Page 1391 - Cote clinical veterinary advisor dogs and cats 4th

702 Obsessive-Compulsive Disorder

Epidemiology PHYSICAL EXAM FINDINGS • Treatment is a combination of behavioral and
SPECIES, AGE, SEX • Often unremarkable environmental modification and psychotropic
VetBooks.ir GENETICS, BREED PREDISPOSITION • Weight loss if near-constant • The goal is to minimize and, if possible,
• Skin lesions possible with overgrooming/
medication.
Dogs and cats of any age
self-mutilation
eliminate bouts of compulsive behavior and
Dogs: genetic predisposition is suspected. Anec-
dotally, certain syndromes are more commonly Etiology and Pathophysiology the concomitant focused, anxious states that
accompany them.
associated with some breeds: • A genetic contribution is suspected.
• Acral lick dermatitis: large and giant dog • In humans, the current hypothesis for Acute and Chronic Treatment
breeds OCD involves dysfunction in a neuronal • Owner should identify and eliminate trigger
• Air/fly snapping, checking (hindquarter area), circuit traversing from the orbital frontal events/situations whenever possible.
star gazing: miniature schnauzer cortex to the cingulate gyrus, caudate • No punishment should ever be used because
• Flank sucking: Doberman pinscher nucleus, putamen (i.e., striatum), globus it can heighten anxiety and worsen, not
• Spinning/tail chasing: German shepherd dog, pallidus, thalamus, and back to the frontal improve, the problem.
bull terrier, Parson Russell and Jack Russell cortex. • If possible, the pet can be redirected to an
terriers • Dysfunction involving glutamate and/or alternative and incompatible behavior, such
Cats: fabric chewing or ingestion is anecdotally gamma-aminobutyric acid (GABA) is an as licking food from a toy instead of licking
associated with Asian breeds (e.g., Siamese, additional focus of research. the skin, as long as the redirection does not
Tonkinese, Burmese). • Acral lick dermatitis appears to involve make the pet more anxious.
interplay between behavioral, neurologic, • The pet should be calmly rewarded for any
RISK FACTORS and dermatologic conditions in many cases spontaneous calm behavior.
• Stressful or traumatic event, especially for (p. 16). • Keeping a structured daily routine helps
cats decrease anxiety.
• Lack of a daily routine or change in a well- DIAGNOSIS • The most successful medications used in the
established routine treatment of OCD in people include selective
Diagnostic Overview serotonin reuptake inhibitors (SSRIs) and
CONTAGION AND ZOONOSIS Performance of repetitive, invariant behaviors clomipramine, a tricyclic antidepressant (TCA).
Characteristically, OCD is not induced in that are spontaneous or triggered, are difficult In dogs and cats, the most commonly used are
conspecifics (e.g., housemates) by affected or impossible to interrupt, and interfere with ○ Clomipramine (Clomicalm): dogs, 2-3 mg/
individuals. normal maintenance and social behaviors are kg PO q 12h; cats, 0.5 mg/kg PO q 24h
characteristic of OCD. ○ SSRI drugs (fluoxetine [Prozac]): dogs,
ASSOCIATED DISORDERS 1 mg/kg PO q 24h; cats, 0.5 mg/kg PO
The patient may have multiple diagno- Differential Diagnosis q 24h, paroxetine (Paxil): dogs, 1 mg/kg
ses of other impulsive or anxiety-based • Attention-seeking (behavior occurs only when PO q 24h; cats, 0.25-0.5 mg/kg PO
disorders. the owner is present) ○ Treat for a minimum of 16 weeks; many
• Separation anxiety (behavior occurs only OCD patients require lifelong medication.
Clinical Presentation when the owners are absent) • Very distressed pets may need concomitant
HISTORY, CHIEF COMPLAINT • Cognitive dysfunction (middle-aged/geriatric use of benzodiazepines (BDZs); anxiolytics
• Repetitive behavior that is out of context animals that pace or stare) have faster onset of action
(might have been exacerbated over time or • Hyperthyroidism (primarily cats) ○ Diazepam or oxazepam (oxazepam for cats,
begun suddenly) • Neuropathic pain disorders (e.g., feline hyper- obese patients, liver disease) 0.2-0.4 mg/kg
• Inciting triggers may be identifiable, or the esthesia, neck and shoulder hyperesthesia in PO q 12-24h, alprazolam 0.01-0.025 mg/
behavior may occur spontaneously. syringomyelia in the Cavalier King Charles kg PO q 8-24h, or clonazepam (dogs)
• Earlier in the course, the owners might spaniel) 0.01-0.05 mg/kg PO q 12-24h for the
have been able to stop the behavior, but • Degenerative joint disease, anal sac disease, first 2-3 weeks of treatment. Adjust to
that may not be the case at the time of cystitis, and less commonly, endoparasitism ideal dose based on response and lack of
presentation, and the pet may not stop until (excessive licking or hindquarter checking) adverse (e.g., hepatic) effects. May also be
exhausted. • Circling, spinning, and air-snapping patients used preemptively when stress or change
• The pet may hide (to perform the behavior), should be evaluated for peripheral or central in routine is anticipated
become aggressive when the owners try to vestibular disease, psychomotor seizures, or • Gabapentin, a GABA analog, is another
stop the behavior, or may begin avoiding other central nervous system lesions. useful adjunct medication; dogs, 3-5 mg/
the owners. kg PO q 12h; cats 5-10 mg/kg PO q 12h
• Distress vocalizations (whining, crying, Initial Database starting low and titrating to effect
yowling, or growling) may occur before, • CBC, urinalysis, and serum chemistry • N-methyl-D-aspartate (NMDA) antagonists
during, or after performance of the com- profile: usually within reference limits (assess hold promise as a potential treatment of
pulsive behavior. for systemic disorders before initiation of OCD as single pharmacologic agents or as
• When owners do not identify the behavior medications). Fecal exam warranted for an adjunct to SSRIs.
as abnormal, the chief complaint may hindquarter checking. • Skin lesions secondary to overgrooming
be damage to self (alopecia, granuloma, • Neurologic examination (p. 1136) may require treatment with antibiotics,
weight loss, change in voice, recurring • Dermatologic diagnostic tests (p. 1091) if analgesics, and/or antiinflammatories. Cold
gastrointestinal obstruction due to pica), skin lesions are a feature laser therapy can be used to decrease pain
damage to the home, or altered social and inflammation and to speed healing of
interactions. TREATMENT acral lick granuloma lesions. The underlying
• The chief complaint may suggest partial mood disorder that led to excessive grooming
seizures or dysphoria. Treatment Overview needs to be managed (p. 16).
• With chronicity, some owners may not • All cases of OCD warrant intervention, which • Typically, TCA or SSRI therapy is necessary
consider the behavior problematic or is individualized and based on frequency and for longer periods than other anxiety-based
abnormal. severity of clinical signs. disorders (months to years, depending on

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