward calm/relaxed behavior
  • Allow the animal to cope/hide during event
  • Comforting doesn’t reinforce fear
  • Positive attitude/don’t show fear
  • AVOID punishment - increases fear
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12
Q

How can Desensitization and Counter-Conditioning be used for Noise phobias?

A
  1. Begin with scary stimulus at low volume (not causing symptoms)
  2. Gradual volume increase
  3. Move slowly & gradually to increased volume (if no symptoms)
  4. 5 - 10 minute sessions daily
  5. Provide special treats, massage or play during noise
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13
Q

What medications can be used for Noise Phobias?

A
  • Dexmedetomide Oromucosal gel - Sileo
  • Imepitoin - Pexion
  • Benzodiazepines
  • Clonidine
  • Trazodone
  • Gabapentin
  • Acepromazine
  • TCAs
  • SSRI’s
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14
Q

What is Dexmedetomide oromucosal gel - Sileo?

A
  • Centrally actin norepinephrine blocker
  • Anxiolytic effect
  • FDA-Approved canine noise aversion treatment
  • Give 30 minutes before event
  • Side effects - vomiting, excessive sedation
  • Avoid with cardiovascular disease, respiratory, liver or kidney disease, shock, debilitation, dental or gingival disease
  • Owner must wear gloves to administer
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15
Q

What is Imepitoin - Pexion ?

A
  • A partial agonist at the benzodiazepine binding site of the GABAA receptor
  • Binds to receptor 600x less than diazepam (lessen side effects & development of dependence/abuse)
  • Action is neuronal inhibition 2-3 hours after a dose
  • anxiolytic
  • Anti-convulsant
  • FDA approved for treatment of noise aversion in dogs (not available in USA)
  • Side-effects: lethargy, ataxia, increased appetite, vomiting
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16
Q

What Benzodiazepines are used for Noise Aversion?

A
  • GABAA agonists (inhibitory neurotransmitter)
  • Give 30 minutes to 1 hour prior to event (but can work during event)
  • Anxiolytic
  • Anti-panic
  • Drugs:
    • Alprazolam (favorite because of longer half life)
    • Lorazepam
    • Diazepam (short duration of effect-rescue drug if in an event)
  • Risks sleepiness, ataxia, behavioral disinhibition (avoid with aggression) idiopathic excitement, human abuse
17
Q

What is Clonidine?

A
  • Centrally acting norepinephrine blocker (alpha 2 agonist)
    • reduced sympathetic outflow from the central nervous system (gave prior to the event to be effective)
  • Side effects: low blood pressure, low heart rate, drowsiness, constipation (avoid cardiovascular & kidney disease)
18
Q

What is Trazodone?

A
  • Serotonin antagonist/reuptake inhibitor human medication
  • Effect in 45-2.5 hours in dogs & repeated up to every 8 hours
    • must give prior to event to be most effective
  • Side-effects: sleepiness, behavioral disinhibition, rarely GI upset
  • Document client discussion of risks & closely monitor if utilizing two serotonin enhancing drugs together
19
Q

What is Gabapentin?

A
  • Unknown anxiolytic properties in dogs & cats
  • Trial to gauge effect (usually about 2 hours prior in dogs & cats & must give prior to event to be most effective)
  • May see sedation, ataxia, and rarely GI side effects
20
Q

What is Acepromazine?

A
  • Phenothiazine tranquilizer
  • Blocks dopamine receptors in the brain dulling awareness & reduces motor function
  • Tranquilizes in 45-60 minutes & lasts up to 8 hours
  • Not an anxiolytic
  • Should not be used alone to manage noise phobias
  • Can be combined with other anxiolytics
  • Low doses initially & increase for additional sedation
21
Q

What are Tricyclic Antidepressants (TCA’s)?

A
  • None FDA approved for noise phobias in dogs or cats
  • 4-8 weeks to effect
  • Options:
    • Clomipramine
    • Amitriptyline
22
Q

What are Selective Serotonin Re-uptake Inhibitors (SSRI’s)?

A
  • None FDA approved for noise phobias in dogs or cats
  • 4-8 weeks to effect
  • Options
    • Fluoxetine
    • Sertraline
    • Paroxetine
23
Q

What are the Alternative Therapies for Noise Aversion?

A
  • Headphones
    • mutt muffs
  • Auditory distraction
    • white noise, music, etc.
  • Decreased electrical charge
    • Storm Defender Cape
  • Decreased visual input
    • Doggles
    • Thundercap
  • Pressure/swaddling wraps
    • AnxietyWrap
    • Thundershirt Insanely Calm
24
Q

How can owners be supported?

A
  • Set expectations
    • Formulate environmental & behavioral management plans
    • Medications may be needed & may be multi-modal or multiple anxiolytics together
    • Desensitization & Counterconditioning takes months
    • Some pets require medication forever
  • Empathize
    • Owners have a range of emotions when caring for fearful pets