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788 Phobias

Paroxetine (Paxil) 1 mg/kg PO q 24h Drug Interactions ○ Client compliance (good compliance:
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(dogs); 0.25-0.5 mg/kg PO q 24h • BZDs, TCAs, SSRIs, and SARIs can be • If the best outcome is to be obtained, early
prognosis more favorable)
VetBooks.ir ■ Sertraline (Zoloft) 1 mg/kg PO q 24h needed, but there is potential for sedation, • If the problem is chronic before treatment
(cats). Treat for a minimum of 8 weeks.
combined at lower than normal dosages if
intervention is essential.
and patient response must be evaluated on
(dogs); 0.5 mg/kg PO q 24h (cats).
Treat for a minimum of 8 weeks. Can
a case-by-case basis.
be successful for situations in which • TCAs, SARIs, and SSRIs should not be is sought, treatment may well be lifelong,
especially with other comorbid anxiety-
other medications have been less given with monoamine oxidase inhibitors related conditions.
helpful (MAOIs), found in some flea and tick collars
○ BZD medications and dips and in some cognitive dysfunction PEARLS & CONSIDERATIONS
Diazepam or oxazepam 0.2-0.4 mg/kg medications.
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PO q 12-24h. Treat for a minimum 30 • Use of SSRIs and SARIs with tramadol may Comments
days. increase the risk of serotonin syndrome and • Client observations and reports are critical in
Alprazolam 0.01-0.025 mg/kg PO q should be avoided if possible. If they must data collection; it is important to spend time
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8-24h or q 4-6h for panic (dose should be combined, start both at reduced doses, understanding the client’s use of language.
be increased to a maximum of 2 mg/ titrate each to effect, and watch for signs Asking clients to describe what they see their
dose for a medium-sized dog until of serotonin syndrome; risk is reduced but pet do, rather than their interpretation of
effect or sedation before deciding the not eliminated, and the client should be the behavior, is key in obtaining behavioral
medication is not effective) informed. data.
Clonazepam 0.01-0.05 mg/kg PO q • TCAs should be used with caution in patients • The single best tool for evaluating behavior is
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12-24h or q 4-6h for panic as needed with cardiac arrhythmias, existing hepatic or observing the behavior itself. Video recording
(dogs) thyroid disease. with smart phones and webcams make this
Response to benzodiazepines is very • Paroxetine should be avoided in animals possible. Consider having a video camera
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individualized, and constant com- with renal disease, and gabapentin should clinicians can use in the practice and lend
munication between practitioner and be used with caution. Anecdotal reports of to clients.
client is necessary to achieve adequate constipation are more common in cats, and
titration of the patient’s dose. their owners should be cautioned to monitor Prevention
○ SARI medications stool consistency. • When selecting breeding stock, temperament,
Trazodone 3-7 mg/kg PO, used prn conformation, and medical phenotypes
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or q 8-24h (dogs); 3-8 mg/kg or Possible Complications should be assessed because genetic predisposi-
25 mg/CAT (cats). If given daily, using • Generalization to triggers that are similar tion is suspected to be a strong contributor
one-half of the target dose for 3 days to the original stimulus (e.g., a thunder- to mood disorder development.
may diminish the likelihood of side phobic dog begins to respond to firework • At the first sign of any fearful behavior, clients
effects. Trazodone is well tolerated by displays and then reacts to all loud noises in should watch for worsening of the behavior
dogs, but starting at the lower end of general) and possible triggers that might indicate the
the range and carefully titrating upward • Phobias are almost always comorbid development of a phobia.
is advised while monitoring for signs conditions; screen for comorbidities (most • Veterinarians should screen for fear
of serotonin syndrome. Alone, prn common are separation anxiety, panic and phobias as a routine part of every
treatment is usually not sufficient to disorder, and generalized anxiety disorder). appointment.
abort a phobic response. • BZDs have the potential for drug diversion
○ Gabapentin (GABA analog) 3-5 mg/ and abuse by clients. Technician Tips
kg PO q 12h (dogs); 5-10 mg/kg PO q Noise-phobic dogs may startle repeatedly in
12h (cats), starting low and titrating to Recommended Monitoring response to any small sound.
effect • Animals that take BZDs require a physical
○ Adrenergic agonists exam every 6 months in most U.S. states. Client Education
Clonidine 0.01-0.05 mg/kg PO q The potential for human diversion warrants • Most behavioral conditions are due to
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8-12h (dogs) vigilance regarding refills. chemical and functional brain abnormalities
2
Dexmedetomidine 125 mcg/m (p. • Yearly CBC, serum chemistry profile, (areas of the limbic system and prefrontal
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609), delivered as an oromucosal gel urinalysis, and thyroid screen (q 6 months cortex) and therefore are not willful acts of
(Sileo) (dogs) for geriatric pets) if taking psychotropic disobedience by a pet.
• Using positive reinforcement, clients should medications. Cardiac monitoring is recom- • Treatment of behavioral conditions is an
teach dogs to relax while making eye contact mended if syncope or other suspected cardiac ongoing process, often for the duration of the
with them so that this new behavior can be signs are involved in panic. pet’s life. Relapses may occur with treatment
used when the dog encounters a situation discontinuation or with added stressors.
about which it is anxious or unsure. Clients PROGNOSIS & OUTCOME
should learn to monitor facial cues, body SUGGESTED READING
postures, pupil size and shape, and respiration Prognosis varies and depends on Overall KL, et al: Phenotypic determination of noise
associated with relaxation versus anxiety. • Timeliness of diagnosis (prognosis more reactivity in 3 breeds of working dogs: A cautionary
○ Avoidance of exposure to the panic- favorable for early diagnosis) tale of age, breed, behavioral assessment, and genet-
inciting stimulus • Frequent and thorough communication ics. J Vet Behav Clin Appl Res 16:113-125, 2016.
○ Desensitization to the triggers can be between clinician and client allows treat- AUTHOR: Soraya V. Juarbe-Diaz, DVM, DACVB
accomplished if triggers can be identi- ment to be adjusted according to the EDITOR: Karen L. Overall, MA, VMD, PhD, DACVB
fied and reproduced faithfully and in a animal’s response and needs: prognosis is
systematic and incremental fashion. more favorable.
○ Clients should offer positive reinforcement • Client factors
to their animals for all relaxed and calm ○ Diligence of treatment (comprehensive,
behaviors, particularly when facing phobic persistent treatment plan, and follow-up:
triggers. prognosis more favorable)

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