Page 1561 - Cote clinical veterinary advisor dogs and cats 4th

Phobias 787

Phobias
VetBooks.ir Diseases and Disorders

ptyalism, elimination, anal sac expression,
BASIC INFORMATION
immobility, repeated startle responses, and systemic illness triggering or contributing to
phobic states or before initiating medication
Definition behaviors associated with avoidance). (if indicated)
Behaviors are characterized by persistent and • The onset may be acute, with or without an • Perform additional tests based on history and
extreme anxiety and avoidance that occur only identifiable trigger, or may worsen over time. physical exam findings (e.g., feline leukemia
in response to specific triggers. The fear response If escape attempts are interrupted, growling, virus, feline immunodeficiency virus, serum
is out of proportion given the objective threat, is snarling, lunging, or biting may be elicited. T 4 assays in most adult cats).
beyond voluntary control, and may be preceded • The aroused state may persist for minutes/
by anticipatory anxiety. hours. Advanced or Confirmatory Testing
• Clients’ chief complaints may be only If signs of neurologic dysfunction are present
Epidemiology destructive behavior, excessive vocalization, or develop, a primary behavioral abnormality is
SPECIES, AGE, SEX or house soiling, without awareness of their virtually never the sole diagnosis. Extracranial
• Dogs and cats of any age meaning as markers of anxiety. Because and intracranial medical disorders should be
• As with most behavioral conditions, phobias many clients crate their dogs to resolve such investigated as appropriate.
most commonly develop during social behaviors, it is important to query clients
maturity (12-36 months in dogs, 24-48 regarding the reason they do so; otherwise, TREATMENT
months in cats). signs may be missed until the dog escapes
the crate, frequently injuring himself/herself Treatment Overview
GENETICS, BREED PREDISPOSITION in the process. The goal is to produce a decreased or ablated
Predispositions are suspected, but modes of • Cats may show signs that the clients may response to the inciting trigger as evidenced by
inheritance, population, and breed variability misinterpret as normal, such as frequent a reduction in or elimination of overt signs of
are mostly unproven. Candidate gene regions and extended hiding out of context with sympathetic arousal.
are associated with noise-reactive phenotypes the situations that trigger the behaviors (i.e.,
in Australian shepherds, border collies, and scaredy cats). Acute and Chronic Treatment
German shepherds. • The client should help the pet avoid exposure
PHYSICAL EXAM FINDINGS to the panic-inciting stimulus if it has been
RISK FACTORS • Generally unremarkable exam findings; identified.
Mild signs may exacerbate quickly after expo- damage to teeth, nails, or feet in extreme • The client should reward any spontaneous
sure to a trigger of large magnitude. cases decrease in reactivity to phobic triggers.
• Self-inflicted injuries as dogs attempt to break • Benzodiazepines (BZDs) for their quick
CONTAGION AND ZOONOSIS out of crates in which they are confined as onset of action and specific panicolytic
A young dog that seems well adjusted and joins “treatment” for anxiety-associated behaviors effects should be prescribed in combina-
a home with a phobic dog may learn (and/or tion with other psychotropic medications
may react to) some of the behaviors associ- Etiology and Pathophysiology such as tricyclic antidepressants (TCAs)
ated with the phobia (e.g., reactive barking), Dogs, like humans, may have susceptibility or selective serotonin reuptake inhibi-
especially if these behaviors engender attention. genes for development of pathologic anxieties. tors (SSRIs). Clonidine and gabapentin
Dysfunction or dysregulation of caudate nuclei are also options as adjuncts to TCAs or
GEOGRAPHY AND SEASONALITY in the brain has been implicated in some phobic SSRIs.
Holidays that are celebrated with fireworks, states. Inadequate in utero nutrition has also • Trazodone, a serotonin antagonist and
gunfire, or cannon blasts; seasonal thunderstorms been associated with heightened reactivity. Cats reuptake inhibitor (SARI) may be a useful
may remain aroused for 24-48 hours after an adjunct in combination with an SSRI or
ASSOCIATED DISORDERS event of profound hypothalamic stimulation. TCA when other combinations do not reduce
Comorbidity of thunderstorm phobia and The worse the panic, the more insensitive the symptoms. A dexmedetomidine oromucosal
separation anxiety (p. 905) is high. animal is to routine physical or social stimuli. gel (Sileo) is FDA approved to treat noise
aversion and provides almost immediate relief
Clinical Presentation of sympathetic signs.
DISEASE FORMS/SUBTYPES DIAGNOSIS ○ TCA medications
• Thunderstorm/storm phobia Diagnostic Overview ■ Amitriptyline 1-2 mg/kg PO q 12h
• Noise phobia (single or combination noise From the behavioral history, a diagnosis is made (dogs); 0.5-1 mg/kg PO q 12-24h
types such as booming, metallic, electronic, when extreme fear or anxiety (anticipatory fear) (cats). Treat for a minimum of 30
other noises) is provoked by specific triggers and the severity days. First drug of choice in mild cases
• Neophobia (fear of new objects or of the fearful response is out of context with without contraindications to their use;
circumstances) the risk the trigger represents. inexpensive
• Panic ■ Clomipramine 2-3 mg/kg PO q 12h
• Other phobias (e.g., reflective surfaces or Differential Diagnosis (dogs); 0.5 mg/kg PO q 24h (cats).
floors, nighttime, other animals) • Generalized anxiety disorder Treat for a minimum of 8 weeks.
• Separation anxiety Most successful when the behaviors
HISTORY, CHIEF COMPLAINT • Learned fear after a traumatic event have a ritualistic or elimination
• Exposure to or anticipation of exposure to • Attention-seeking behavior component
discrete triggering events elicits observable signs ○ SSRI medications
of sympathetic arousal (e.g., tremor, pacing, Initial Database ■ Fluoxetine (Prozac) 1 mg/kg PO q 24h
hypervigilance, scanning of the environment, • CBC, serum chemistry profile, urinalysis: (dogs); 0.5 mg/kg PO q 24h (cats).
restlessness, vocalization, mydriasis, piloerection, generally unremarkable; used to assess Treat for a minimum of 8 weeks.

www.ExpertConsult.com