Separation anxiety

Question 1

What is anxiety?

Answer 1

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

Question 2

What is fear?

Answer 2

• 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

Question 3

What is a phobia?

Answer 3

• Excessive (panic, hysteria, catatonia) and maladaptive fear

Question 4

What is Flooding?

Answer 4

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

Question 5

What is classical conditioning?

Answer 5

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

Question 6

What is desensitization?

Answer 6

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

Question 7

What is Counter conditioning?

Answer 7

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

Question 8

What is separation anxiety?

Answer 8

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

Question 9

What is barrier frustration?

Answer 9

• 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

Question 10

What are the statistics of separation anxiety?

Answer 10

• ~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

Question 11

What are the symptoms of separation anxiety in dogs?

Answer 11

• 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

Question 12

What are the symptoms of separation anxiety in Cats?

Answer 12

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

Question 13

How is Separation Anxiety diagnosed?

Answer 13

• 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

Question 14

How can the environment be managed for separation anxiety?

Answer 14

• 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)

Question 15

What owner training can be modified for separation anxiety?

Answer 15

• 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

Question 16

What is Mat Training?

Answer 16

• 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

Question 17

How can pets be desensitized to departures?

Answer 17

• 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

Question 18

How can pets be counter conditioned for departures?

Answer 18

• 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”

Question 19

What should owners do during a graduated planned departure?

Answer 19

• 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

Question 20

What should owners do during the real departure?

Answer 20

• 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

Question 21

Why use medications for separation anxiety?

Answer 21

• 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

Question 22

What are the options for medication for separation anxiety?

Answer 22

• 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

Question 23

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

Answer 23

• Benzodiazepines
• Trazodone
• Gabapentin
• Clonidine

Question 24

How can Benzodiazepines be used for separation anxiety?

Answer 24

• 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

Question 25

How can Trazodone be used for separation anxiety?

Answer 25

* 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

Question 26

How can Gabapentin be used for separation anxiety?

Answer 26

* **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**

Question 27

How can Clonidine be used for separation anxiety?

Answer 27

* Alpha 2 adrenergic agonist * Consider with panic * Side effects: * sedation/ataxia, aggression, hypotension

Question 28

What are the daily Medications available for Separation Anxiety?

Answer 28

* Fluoxetine * Clomipramine

Question 29

How can Fluoxetine be used for separation anxiety?

Answer 29

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

Question 30

How can Clomipramine be used for separation anxiety?

Answer 30

* 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

Question 31

What is Serotonin Syndrome

Answer 31

* 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

Question 32

How can acepromazine be used for separation anxiety?

Answer 32

* 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

Question 33

What are alternatives to medication to manage Separation Anxiety?

Answer 33

* Dietary * Auditory * Pheromones * Targeted Pulse electromagnetic field

Question 34

What is Purina ProPlan Veterinary Supplement Calming Care?

Answer 34

* 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)

Question 35

What Pheromone is available for separation anxiety?

Answer 35

* 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

Question 36

What is a Calmer Canine device?

Answer 36

* 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

Question 37

What behaviors should owners avoid?

Answer 37

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

Question 38

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

Answer 38

* 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

Question 39

What should you remember as a veterinarian treating separation anxiety?

Answer 39

* 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