Separation anxiety Flashcards

1
Q

What is anxiety?

A
  • Reaction to an anticipated threat (about something)
  • Physiologic and behavioral manifestations may be displayed
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2
Q

What is fear?

A
  • Real and present danger
  • Physiologic and behavioral manifestations may be displayed varying with proximity of stimulus
  • Response may be adaptive or survival driven
    • Genetic
    • Aversive experiences
    • Learned
    • Lack of exposure
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3
Q

What is a phobia?

A
  • Excessive (panic, hysteria, catatonia) and maladaptive fear
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4
Q

What is Flooding?

A
  • Constant stimulus exposure until the fear response abates
  • NOT recommended
    • Inhumane
    • Unable to realistcally continue the stimulus to fear resolution
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5
Q

What is classical conditioning?

A
  • Potent + Neutral stimulus
    • Ex:
      • food + can opener
      • toy + mtat
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6
Q

What is desensitization?

A
  • Low level stimulus exposure without eliciting fear
  • EX:
    • practicing picking up keys without leaving
    • Practicing very short (few seconds) departures without anxiety
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7
Q

What is Counter conditioning?

A
  • Unpleasant + Pleasant
  • Ex:
    • Picking up keys when this triggers anxiety + giving food stuffed toy
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8
Q

What is separation anxiety?

A
  • Distress away from the primary caregiver to whom the pet is attached
    • Common in dogs
    • Uncommonly recognized in cats
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9
Q

What is barrier frustration?

A
  • Form of separation anxiety associated with virtual absence from the desired caregiver
    • Ex:
      • Pet in a crate and cannot see owner in the next room
      • Owner is behind a wall or door
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10
Q

What are the statistics of separation anxiety?

A
  • ~17% of dogs seen in US vet clinics have separation anxiety
  • Diagnosed in 20-40% of dogs presenting to behaviorists
  • Separation anxiety is a common cause of relinquishment to animal shelters
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11
Q

What are the symptoms of separation anxiety in dogs?

A
  • Overt behaviors
    • Vocalization
    • Destruction
    • Inappropriate elimination
    • Repetitive or self-mutilation behaviors
    • Autonomic signs
  • Covert behaviors
    • Not eating or drinking when alone
    • Blocking owners exit
    • Playful appearing behavior that is anxiety
  • Occur with virtual or real absence
    • Within minutes or departure & persist or wax/wae
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12
Q

What are the symptoms of separation anxiety in Cats?

A
  • inappropriate urination
    • 75% urinate on the owners bed
  • Inappropriate defecation
  • Excessive vocalization
  • Destructive behavior
  • Psychogenic grooming
  • Hiding, trembling anorexia
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13
Q

How is Separation Anxiety diagnosed?

A
  • Depression/hiding, anxiety, clingy or aggression at indications of leaving
    • Pre-departure cues may trigger behavior
      • Jingling keys
      • Picking up backpack, purse
      • Putting on shoes or coat
  • Video/audio surveillance (may be key in diagnosis)
    • Symptoms consistent with separation anxiety usually within 10 minutes of departure
  • Hyper attachment may (or may not) be common
    • following & touching
  • May demonstrate excessive or urination upon owner arrival
  • History-consistent signs
  • Physical examination (including orthopedic and neurologic)
  • Testing (to rule out another medical cause)
    • CBC
    • Chem 10
    • Urinalysis (possible culture)
    • +/- thyroid testing
    • +/- imaging
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14
Q

How can the environment be managed for separation anxiety?

A
  • Create a calm environment
    • Clean and disinfect soiled areas
    • Consider calming music to reduce anxiety
  • Confinement often worsens anxiety
    • Avoid confinement & create sanctuary space
      • Baby gate/barrier
      • daycare
      • pet sitter
      • take to work
    • Revisit crate training if must be crated
      • use anxiolytics
      • Avoid collar (strangulation risk)
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15
Q

What owner training can be modified for separation anxiety?

A
  • Goal of creating pet independence
    • Ignore attention seeking behaviors (not the pet)
    • teach settle/relax, sit & stay
      • create sanctuary space
    • Earn attention through task performance
      • Nothing is free
      • Eye contact, talking, touching are attention
    • Predictable & adequate enrichment
      • Physical
      • Sniff walks
      • Mental
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16
Q

What is Mat Training?

A
  • Encourage a mat or pet bed in sancutary space
    • Clicker when pet looks at mat
    • Use massage/petting on mat
    • Giving treats/toys/praise on the mat
    • Using mat for obedience exercises
17
Q

How can pets be desensitized to departures?

A
  • Uncoupling departure cues
    • Put on coat, jingle keys, pick up bag, etc. at a level that does not create anxiety & not in association with departure
      • Repeat process until pet is not reactive
        • 2-4x per day
        • pet must be calm between session
18
Q

How can pets be counter conditioned for departures?

A
  • Goal: Pet cannot be anxious & relaxed concurrently
  • Identify a special toy/treat for departures
    • Give also at times not departing to avoid predicting departure
    • Give to reward calm behavior 10 minutes prior to leaving
  • Teach alternative activity when owner approaches door
    • Down/stay
    • “go to mat”
19
Q

What should owners do during a graduated planned departure?

A
  • Only begin this training if pet relaxed & can settle
  • Ignore 15-30 minutes before departure and offer special toy/treat & consider placing into sanctuary space
  • Departure is VERY short (1-5 minutes)
  • Use a “safety cue” that departure is short
    • Ex: air freshener, radio, rug put down
  • Practice short departures of varying times
    • 1-5 minutes with goal to lengthen time away
  • Use audio/video surveillance to monitor anxiety
    • Do not engage a this may confuse/increase anxiety
20
Q

What should owners do during the real departure?

A
  • Ignore for 15-30 minutes prior then calmly leave
    • May encourage sanctuary space if needed
    • Offer special toy or treat prior to departure
  • Only performed when settled/relaxed
  • Use audio/video surveillance to monitor anxiety
    • Do not engage as this may confuse/increase anxiety
  • Be aware of trigger stacking
    • progressive anxiety as departures continue over the week or schedule changes
21
Q

Why use medications for separation anxiety?

A
  • Some pets are at risk of injury due t the pet’s phobia
  • Medication along with behavioral training can speed improvement & more quickly improve quality of life
  • Failure to promptly address separation anxiety may result in relinquishment or euthanasia
22
Q

What are the options for medication for separation anxiety?

A
  • Event medications (as needed)
    • effect in 1-2 hours
    • off label
  • Daily Medications (slow acting
    • Full effect in 4-6 weeks
    • 2 FDA approved
  • Tranquilizers
    • effect in 1-2 hours
    • off label
23
Q

What are the event medications that can be used for separation anxiety?

A
  • Benzodiazepines
  • Trazodone
  • Gabapentin
  • Clonidine
24
Q

How can Benzodiazepines be used for separation anxiety?

A
  • Alprazolam (less sedation)
  • Diazepam (dogs only)
  • Lorazepam (less paradoxical excitation)
  • Clonazepam (longest acting)
  • MOA:
    • potentiate GABA
      • inhibitory neurotransmitter
  • Risks:
    • sedation, paradoxical excitement, disinhibit aggression, human abuse, may inhibit learning & require frequent dosing
  • Most likely category to see aggression in
25
Q

How can Trazodone be used for separation anxiety?

A
  • Serotonin antagonist/reuptake inhibitor
  • Short-acting, non-FDA approved
  • WIDELY used in dogs and cats for anxiety disorders
  • Peak 1-2 hours (dogs), 2 hours (cats)
    • less effective is already fearful
  • Acute or chronic dosing
  • Side Effects:
    • none, sedation, GI, rarely paradoxical behavior including aggression, may decrease blood pressure in cats if >50mg/cat
  • Caution with seizures, heart disease, liver, or kidney disease
  • Can be used with SSRIs, TCAs or benzodiazepines to improve anxiety management
26
Q

How can Gabapentin be used for separation anxiety?

A
  • Unknown MOA as an anxiolytic
  • Give 1-2 hours before needed
  • side-effects:
    • sedation/ataxia, rarely GI upset
  • Dogs:
    • 10-40 mg/kg PO q 8hr
  • Cats:
    • 10-20 mg/kg PO q 8 hr
    • 50-100 mg/cat PO q 8 hr
  • Some human liquid formulations contain xylitol
    • Avoid in dogs as this can cause severe drop in blood sugar and liver necrosis
27
Q

How can Clonidine be used for separation anxiety?

A
  • Alpha 2 adrenergic agonist
  • Consider with panic
  • Side effects:
    • sedation/ataxia, aggression, hypotension
28
Q

What are the daily Medications available for Separation Anxiety?

A
  • Fluoxetine
  • Clomipramine
29
Q

How can Fluoxetine be used for separation anxiety?

A
  • SSRI
  • FDA-Approved for canine separation anxiety
    • Good for panic, vocalization, pacing, panting, fear-based aggression
  • Only effective when combined with behavior modification
30
Q

How can Clomipramine be used for separation anxiety?

A
  • TCA with affects on Serotonin & Norepinephrine
  • Some anticholinergic effects
    • Consider for those with vomiting, diarrhea, drooling
  • FDA Approved for canine separation anxiety
    • recommend divide daily dose into 2 doses
31
Q

What is Serotonin Syndrome

A
  • Syndrome characterized by mental, autonomic & neurological symptoms
    • Hyperthermia
    • Dilated pupils
    • Agitation
    • Tachycardia
    • Panting
    • GI distress
    • Muscle Tremors
    • Seizure
    • Death
  • Occurs:
    • Combining 2 serotonin enhancing drugs, or with overdose of one serotonin enhancing drug
    • We believe some animals have a higher innate risk of this occurring
32
Q

How can acepromazine be used for separation anxiety?

A
  • Phenothiazine tranquilizer
    • Blocks dopamine receptors in the brain dulling awareness
    • Reduces motor function/tranquilizers 45-60 minutes after given
    • Lasts up to 8 hours
  • NOT an anxiolytic
  • Should NOT be used alone to manage separation anxiety or phobias
  • Can be combined with short & long-acting anxiolytics
    • Low doses initially & increase (to effect) for additional sedation
      • EX: dog trying to jump out an apartment window when on trazodone + gabapentin & starting a daily anxiolytic for separation anxiety
33
Q

What are alternatives to medication to manage Separation Anxiety?

A
  • Dietary
  • Auditory
  • Pheromones
  • Targeted Pulse electromagnetic field
34
Q

What is Purina ProPlan Veterinary Supplement Calming Care?

A
  • Bifidobacterium longum BL 999
    • action upon the gut-brain axis by signaling to the brain via the vagus nerve
    • alters the microbiome - only while taking the supplement
  • Off-label use in cats (can try ½ packet per day)
35
Q

What Pheromone is available for separation anxiety?

A
  • Adaptil for dogs
    • Mimic the properties of the natural pheromones of the lactating female
    • Wipes, spray, collar, diffuser (72 hrs to build up effect)
    • 1 study
36
Q

What is a Calmer Canine device?

A
  • A targeted pulse electromagnetic field (tPEMF) of a loop held by a vest two 15-minute sessions per day for 4-6 weeks = 1 treatment course
  • Inhibits proinflammatory cytokines in brain
    • Increase serotonin, endorphins & dopamine
37
Q

What behaviors should owners avoid?

A
  • Yelling
  • Recognize “he looks guilty” is an appeasement gesture
  • Hitting
  • Shock collars
  • Emotional departures & greetings
  • Get another pet & assume it will “fix” the problem
38
Q

What behaviors should owners remember to do to reduce separation anxiety?

A
  • Reward relaxed behaviors
  • Reward a pet following a simple command
  • Keep routine consistent (as possible)
  • Continue mental & physical enrichment
  • Greet the pet with a soft/calm voice when calm
39
Q

What should you remember as a veterinarian treating separation anxiety?

A
  • Empathy
    • some owners believe the pet is acting out of anger or spite
      • Educat that the pet is experiencing an emotional disorder
    • Communication before & after appointment is key
    • Plan:
      • set expectation of 4-8 weeks to modify behavior
      • No more than 5 recommendations
      • no more than 30 minutes per day of actively working on the condition