AN UPDATE ON :

DRUGS MODIFYING ABNORMAL BEHAVIOUR IN PETS

Behavioural disorders/abnormalitiesDOGS ► Anxiety/ Over-excitability ► Excitement urination► Marking behaviour► Submissive urination► Fears/Phobias ► Tail chasing and recurring 'habits‘ (OCD),► Aggression► Disobedience ► Excessive barking ► Destructiveness ► Chewing, scratching ► Inappropriate urination and/or defecation ► Separation-related disorders (seperation anxiety)

Behavioural disorders/abnormalities

CATS

►Indoor Spraying

►Soiling in the home (House soiling)

►Aggressiveness

►Intermittent litter tray usage

►Inappropriate hunting

►Fabric eating

►Destructive scratching

►Periodic absence and insecurity

►Aggression

Aggression

► Inter-species aggression /Territorial aggression

► Redirected aggression

► Fear aggression

► Status-related aggression (dominanace)

► Predatory aggression

► Petting aggression (Biting)

► Pain-Induced Aggression

► Maternal Aggression

► Aggression towards visitors and owners

Elimination problems

► Housesoiling in cats

► Urine marking

►Inappropriate defecation inappropriate urination

►

► Urine spraying -urination as marking behaviour

►Other causes of inappropriate defecation and urination: diseases of the urinary tract (cystitis, urethritis, etc.), the nervous system and digestive system.

Separation anxiety

► Behavioural disorder

► Dogs exhibit exaggerated signs of anxiety when they do not have access to family members.

►Hyper-attachment to owner/ one or more family members

►Dog can’t get the owner’s attention

► Manifested by: Barking, Whining, Licking, Destructive Behavior, Chewing, Panic Attacks, Digging, Inappropriate Urination, House Soiling, Self Mutilation, Escaping, Diarrhea, Loss Of Appetite, Excessive Salivation, Vomiting

Canine Cognitive Dysfunction Syndrome

► Similar to Alzheimer's Disease that affects humans, affects the brain of elderly dogs, causing confusion, forgetfulness about many lifelong habits

► The chemical and physiological changes that occur in an older dog's brain, accelerating degeneration of the brain

Symptoms► Aimless Wandering► Disorientation► Confusion about a previously familiar place (ie: gets lost in

the house, can't find her way out of a corner, seems lost in her yard)

► Forgetting to eat, even forgetting to drink in some cases► Fails to recognize previously favorite people, or who she met

recently, be it dog or human► Sleeping pattern changes drastically► No longer seeks attention, or wanders away when being pet► Forgets or stops responding to her name

TREATMENT OF BEHAVIOURAL PROBLEMS

► Environmental manipulation

► Training

► Behavioural modification techniques►Treatment of any concurrent disease

► Surgery such as castration/ neutering (for aggression, urine spraying etc)

► Pharmacological agents

INTRODUCTION TO PSYCHOPHARMACOLOGY

► Pharmacological treatment -most useful when combined with behavior modification.

►Diagnosis or list of diagnoses

► Understanding the mechanism of action of the available drugs, and the potential side effects.

►Minimizing the potential adverse reactions of drugs

by performing a premedication

hematological examination

Urinalysis, and serum biochemistry profile

A complete behavioral and medical history.

PSYCHOPHARMACOLOGY…contd

The factors before selecting a suitable pharmacological agent for behavioural abnormalities in small animals

►Etiology ►Predisposing factors ►Condition►The owner’s cooperation should be taken in to

consideration.

Considerations in psychopharmacology of

animals

►The majority of the drugs - unlicensed and not registered for veterinary use: used in an extra-label fashion

►Consent forms from owner

►Risk of potential client drug abuse► Strict control of the drug dispensing is needed

►The client cooperation over administration►The lowest effective dose

►Gradual withdrawl of medication

►Drugs always an adjunct to behaviour modification therapy; not as a replacement/ substitute.

►An attempt to wean off medication -once the desired result is achieved and maintained for a period of 2 - 3 months.

►Life long medication : should be made clear to the owner at the outset of therapy.

Benzodiazepines ( BZDs)

► Anxiolytics work by enhancing the action of GABA (gamma-aminobutyric acid), an inhibitory neurotransmitter.

► oxazepam, clorazepate, lorazepam, temazepam, clonazepam, diazepam and alprazolam

► The last two being most commonly indicated for treatment of anxiety related behaviour problems like urine spraying and short treatment for sound phobias (eg: fireworks, thunderstorms) because of their episodic nature and the rapid onset of action in dogs and cats.

► At therapeutic levels there is calming effect but little or no effect on motor or mental functions.

► Cats may stagger for the first 3 - 4 days but this resolve spontaneously.

► Oxazepam has non active metabolites and is biotransformed by conjugation not oxidation, it is preferred in patients with liver disease.

Benzodiazepines ( BZDs)…contd

Diazepam► At low doses diazepam retains its amnesic effects

►higher doses -anxiolysis and sedation are achieved

►given prior to an anticipated fearful or phobic event

►behavioural adverse effects of ataxia, hyperexcitability and disinhibition.

►Before giving this drug in advance of a phobic event at least one trial dose should be given to the animal, at a quiet and non-stressful time, in order to identify a dose effect, speed of onset, and any adverse effects.

►may increase predation in cats

Benzodiazepines ( BZDs)…contd

Alprazolam►may also be given after a phobic event in order to

impair the dog’s memory of it

►used to block the effects of unanticipated phobic events in order to prevent them from having an emotional impact on the animal in the future.

►should be given as soon after the event as is safe and practical.

►Alprazolam is a schedule 4 controlled drug. There is no licensed veterinary preparation.

Benzodiazepines ( BZDs)…contd

►BZDs are contraindicated in states of hepatic and renal impariement and for long term use in cats.

► Side effects► increased appetite, transient ataxia (should resolve in 3 - 4

days)

►paradoxical hyperactivity in some cats, increased affection/friendliness

► increased vocalization in cats, drug tolerance,disinhibition of suppressed behaviour eg aggression, interference with learning conditioned responses

Tricyclic antidepressants (TCAs)

►Closely related to phenothiazines and block amine

(serotonin,norepinephrine, dopamine) re-uptake

►Antianxiety effects .

►Take about two wks to produce any beneficial effects .

► Indicated for anxiety related behavioural disorders in

dogs and cats such as separation anxiety, obsessive-

compulsive behaviors, stereotypies, aggression, and

inappropriate elimination, urine spraying in cats, feline

hyperaesthesia, compulsive disorders and behavioural

problems secondary to idiopathic cystitis.

►Clomipramine and amitryptilline are the TCAs licensed

for use in veterinary medicine

Tricyclic antidepressants (TCAs)

► Side effects►short term lethargy or sedation, mild and intermittent

vomiting which is usually transient and increases or decreases in appetite.

► sedation (antihistamine effect), dry mouth (antimuscarinic effect), constipation (antimuscarinic effect), urinary retention, tachycardia, cardiac arrhythmia, ataxia, decreased tear production, mydriasis, dilated pupils, disturbances of accommodation which usually disappear with decrease or withdrawal of medication

►The antihistaminic effect may be a useful adjunct in controlling pruritus due to atopy and food allergies

►High doses; hepatotoxicity and convulsions.

►Urine retention in cats after treatment with clomipramine.

► Contraindicated in animals with seizures, urinary retention or history of cardiac arrythmias and within two weeks of administration of a monoamine oxidase inhibitor.

Selective Serotonin ReUptake Inhibitors (SSRIs)

► Selectively block the reuptake of serotonin► Indicated for the treatment of behavioural conditions which

involve a component of impulsivity ► Fluoxetine, sertraline and fluvoxamine► For treating psychogenic alopecia, allergy-related pruritus,

anxiety related condition, s dominance-related aggression, fearful behaviors, obsessive-compulsive behaviors, and urine marking

► Fluoxetine is approved drug in dogs, useful in the treatment of some but not all forms of aggression.

► It is used for inter-dog aggression in conjunction with behavioral training and neutering of the less dominant dog.

► Fluoxetine is also used for the treatment of obsessive-compulsive disorders in dogs.

Selective Serotonin ReUptake Inhibitors (SSRIs)

► Gastrointestinal side effects, constipation in cats. ► Concomitant MAOI therapy is contraindicated to avoid

serotonin syndrome. ► This most commonly occurs with a combination of SSRI and

MAOI medications, although there are some opioid analgesics with serotonergic activity.

► Symptoms include neuromuscular hyperactivity, hyperthermia, autonomic hyperactivity and altered mental status At least 2 weeks should be allowed as a washout period between SSRI and MAOI therapy

Monoamine oxidase inhibitors(MAOIs)

Selegiline► For treatment of behavioural disorders with an emotional

origin, which includes fears and phobias.

► Reduces fearfulness, increases exploratory behaviour and has positive effects on cognition even in healthy animals.

► Takes 4-8 weeks to begin to become effective, and is a useful adjunct to behavioural therapy, especially in individuals that are frequently exposed to noise events

► Used to increase the confidence of a dog that has become afraid of going outside after dark due to a number of fearful experiences

► Approved drug for Canine cognitive dysfunction syndrome

Azapirones

Buspirone► for treatment of mild to moderate anxiety related

problems and urine spraying in dogs and cats. ► This is a novel antianxiety agent that is not chemically or

pharmacologically related to theBenzodiazepines ► Advantages include lack of sedation and high safety margin

however the frequency of dosing and cost can present problems.

► Side effects : bradycardia/tachycardia, nervousness, gastrointestinal disturbances, stereotypic behaviours and restlessness.

► Contraindicated : renal, hepatic impairment, epileptics, allergic reactions and caution is needed as treatment can lead to an increase in aggression as it may decrease the inhibitory effects of fear.

► It is ineffective in cases such as sound phobias or separation anxiety in dogs.

Beta blockers

►Indicated in treatment of situational anxities in dogs and cats.

► Propranolol and pindolol are are the common ones, used before the anticipated situation occurs.

►They are contraindicated in animals with cardiac disease, hypotension, and bronchospasm.

Antiepileptics

► Mood-stabilizing drugs, primarily indicated in those cases where epileptic activity is in the etiology of the condition

► Agents: phenobarbitone, carbamazepine, and valproic acid are unrelated chemical compounds that are used in human medicine to treat bipolar disorder, impulsivity, emotional reactivity, and aggression.

► Carbamazepine in cats decrease fear-related aggression against people, but it may paradoxically increase aggression against same species.

► Lithium (75 mg total dose, bid) has been used to treat dominance-related aggression and psychotic behavior (random air-snapping, pawing) in a Cocker Spaniel; has narrow therapeutic index exhibiting side effects like polyuria, polydipsia, memory problems, weight gain, and diarrhea.

Hormonal preparations► Progestogens► antiandrogens ► A dopamine 2 receptor agonist drug with hormonal activity,

CabergolineProgestins► only be given to neutered animals ► Generally considered the treatment of last choice ► Side effects -increased appetite, weight gain, transient

hyperglycaemia, mammary gland hyperplasia and carcinomas, bone marrow suppression, adenocarcinoma, pyometra, adrenocortical suppression, depression, lethargy.

► Avoided in diabetes mellitus, breeding animals and with concurrent corticosteroid use.

► The use of is generally outdated as better drugs are available

Hormonal preparations…contd

Antiandrogen

►Delmadinone acetate.

Cabergoline

►antiprolactin effects

►For the treatment of psedopregnancy in bitches and in spayed bitches with aggressive behaviour attributable to elelvated prolactin levels

Antihistamines

►Diphenhydramuine and cyproheptadine

►Management of mild anxiety associated with travel, inappropriate night time activity and anxiety conditios in which pruritus plays a important role.

►Sedative CNS side effects are being exploited for their behavioural benefit.

►Contraindicated in animals with glaucoma, urinary retention and hyperthyroidism.

Alpha adrenoceptor stimulants

Phenylpropanolamine

► Sphincter mechanism incontinence in bitches and can therefore used to manage house soiling in these cases

►Increased aggression is the possible side effect.

Alpha adrenoceptor antagonists

Nicergoline

►For sleep disorders, diminished vigour and fatigue.

►Acts as a cerebral vasodilator, act as cognitive enhancer by reversing the vasoconstricitive effect of cerebral catecholamines.

►It should not be administered within 24 hours of using alpha 2 agonists such as xylazine or medetomidine.

Xanthine derivatives

Propentofylline

► canine age related behavioural changes such as dullness, lethargy and cognitive decline

►Respond better if combination therapy with selegiline is used.

Neuroleptics (Antipsychotic agents)

► Low potency phenothiazine tranqillisers (acepromazine, chlorpromazine, and thioridazine hydrochloride)

► All the antipsychotics are used for nonselective tranquilization and diminishing behavioral arousal.

► Acepromazine is used as a short-term tranquilliser during phobic events related with fireworks and thunderstorms and travel associated behaviour problems.

► High doses required in order to sedate a dog during a phobic event.

► High doses may lead to hypovolaemia, hyperexcitability and extrapyramidal side effects in some animals

► Not considered suitable for the management of canine noise phobias

Pheromones

►A new approach to dealing with urine marking►A synthetic analogue of feline facial pheromone along

with a cat attractant (the alcoholic extract of the plant Valeriana officinalis)

►Decrease anxiety ►DAP (dog appeasing pheromone) is a synthetic

analogue of a chemical produced by the bitch while she is lactating.

► It has anxiolytic properties shown to reduce the signs of fearfulness during firework events.

► Safely combined with other treatments, such as benzodiazepines and triazolobenzodiazepines.

► Pheromones : diffuser, spray , collar.►No side effects.

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