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744 Panic Disorders and Canine Post-Traumatic Stress Disorder

Panic Disorders and Canine Post-Traumatic Stress Disorder
VetBooks.ir Advanced or Confirmatory Testing

HISTORY, CHIEF COMPLAINT
BASIC INFORMATION
• PD: change in behavior associated with some None. In humans, fMRI confirms asso-
Definition circumstances or pattern of behaviors ciation between stimuli and regional brain
• Extreme responses (e.g., avoidance, escape, • C-PTSD: change occurs with acute trauma response.
anxiety) driven by the sympathetic nervous and associated sensory triggers in an environ-
system in response to an innate perception ment where the dog cannot escape or gain TREATMENT
(panic disorder [PD]) or exposure to an control.
identifiable stimulus/situation from which Treatment Overview
escape is impossible (canine post-traumatic PHYSICAL EXAM FINDINGS Treatment decreases hyperreactivity and
stress disorder [C-PTSD]) Dogs may be acutely fearful and avoidant or hyperarousal associated with stimuli (or
○ C-PTSD signs develop only after the hyperreactive and explosive. Weight loss is remembrance of stimuli) and ultimately gives
terrifying incident that triggered the common. Coat condition may be poor, and the dog control over how he responds to such
disorder. teeth/claws may have been broken attempting stimuli by allowing him to engage in a set
• May include mania or catatonia concomitant escape. of learned, calming behaviors that minimize
with decreased sensitivity/responsiveness to arousal and fear (i.e., cognitive behavioral
pain or social stimuli Etiology and Pathophysiology modification).
• Repeated exposure to any aspect of the cir- • C-PTSD is reported in U.S. military working
cumstance that triggered the original response dogs proportionately to soldiers. It also can Acute General Treatment
(or its memory) results in the characteristic occur in pet dogs subjected to inescapable • If the dog is sleeping fitfully, medication
response. abuse or trapped in terrifying situations (e.g., to encourage restorative sleep is essential:
dogs in crates during fires/burglaries, bait benzodiazepines (alprazolam 0.02-0.04 mg/
Epidemiology dogs for dog fights, prolonged or repeated kg to start; clonazepam 0.125-1.0 mg/kg);
SPECIES, AGE, SEX threat by another dog, injury and entrapment gabapentinoids (gabapentin 10-20 mg/kg
• PD: any dog; little is understood about PD in car accidents). PO q 8-12h or prn before sleep).
in cats, although it likely occurs • Hyperresponsivity to environmental events • Panicolytic: alprazolam; Sileo (i.e., dexme-
2
• C-PTSD: any dog and hypervigilance, behaviors aimed at detomidine, 125 mcg/m ) and fast-acting
escaping or avoiding previously positive or anti-anxiety medications (benzodiazepines)
GENETICS, BREED PREDISPOSITION neutral environments or tasks, changes in daily while giving tricyclic antidepressants
There may be a genetic influence (as in humans). social interaction with human handlers (for and/or selective serotonin inhibitors (clo-
working dogs) or owners/friendly humans mipramine 2-3 mg/kg PO q 12h; fluoxetine
RISK FACTORS (for pet dogs), and failure to perform previ- 1 mg PO q 24h; sertraline 1-2 mg/kg PO
• PD: prior episodes of panic; likely genetic/ ously mastered tasks. q 24h).
neurochemical liability • Removal from the situational environment • Agents that affect peripheral responses:
• C-PTSD: exposure to inescapable traumatic does not alleviate PD or C-PTSD. Signs beta-blockers (propranolol 0.5-1 mg/kg) or
event(s) from which the patient was helpless persist continuously or sporadically. alpha-agonists (clonidine 0.01-0.05 mg/kg;
2
to escape • Human/rodent models suggest a key role Sileo 125 mcg/m [p. 609]) can be given
for the amygdala in hyperresponsivity and multiple times daily.
ASSOCIATED DISORDERS hypervigilance. Caudate nuclei volume differs • Medications can be combined (e.g., fluox-
Separation anxiety, chronic or sporadic diarrhea in matched affected and unaffected twin etine q 24h; gabapentin q 12h; clonazepam
humans. q 24h before sleep; Sileo q 4-6h prn).
Clinical Presentation • Any situation that renders the dog calmer
• PD: acute anxiety in odd contextual circum- DIAGNOSIS (darkened rooms, eye shades, white noise,
stances that are repeatable and consistent certain toys, clothes/bedding that smells like
• C-PTSD: working dogs lose focus, appear Diagnostic Overview the client) should be provided.
distracted, are reluctant to emerge from Diagnosis is based on behavioral evalua-
their kennels or try to return quickly, show tion and in ruling out other differential Chronic Treatment
increased hesitance in work until refusing diagnoses. Treatment is lifelong. Cognitive behavior
or being unable to do so modification teaches the dog to use practiced
• Pet dogs actively resist being left in any social/ Differential Diagnosis calming behaviors to alter his physiologic state.
physical circumstance associated with the Lack of early social exposure, lack of early Daily medication helps facilitate and maintain
provocative event(s). They pant, salivate, exposure to novel environments; traumatic these responses.
shake, tremble; have an oblique, darting brain injury (TBI), organic brain disease (e.g.,
gaze; and experience muscle fasciculations, neoplasia) Behavior/Exercise
lowered body postures, cringing, and tail Cognitive games (e.g., find it, the shell game,
tucks. Dogs may have nightmares that Initial Database nosework) or exercise may help. Any task
manifest these signs, and signs appear on • CBC, serum biochemistry profile, urinalysis: engendering engagement should be rewarded,
exposure to a triggering stimulus (e.g., fire to rule out medical disorders and in anticipa- even if it is just sitting and looking happy for
alarm, someone who resembles an abusive tion of medical treatment. Stress leukogram a treat.
trainer). is common (p. 1283).
• Other tests for common illnesses that owner/ Possible Complications
DISEASE FORMS/SUBTYPES handler may mistake for signs of PD or If the client is unable to protect the dog from
Unlike panic, which can be idiopathic, all forms C-PTSD (e.g., thyroid profile, vector-borne the provocative stimuli (e.g., police/ambulance
of C-PTSD are induced by trauma. disease titers) sirens), recovery will be more difficult.

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