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Microsoft word - seibert compulsive disorders in dogs and cats.docCOMPULSIVE DISORDERS IN DOGS AND CATS Lynne M. Seibert DVM, MS, DACVB Stereotypic behaviors have been reported in most domestic species, captive wild animals, and humans. Redirected behavior: animal is motivated to perform an activity toward an appropriate target but is interrupted or prevented from reaching the intended target, and directs its behavior toward a less appropriate target Displacement behavior: animal is motivated to perform two behaviors that are in conflict with each other (approach/avoid); may be a normal behavior but shown at an inappropriate time, such as grooming Stereotypy: intentional, unvarying, repetitive, or constant behavior pattern that has no obvious goal or apparent function; often performed in a predictable sequence; may be performed as components of displacement behaviors or compulsive disorders Obsession: persistent idea, thought, impulse, or image that is experienced as intrusive or senseless Compulsion: a repetitive, purposeful, and intentional behavior performed in response to an obsession Components of Compulsive Disorder Performed out of context Exaggerated or excessive in duration, frequency, or intensity Directed toward unnatural stimuli or objects Repeated in a constant manner Involves changes in brain neurotransmitters that maintain stereotypic behaviors Interferes with normal daily functions Derived from normal behavior patterns (predation, foraging, ingestion, grooming, locomotion, fear/avoidance, procreative activities, and possibly aggression), but appear abnormal because they are excessive, intense, or performed out of context Etiology (exact causes unknown) It is generally accepted that stereotypies are acquired and result from conflicts induced by inappropriate environments or human-animal interactions. Genetic factors have been postulated in humans with obsessive-compulsive disorder and some compulsive disorders in animals. Diagnosis How much time spent on behavior in 24-hour period Can behavior be interrupted? If so, how? Anything associated with occurrence of the behavior Exclusion of medical causes Animal is in full consciousness and aware of surroundings Can usually be interrupted (may require strong stimulus) Not dependent on the owner’s presence Differential diagnoses for Compulsive Disorder Acute conflict behavior / generalized anxiety Attention-seeking behavior Operant conditioning (owner or self-reinforcement) Neurological disorders (seizures, psychomotor epilepsy) Dermatological conditions (atopy, food allergy) Hyperkinesis Systemic disease (tick-borne diseases, distemper, hepatopathies) Breed Predispositions Doberman Labrador Retrievers Doberman Pinschers Great Danes German Shepherds Golden Retrievers Irish Setters Oriental (Siamese, Burmese, Birman) Species Predispositions Horses: cribbing, wood chewing, stall walking, pawing, weaving, stall kicking Cattle: kicking, bar licking, tongue rolling Parrots: feather picking, self-mutilation Pigs: chain rooting and sham chewing Humans: hand washing, checking, counting Classification in Companion Animals Classified according to the normal behavior from which the abnormal behaviors are derived Locomotion Neurophysiology Different behaviors rely on different neural pathways, which may explain the differential responsiveness of various forms of OCD to pharmacological intervention. Opioids (ingestive behaviors, SIB) Increase in number, affinity, or activity of endorphin receptor sites May play more important role early in development of stereotypy Some stereotypies responsive to opiate receptor blockers (mu receptors) Opioid receptors closely associated with dopaminergic and serotonergic neurons Dopamine (locomotion, grooming) Excess dopamine in basal ganglia structures; increased turnover of dopamine Drugs that stimulate the dopaminergic system (amphetamine, apomorphine) may induce stereotypies; some stereotypies respond to dopamine antagonists Serotonin (wide range of modulatory functions in different areas of the brain) Serotonergic dysregulation: specific effects not yet determined Serotonin may modulate other neurotransmitter systems: inhibitory effect on nigrostriatal dopamine system General Treatment Considerations MEDICAL Rule out medical problems that may cause or contribute Treat concurrent medical conditions ENVIRONMENTAL Identify and remove cause Reduce environmental stress, sources of arousal, and conflict Provide sufficient stimulation Provide sufficient exercise on a consistent schedule Create a predictable environment Confinement may be necessary for pica, fabric eating to prevent intestinal FB Physically preventing the animal from performing the behavior may be acceptable provided that the cause of the conflict has been removed. BEHAVIORAL Highly structured interactions with the owner: include set expectations for play time, training, exercise and feeding Avoid inconsistent interactions Avoid all forms of owner-administered punishment Desensitization to stress-inducing situations Avoid reinforcing inappropriate behaviors Counter-conditioning exercises: Positive reinforcement for behavior that is incompatible with the stereotypic behavior When not supervised, prevent stereotypic behavior (E-collar) Whenever animal shows any inclination to perform the undesirable behavior, interrupt or distract Then ask it to perform the alternate behavior, and then offer reward PHARMACOLOGICAL All drugs used for CD in animals are extra-label No individual drug treatment is effective for more than 60% of the population Opioid antagonists Naloxone: 0.2 mg/kg SQ (dog) Naltrexone (Trexan®): 1-2.2 mg/kg PO q8-12h (dog) Dopamine receptor blockers (antipsychotics or neuroleptic drugs) Haloperidol (Haldol®): 0.05-0.1 mg/kg PO BID (dog); 0.2 mg/kg PO BID (bird) Pimozide (Orap®): 0.05-0.1 mg/kg PO q24h (dog) Tricyclic Antidepressants Clomipramine (Clomicalm, Anafranil®): 1.0 – 3.0 mg/kg PO q12-24h (dog); 0.5 – 1.0 mg/kg PO q24h (cat); 3.0–5.0 mg/kg PO BID (bird) Selective Serotonin Reuptake Inhibitors Fluoxetine (Prozac®): 1.0 – 1.5 mg/kg PO q24h (dog); 0.5 – 1.0 mg/kg PO q24h (cat) 2.0 – Sertraline (Zoloft®): 1.0 – 4.0 mg/kg PO q12-24h (dog); 0.5 – 1.0 mg/kg PO q24h (cat) Paroxetine (Paxil®): 1.0 mg/kg PO q24h (dog); 0.5 – 1.0 mg/kg PO q24h (cat) Recommended Reading Goldberger E, Rapoport JL. (1991). Canine acral lick dermatitis: response to antiobsessional drug clomipramine. Journal of the American Animal Hospital Association, 27, 179-182. Hewson CJ, Luescher UA, Parent JM, Conlon PD, Ball RO. (1998). Efficacy of clomipramine in the treatment of canine compulsive disorder. Journal of the American Veterinary Medical Association, 213(12), 1760-1766. Luescher UA. (1998). Pharmacologic treatment of compulsive disorder. In N.H. Dodman and L. Shuster (Eds.), Psychopharmacology of animal behavior disorders (pp. 203-221). Malden, MA: Blackwell Science. Luescher UA, McKeown DB, Halip J. (1991). Stereotypic and obsessive-compulsive disorders in dogs and cats. Veterinary Clinics of North America: Small Animal Practice, 21, 401-413. Moon-Fanelli AA, Dodman NH. (1998). Description and development of compulsive tail chasing in terriers and response to clomipramine treatment. Journal of the American Veterinary Medical Association, 212(8), 1252-1257. Overall KL. (1998). Self-injurious behavior and obsessive-compulsive disorder in domestic animals. In N.H. Dodman and L. Shuster (Eds.), Psychopharmacology of animal behavior disorders (pp. 222-254). Malden, MA: Blackwell Science. Sawyer LS, Moon-Fanelli AA, Dodman NH. (1999). Psychogenic alopecia in cats: 11 cases (1993-1996). Journal of the American Veterinary Medical Association, 214(1), 71-74.
PORTARIA Nº 457, DE 21 DE MAIO DE 2012 Aprova o Protocolo Clínico e Diretrizes O Secretário de Atenção à Saúde, no uso das atribuições, e Considerando a necessidade de se atualizar parâmetros sobre a hepatite autoimune no Brasil e de diretrizes nacionais para diagnóstico, tratamento e acompanhamento dos indivíduos com esta doença; Considerando que os Protocolos Clínicos e Dir