Page 1024 - Problem-Based Feline Medicine

1016 PART 12 CAT WITH BEHAVIORAL PROBLEMS

(tongue, pharynx and hard palate) making eating diffi- Remove or minimize the cause of the anxiety if
cult or impossible. Bleeding may occur associated with possible.
hard palate ulcers.
Provide a regular predictable routine, such as feed
In feline hyperesthesia syndrome, cats may become and play at a set time each day. Treatment involves
agitated and aggressive and show skin rippling and altering the neurochemical as well as the physical envi-
muscle spasms, usually over the lumbar area after stim- ronment. Potential side effects should be explained to
ulation such as stroking. They may exhibit frenzied the owner prior to instigating any therapy, as most of
behavior such as licking or biting at the flanks, back or the drugs are not registered for use in animals.
tail or frantic running. ● Medications that influence serotonin metabolism,
such as the selective serotonin reuptake inhibitors
Diagnosis and the tricyclic antidepressants have been used in
the treatment of anxiety-related disorders. Anxiolytic
Diagnosis is based on a complete behavioral history,
medication has also proved useful in some cases.
and thorough physical examination including a com-
The comparative effectiveness of each medication
plete blood count and biochemistry panel.
remains to be evaluated and may depend on elicit-
No evidence of dermatological causes, such as atopy, ing causes.
external parasites, food allergy is identified. ● Tricyclic antidepressants (TCAs) have proved to
be effective.
Microscopic examination of plucked hair has evi-
– Amitriptyline (0.5–1 mg/kg PO q 12–24 h, aver-
dence of shear. Hair that is lost due to endocrine con-
age of 5–10 mg/cat PO q 24 h). Start at the low-
ditions has telogen bulbs visible.
est dose and increase after 10 days if no response.
– Clomipramine (0.5 mg/kg PO q 24 h).
Differential diagnosis
● Selective serotonin re-uptake inhibitors (SSRIs)
Any skin disease causing pruritus should be eliminated. such as fluoxetine (0.5 mg/kg PO q 24 h) have
● External parasites, dermatitis of fungal or bacte- been successful in controlling signs in some cases.
rial origin are differentiated on the basis of derma- Toxicity has been reported in humans when used
tological examination. with cyclosporine.
● Food allergy is differentiated by use of a food ● Benzodiazepines, such as diazepam (0.2–0.4
trial for 6–8 weeks that leads to resolution of signs mg/kg PO q 12 h – average of 1–2 mg/cat PO q 12
when a novel protein such as venison or duck is h) are effective in some cats. Oxazepam (0.2–0.5
introduced. mg/kg PO q 12–24 h) is useful where diazepam
● Endocrine disorders are differentiated on the leads to excessive sedation.
basis of distribution of hair loss that is usually ● Blood biochemistry analysis should be done prior
symmetrical, as well as microscopic examination to medication to determine baseline concentrations
of hair indicating the presence of telogen bulbs. especially for liver and kidney parameters. The cat
● Feline hyperesthesia syndrome is a poorly under- may require medication for a prolonged period
stood condition which may be differentiated on the (up to 6–12 months) and then slow withdrawal of
basis of signs of extreme sensitivity to touch on medication should be attempted. If cats require
the dorsal region, skin rippling, biting or licking of longer-term or lifetime medication, biochemistry
the area with no obvious dermatological or neuro- parameters should be monitored every 6–12 months.
logical basis.
Punishment is not effective in changing behavior. It
● Pain associated with any condition including
serves to further increase the anxiety, as well as impede
trauma or infection is differentiated by response to
learning of non-anxious behavior.
analgesia or alleviation of pain.
Treatment Prognosis

Treatment of any concurrent or underlying medical Prognosis is variable and depends on owner commit-
problem is essential, such as elimination of fleas, or ment, success in determining an underlying cause, and
resolution of food allergy by changing the diet. management of the underlying problem. Prognosis