Update on Behavior Medicine

Debra Horwitz, DVM, DACVB Veterinary Behavior Consultations

St. Louis, Missouri

Morning lectures Canine aggression and assessing dog behavior: using what you already know to help clients ........................ 1 Separation Anxiety in dogs .............................................................................................. 7 Canine Aggression toward people on walks and at the door ......................................... 11 Afternoon lectures The link between house soiling and aggression in cats................................................. 17 Feline aggression toward people .................................................................................. 23 Update on medications in behavioral medicine ............................................................. 29  

CANINE AGGRESSION AND ASSESSING DOG BEHAVIOR: USING WHAT YOU ALREADY KNOW TO HELP CLIENTS

Debra Horwitz, DVM, DACVB

Veterinary Behavior Consultations St. Louis, Missouri

Unfortunately, training in behavior is not available at many veterinary schools in the United States leaving many veterinarians to question how much they know about behavioral medicine. However, veterinarians by virtue of what they do every day have accumulated a great deal of knowledge about animal behavior, most specifically about canine signaling behavior. The ability to interact and treat dogs on a daily basis requires an understanding of body postures and facial expressions that indicate fear, anxiety, threat and the precursors to more dangerous behaviors such as biting. What is missing is the ability to actually see this as knowledge and the inability to label this knowledge appropriately so it can be shared with staff and owners to aid in developing better safety, welfare and handling practices for their patients. Classification of aggression

Aggression is usually defined as threat or harmful action directed to one or more individuals1. The behavior can consist of vocalizations, facial expressions, body postures, inhibited attacks and physically injurious attacks. There are many different methods to classify and categorize aggression in animals. The victim or target, the location where the aggression occurs or the type of aggression such as offensive or defensive are also used to classify aggressive behavior. In veterinary behavioral medicine, diagnostic categories classify aggression in animals. Those commonly cited include: dominance/conflict aggression, fear, possessive, protective and territorial, parental, play, predatory, redirected, pain induced or irritable, pathophysiological or medical and learned2,3,4. However, no standardization of diagnostic categories presently exists. In many cases, more than one form of aggression may be exhibited in any one animal since aggressive responses tend to be multi-factorial and complex.

Identifying indicators of aggression Canids have evolved a series of facial expressions and body postures designed to indicate their intention in social encounters with other canids and use these same signals in their encounters with humans. Often the misunderstanding of these signals results in biting episodes. In dogs, staring, snarling (lifting the lip), growling, snapping and biting are all indicators of aggression and ones that veterinarians often understand. However, subtle changes such as turning the head or body are also indications of discomfort with the social encounter. In addition, the position of the ears, tail and hair indicate what the animal will do and the underlying emotional state such as fear, anxiety, etc. It is the understanding of these aggressive indicators that help veterinarians almost unknowingly avoid injury in many cases. Not all dogs will go through the different signals in order, or slowly. The type of intruder, the distance to the dog, the speed of approach and prior encounters will all influence the dog’s response. If a dog has learned that an aggressive response results in what the dog considers a beneficial outcome, the aggressive response is likely to be repeated. Why do dogs use aggressive signaling? We all recognize that dogs are not verbal, they cannot tell us with words how they are interpreting a social situation. Therefore, a dog will use various forms of signaling to broadcast their intent in a social encounter. Some of these signals can be very subtle and easily missed

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which may require the dog to use another more emphatic signal. Additionally, canines often have different expectations in social encounters than do the humans with whom they interact. In a canine to canine social encounter involving a possession or food, if dog “A” has the item and dog “B” approaches, dog “A” may respond with an assertive and/or an aggressive response which usually would clearly signal to dog “B” not to continue to try and obtain the object. This dynamic may not necessarily be related to the size of the dogs involved, smaller dogs often keep objects they have even when approached by larger dogs. However, when a human decides that they want something the dog has, they will attempt to get it often despite low level signals from the dog that are designed to discourage interaction and end the encounter. A dog may use a subtle body posture or facial expression to slow or stop the approach of another dog; they will use the same to humans who often are oblivious to the meaning. If these subtle measures do not work, then often stronger ones may be utilized instead. Certainly interpretations of the significance of the interaction, the intent of the approaching individual whether a dog or a human and the individual temperament and experience of the dog involved also influence what responses are offered. What about dominance, submission and deference? Much has been written and said about the dominant theory of dog communication both between dogs and between humans. The concept of dominant and subordinate relationships between animals was developed from observation of animals (wolves, baboons, chickens) living in social groups.5 Social hierarchies arranged around dominant and subordinate relationships decrease the conflict associated with the allocation of critical resources, i.e. food, shelter, mates and territory6. However, one’s dominance is within the context of a relationship with another individual, not of the individual himself and neither is dominance synonymous with aggression. An individual could be dominant in one relationship and not in another. On the other side of the dominance equation, is the use of subordinate and deferential acts between conspecifics that help diffuse tension and conflict. The communication between people and dogs is across species; therefore a more likely explanation that humans should use is that social encounters are a dance between the participating individual’s expectations and understanding. Dogs will use canine communication methods and humans will use verbal communication methods. We as humans are very in tune with verbal communication, but our canine counterpart in interaction is concerned with visual communication; what we project with our body postures and facial expressions. To have a meaningful encounter with dogs, we need to rely on the visual aspects of canine communication signals-something that veterinarians do every day. Assertive postures, head up, body stiff, tail up and direct eye contact should give us pause and suggest that we rearrange our means of social interaction to diminish that tension. Subordinate and deferential body posters, lowered and/or turned head and body and tail should caution us to rearrange our body posture to diminish fear and anxiety. Rather than fight the body signals, we need to embrace them, counter them with our own to diminish tension and reach an understanding. How best to interact with dogs?

The complex interspecies relationship between a companion dog and its human family involves a variety of motivations and influences, including genetics, socialization, available resources, fear, conflicts, learning, behavioral pathology, and disease. Communication is hindered because of misunderstood meaning and intent behind each species’ communication methods. Most dogs that are engaged in unwanted or undesirable behaviors are anxious and fearful or misunderstand the social situation from our perspective. We as veterinary health care professionals need to explain to pet owners what their dog means by its responses in social encounters, including what happens in the examination room. A dog growling and snarling is using threat behavior and hiding to indicate that they are fearful and want to avoid confrontation.

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In this scenario, confrontation is likely to result in a further escalation of the aggressive responses rather than a lessening and perhaps even biting behavior. When we approach a dog who then lowers their head, averts their eyes and turns their head to the side we need to recognize the message. In dog language, this indicates an unwillingness to interact, if we reach out to touch the dog and the dog may snap or bite. We need to help people understand what the dog is saying and help them understand although aggressive response are unwanted, to the dog in a certain situation they may not be abnormal. Other factors also come into play. Between humans and dogs, especially within the home environment, the owner may often defer to a dog who assumes that their behavior is appropriate and working. This may allow the dog to learn that he can influence the outcome and each interaction that ends with a beneficial outcome for the dog reinforces that assumption. The animal has learned that certain behaviors result in certain favorable outcomes. In addition, often a behavior occurs because it can, in other words, the owners do not prevent the dog from engaging in a certain behavior and that can be reinforcing and lead to repetition of the behavior. This is not dominance, but rather learning that certain behaviors are acceptable and have beneficial outcomes. However, the owner may be unaware that this dynamic is in place and when they change their mind and try to intervene, the dog responds aggressively. The implicit understanding from the canine side of the communication was not shared by the human participant.

Many dogs that are aggressive to family members are fearful or anxious and exhibit conflict behavior7. Their behavior arises from uncertainty about their role or place within the social group or the response to their actions both assertive and deferential. Their future behavior is often determined by the responses to their threats, yet owners can be very inconsistent, allowing behaviors at some times and punishing them at other times. Caution should be exercised to avoid labeling all aggression toward family members as dominance motivated aggression since this may be simplistic. Whenever you are dealing with an aggressive dog, confrontations should be avoided, these will likely increase rather than decrease aggression since they increase anxiety, fear and defensive responses.

Punishment is contraindicated because it can escalate rather than diminish aggression by causing pain, fear or anxiety. In fact, in many cases underlying anxiety is what has induced the aggressive responses. When interacting with an aggressive dog, all punitive measures including “alpha rolls” and other attempts to dominate must be curtailed as these can increase aggression rather than diminish it8.

Interactions between people and dogs should be clear and concise as well as giving the dog the opportunity to signal if they are uncomfortable with the social encounter. Having simple commands that are reliably performed can calm the pet because it tells them what to do. Owners should be encouraged to teach their dog tasks such as “sit” and “look” that will allow them to get the dog’s attention. Food rewards and praise should be given liberally for earned correct behaviors. Confrontations should be avoided since usually the humans are injured and the human-animal bond threatened by aggression. Instead, people should take a step back and determine if there is another way to get the animal to understand what is required of them. For dogs that are very anxious, fearful and often aggressive the use of basket muzzles is extremely helpful.

Prevention Interacting with pets in a respectful thoughtful manner should always be the goal. Staff and owners should be made aware of low level signaling that broadcasts discomfort and anxiety. When these appear, other options should be tried. If often helps to start off on the right foot, using food rewards liberally and taking time for the animal to understand what is happening to them. The time spent in forming a good bond with the client and pet usually pays off in the end.

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1 Beaver BV, The veterinarian’s encyclopedia of Animal Behavior. Iowa State University Press, Ames, Iowa, 1994 pp. 6 2 Reisner IR An overview of Aggression In: BSAVA Manual of Canine and feline Behavioural Medicine Eds. Horwitz, Mills and Heath, BSAVA, Gloucester, UK. 2002 pg. 181-194. 3 Houpt KA Domestic Animal Behavior for Veterinarians and Animal Scientists, Iowa State University Press, Ames, Iowa, 1991, pp. 34-74. 4 Landsberg G, Hunthausen W, Ackerman L, Handbook of behavior problems of the dog and cat. Saunders, Philadelphia, 2003, pp. 385-426 5 Alcock, J, Animal Behavior: An evolutionary approach. Edition 2. Sunderland, Mass, Sinauer Associates Inc. 1979. 6 Voith, VL, Borchelt, PL, Diagnosis and treatment of Dominance Aggression in dogs, In: Veterinary Clinics of North America: Small Animal Practice, Vol. 12:4, 1982, pp. 655-663. 7 Luescher UA, Reisner IR Canine Aggression toward familiar people: A new look at an old problem In: VCNA Small Animal ed. Landsberg G, Horwitz D, Saunders, PA 38 (2008) 1107-1130. 8 Herron ME, Shofer FS,Reisner IR Survey of the use and outcome of confrontational and non-confrontational training methods in client-owned dogs showing undesired behaviors. Applied Animal Behaviour Science 117: 47-54 (2009)

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Bite

Snap

Growl

Stiffening up, staring

Lying down, leg up

Standing crouched,tail tucked under

Turning body away,sitting, pawing

Yawning, blinking,nose licking

Creeping, ears back

Walking away

Turning head away

Reproduced from Shepherd (2002) in BSAVA Manual of Canine and Feline Behavioural Medicine, edited by Debra Horwitz, Daniel Mills and Sarah Heath, with the permission of BSAVA Publications (www.bsava.com).

‘Ladder of aggression’

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MANAGING SEPARATION ANXIETY: STEPS TO PROMOTE CLIENT COMPLIANCE

Debra F. Horwitz DVM, DACVB Veterinary Behavior Consultations

St. Louis, Missouri

When separated from family members’ dogs may experience distress and engage in problem behaviors related to that distress. These behaviors include destruction, vocalization, elimination of urine and/or stool, anorexia, drooling, attempts at escape and/or behavioral depression. However, separation anxiety is not a unitary phenomenon. Some dogs are distressed about being home alone because the persons to whom they are attached is absent, others are distressed because something fear or anxiety provoking has occurred while they were alone. These two underlying motivations are not mutually exclusive; a dog can be distressed for both reasons. The most common concomitant co-morbid diagnosis is storm/noise sensitivities and separation anxiety. Treatment protocols include independence training, elimination of responses to departure cues, training departures, pheromones and pharmacological intervention.

History taking

Separation anxiety seems to be quite prevalent in the companion dog population. Dogs that are adopted as adults from humane shelters may appear more frequently in behavior case loads1. The problem behavior(s) in the history may include destruction, vocalization and/or elimination in the house while the owners are gone.

While destruction, elimination or vocalization are common when the dog is left alone, some dogs may show signs of increased attachment to the owner and exhibit distress as they get ready to depart. The departure anxiety may be whining, panting or pacing while other dogs may become immobile or hide. Most dogs engage in the separation related behaviors within 30 minutes of owner departure2. Self-mutilation, excessive licking, vomiting or diarrhea can also occur as symptoms of separation distress. While most of the problem behavior occurs shortly after owner departure, some dogs may cycle through periods of re-arousal perhaps brought on by outside stimulus3. Geriatric dogs are more commonly seen for the behavioral complaint of separation related anxiety when compared to younger dogs.4 Other signs may occur including excessive greeting behavior, persistent following behaviors when the owner is home and unwillingness to be out of sight of the humans. In some extreme cases dogs may use aggression to attempt to keep the owner from departing.

Diagnosis

Rule out other causes of house soiling, destruction and vocalization before establishing a diagnosis of separation anxiety. Differential diagnoses for dogs that eliminate when left alone include medical causes of house soiling, inadequate house-training techniques, marking and prolonged periods without access to appropriate elimination locations. When dogs are destructive or barking alternate explanations include young, energetic dogs with limited exercise or play, external stimuli and territorial displays. Destruction may be a component in noise phobias such as thunderstorm phobias. Geriatric dogs may be experiencing changes in cognition and should show other signs of cognitive decline such as wandering, loss of house training, disturbances in sleep/wake cycles and other symptoms that have been associated with Cognitive Dysfunction Syndrome4. Some dogs may be distressed when the owner is gone due to fears, phobias or anxieties about events that occur in the owner’s absence such as storms or other loud noises5. If none of these apply, then a diagnosis of separation related anxiety is appropriate. If the history is not clear, then owner journals, audio and/or video tapings and

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appropriate medical testing may be helpful in establishing a diagnosis. In some situations, more than one dog is showing anxiety and distress and all patients should be treated.

Treatment Standard behavior modification treatment plans generally have the following components6: Owner education Counseling owners that the behavior is anxiety based, not spiteful. Independence training Make the dog less attached and interactions with the pet more focused and structured. Recommendations include: ignoring attention-seeking behaviors (but not the pet), teaching sit/stay, decreasing following behaviors and earning attention by performing a task first. Institute a predictable routine for exercise, play and attention. Teach the dog to settle and relax in a set location or on a bed or mat to teach the dog how to be calm on cue. Departures and returning: habituation to the pre-departure cues, and changing the leaving and return routine The goal is to reduce the predictive value and thus anxiety producing quality of the steps in the owner’s departure routine. To uncouple these cues from actual departures, the owner is to perform them without leaving. For example, the owners might pick up their keys or purse, put on a coat, or open and shut the door without actually departing. This is repeated 2-4 times a day but the dog must be calm between presentations. Owners are instructed to ignore the dog for 15-30 minutes prior to departure and upon return to keep these times neutral and calm. Counter conditioning to departure Teaching the dog to engage in an alternate activity when the owner approaches the door and/or departs may help some dogs cope more easily with owner departure. This can be a simple “sit/stay” or the use of a food stuffed toy prior to departure. The dog can be asked to settle in its previously learned safe location. Graduated planned departures The goal is to replicate real departures, using a new signal to facilitate the dog learning that departures need not produce anxiety. These are generally not begun until the dog can settle and relax on cue and no longer responds to departure cues with distress. Drug and pheromone therapy

Prior to medications a physical examination and a minimum database of a Biochemical Screen, CBC and urinalysis should be performed. Results with drug therapy may not be seen for 14-30 days, the owner must be committed to continue usage. Two drugs are presently formulated and licensed for the treatment of separation anxiety in dogs; Clomipramine Hydrochloride (Clomicalm®)a and Fluoxetine (Reconcile®)b are FDA labeled to aid in treatment of separation anxiety in the USA.

Tricyclic antidepressants (TCA) as a class of drugs primarily affect serotonin, norepinephrine, acetylcholine and histamine. TCA’s are contraindicated in hyperthyroidism, seizure disorders, in animals on thyroid medication, amitraz or selegiline or animals experiencing problems with urinary retention or urine flow. Common side effects with tricyclic antidepressants include urinary retention, constipation, tachycardia, dry mouth, hypotension and mydriasis7. Clomipramine is dosed at 2-4 mg/kg per day either as one dose or divided twice daily8. The most common adverse reactions are vomiting, diarrhea and lethargy. Caution is advised in using Clomicalm with other CNS active drugs including general anesthetics and neuroleptics, anticholinergic and sympathomimetic drugs8. In the placebo blinded drug approval study, the medication was used in conjunction with behavior therapy and withdrawn after 2

a Novartis Animal Health, Greensboro, NC b Elanco, Indianapolis, IN

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months. After week one, 47% of the dogs receiving Clomipramine and behavior modification showed improvement compared to 29% of the dogs receiving behavior modification alone9. In another placebo study by Podberscek et al on treatment for separation anxiety it was found that the Clomipramine patients showed no greater improvement than those on placebo. However, behavioral therapy on its own was highly effective10.

In a large multi-centered double blind, placebo controlled study Fluoxetine was dosed at 1-2 mg/kg once daily with all dogs receiving behavior modification. Seventy three percent of dogs treated with medication and behavior modification showed improvement in overall severity scores compared with 51% of placebo and behavior modification treated dogs at the study conclusion after 8 weeks. Forty-two percent of treated dogs showed improvement within the first week. The most common adverse events reported following fluoxetine treatment were lethargy and vomiting. Seizures occurred in 3 fluoxetine-treated and one placebo-treated dog therefore fluoxetine is not recommended in dogs known to suffer from a seizure disorder. Full details of the study are recently published11. Fluoxetine should not be used concurrently with monoamine oxidase inhibitors (selegiline and amitraz) nor with tricyclics.

Fluoxetine and Clomipramine should not be used concurrently due to the risk of producing serotonin syndrome. When either is used in a treatment program, the medication must be given daily and may take 2-4 weeks to see some effect. Patients may need several months of treatment for sustained improvement to be noted. In some cases, withdrawal of medication may result in the return of symptoms12.

Benzodiazepines have often been suggested for immediate relief or short term control. Benzodiazepines such as alprazolam (0.02 to 0.1 mg/kg orally13) can be dispensed on an as-needed basis shortly before departures. Benzodiazepines may inhibit learning, usually require frequent dosing and may cause dependence and a rebound anxiety when discontinued.

DAP® (Dog Appeasing Pheromone)c may be useful in reducing anxiety associated with owner departure in some dogs. DAP is available as a diffuser that plugs into the wall and remains active for 30 days. One study comparing the efficacy of DAP versus Clomipramine for the treatment of separation distress in dogs found to be them to be approximately equal with respect to owner global assessment scores and there were no significant differences between the two groups in individual signs14.

Why Treatment Results Vary and May Fail Drug therapy alone is rarely curative for most behavioral disorders: Medication alone will not

change behavior and will not “teach” the pet new behaviors. If the pet is not taught how to remain home alone, and anxiety-producing cues are not

habituated to, very little improvement might occur. In fact, some dogs may become worse. Concurrent additional anxieties (storm phobias, noise phobias, inter dog aggression issues)

that are not addressed may limit treatment success Owner expectation of a “quick” cure. Response to behavioral medication can take time. The ongoing destruction, vocalization and elimination continue to strain the human-animal

bond Treatment failure is avoided by regular and detailed follow up either in person or by phone. The behavior modification plan is not complicated, but can be administered incorrectly and result in an increase in anxiety, rather than a lessening of symptoms. In addition, owners often want resolution of the problem and may become discouraged and not notice improvement and small steps in the right directions. Follow up visits in person or by phone allows the clinician or staff to work with the owner to make sure treatment recommendations are properly followed and to

c CEVA Sante Animale/VPL in US

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point out the progress being made. If no progress is happening, then re-evaluation of the diagnosis and treatment plan is necessary.

References

1. McCrave, EA. “Diagnostic Criteria for Separation Anxiety in the Dog.” Veterinary Clinics of North America: Small Animal Practice, Mar.1991, 21:2 : 247-255.

2. Borchelt, PL, Voith, VL. “Diagnosis and Treatment of Separation-Related Behavior Problems in Dogs”. Veterinary Clinics of North American: Small Animal Practice, Nov. 1982, 12:4 : 625-635.

3. Lund, DJ, Jorgensen, MC. “Separation Anxiety In Pet Dogs Behaviour Patterns and Time Course of Activity”. Proceedings of the First International Conference on Veterinary Behavioural Medicine, Universities Federation for Animal Welfare, Great Britain, 1997, p. 133-142.

4. Landsberg, GM, Ruehl, W. “Geriatric Behavior Problems”. Veterinary Clinics of North America: Small Animal Practice, Nov. 1997, 72:6 :1537-1559.

5. Overall KL, Dunham AE, Frank DF. Frequency of nonspecific clinical signs in dogs with separation anxiety, thunderstorm phobias, and noise phobia alone or in combination. J Am Vet Med Assoc 2001;219:467-473.

6. Horwitz, DF Separation-related problems in dogs. In: BSAVA Manual of Canine and Feline Behavioural Medicine, Ed. Horwitz, Mills and Heath, BSAVA, Gloucester, UK, 2001. pp 154-163

7. Overall, KL. “Pharmacologic Treatments for Behavior Problems”. Veterinary Clinics of North American: Small Animal Practice, May 1997, 27:3: 637-665

8. Clomicalm package insert, Clinical and Technical Review, Novartis Animal Health, 1998. Pp.17- 26

9. King JN, Simpson, BS, Overall KL et al Treatment of separation anxiety in dogs with clomipramine: results from a prospective, randomised, double-blind, placebo-controlled, parallel-group multicenter clinical trial. Applied Animal Behaviour Science. 2000 67: 255-275

10. Podberscek, AL, Hsu Y, Serpell, JA Evaluation of clomipramine as an adjunct to behavioural therapy in the treatment of separation –related problems in dogs. Veterinary Record, 1999, 145: 365-369.

11. Simpson BS, Landsberg GM, Reisner IR et al Effects of Reconcile (Fluoxetine) Chewable Tablets Plus Behavior Management for Canine Separation Anxiety, Veterinary Therapeutics, 2007 8: 18-31

12. King JN, Overall KL, Appleby BS, et al. Results of a follow-up investigation to a clinical trial testing the efficacy of clomipramine in the treatment of separation anxiety. Appl Anim Behav Sci 2004;89:233-242

13. Horwitz DF, Neilson JC Blackwell’s Five Minute Veterinary Consult Clinical Companion Canine and Feline Behavior, Blackwell Publishing, Ames, 2007 pp. 531-536

14. Gaultier E, Bonnafous L, Bougrat L, et al. Comparison of the efficacy of a synthetic dog-appeasing pheromone with clomipramine for the treatment of separation-related disorders in dogs. Vet Rec 2005;156:533-538

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CANINE AGGRESSION TOWARD UNFAMILIAR PEOPLE ON WALKS AND AT THE DOOR

Debra F. Horwitz DVM, DACVB

Veterinary Behavior Consultations St. Louis, Missouri

Introduction

Canine aggression directed toward people is a serious problem. Several million people are bitten each year, often by a dog familiar to them1. The injuries range from minor to severe and even death. The causes of human directed aggression are varied yet the underlying motivation is usually fear, or anxiety and not a desire to dominate or control.

Dog bites and canine aggression results from many factors and may a normal but unwanted response or an abnormal response to a particular situation. Early environment, genetics, learning, health (both medical and behavioral), and training contribute to aggressive behavior.

On walks, the owner may inadvertently reinforce a tense and defensive behavior by tightening the leash and/or with their vocal cues and body posture. When the owner tightens the leash and draws the dog in closer they are usually doing so because they are unsure of how their dog may respond. However, these behaviors (leash tightening and tense posture) may signal to the dog that the impending approach is problematic, and therefore increase rather than decrease the dog’s emotional arousal.

Aggression at the door may be due to territorial responses and may be combined with fear related aggression toward strangers. Some dogs will show intense responses when the doorbell rings or someone knocks and then be fine when the people come inside. Others may continue to posture aggressively and/or show fearful responses and perhaps injure visitors if given access to them. The behavior can be directed toward everyone who comes to the home, or only selected individuals.

History taking Background information about the dog’s early experiences with people should be noted and recorded. The lack of appropriate and early exposure to people and new situations as a puppy may contribute to fear based and aggressive responses as an adult. Other animals in the home should be noted and determine if they also exhibit the same behaviors.

All previous attempts to change or correct the problem must be explored and detailed. These might include training, treats, more exposure, confinement etc. Punitive measures including leash corrections, shock collars, physical reprimands should be noted as they can contribute to the anxiety surrounding the situation. Often owners have attempted to “socialize” the dog by repeatedly taking them places where they encounter other people. This may increase rather than decrease the aggressive responses resulting in discouraged owners and a pet quite good at performing the unwanted responses. The aggressive responses on walks should be explored in detail including location, distance to the person and the response itself. Determine both a distance and response gradient; at what distance does the response first begin (perhaps with just alerting behavior, watchfulness and not full blown aggressive behaviors) and what does it look like. The goal is to establish the distance at which the dog first notices another person, what the response is at that time and also to determine when the response is at its peak and where the person is at that time. The owner should be encouraged to describe the response in very precise detail including body posture, vocalizations, and ability to control or divert the dog. Finally, how does the encounter end and when or at what distance does the dog return to a baseline controllable behavior?

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For door related behaviors, the first episodes and several more recent episodes should be explored. Any punishment, reprimands or confinement should be detailed. Are there any people who can come into the home and the dog is relaxed and friendly? Does the behavior occur if people get up and move about the house once they are inside? Are there categories of visitors, i.e. familiar, somewhat familiar, unfamiliar and how does the behavior vary between these groups? How many visits are needed for a person to become a familiar visitor? If they always confine the dog with company, why do they do so? Has anyone been bitten by the dog when they have entered the home? Diagnosis In both situations the responses tend to be a combination of fear based responses, anxiety and learned responses. In some cases it is apparent that the dog has poor social communication skills and does not read the social signals of people appropriately. Responses at the door are usually a combination of fear, anxiety, territorial behaviors and learning combined to solidify and intensify the behavior. General treatment recommendations

All situations that cause either behavior to occur must be avoided. When the dog is able to engage in the behavior repeatedly not only do they learn how to do it better, they may actually bias the synapses for earlier responses. When the problem occurs on walks, all walks must be curtailed until the dog learns new responses. If the only way the dog goes outdoors to eliminate is on a walk then walks must be arranged at times and places where encountering other people is less likely. If the problem is at the door, the dog must be securely confined each and every time someone wants to enter the home. The dog should be placed in confinement by an adult. If the dog will not tolerate confinement, then confinement training should be done as a first step. It is important for the owner to gain control of their pet. Leashes are absolutely necessary (not retractable leashes) and the use of head collars (Gentle Leader® Premier Pet Products) and/or muzzles strongly recommended for dogs that will be in situations with people if they cannot be avoided.

Treatment for aggression on walks

Treatment will focus on three areas, increasing control and ability to leave potentially aggressive situations, systematic desensitization to people and classical counter conditioning to the approach people2.

Two common treatment strategies are often employed. One is counter conditioning and desensitization. The dog is taught to perform a different task that is calm and relaxed. Desensitization is teaching the dog to accept the approach and greeting of people with relaxed body postures. This is begun with people far from the dog until the dog is reliably able to assume calm and relaxed behaviors. Gradually the dog is exposed to people at closer distances2. The other approach is to classically counter condition the dog to associate something pleasant with the sight and approach of people3. Classical counter conditioning

Animals showing unwanted behaviors are usually experiencing the underlying emotions of anxiety and fear that result in the outward aggressive responses. Changing underlying emotional state can help change outward behavior. The goal is to teach the pet to relax AND to associate the stimulus with something pleasant. The conditioning works to change the meaning of the stimulus from one that predicts something unpleasant to one that predicts something desirable.

Learning is unlikely to occur when an animal is highly emotionally aroused. In order to change an emotional behavioral response you must understand how the response changes with varying characteristics of the stimulus. To grade the response you need to know how the pet responds to the stimulus as that stimulus changes either in its proximity, speed of approach,

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location or other characteristics such as sound or size. Essentially you need to know, how the pet responds when the stimulus is 20 feet away, 10 feet away and finally past the owner and pet. And, does the pet respond the same way all the time? Can you grade the response in some way? This helps not only to assess the behavior but can also be used to assess treatment response.

To change underlying emotional state the animal must be offered something enticing that evokes another hopefully happier response. Find a reward that the animal finds especially enticing (an “A” treat) usually food, especially table food. Some dogs will find play an enticing reward but not all dogs will switch gears for play. Training is more successful if there is a gradient of rewards including those that are extremely desirable to less desirable ones. Extremely desirable rewards are saved for training and conditioning sessions only and withheld at other times

Pre-training

The owner needs to identify 3 levels of treats, A treats (very delectable usually table food), B treats (perhaps liver treats) and C treats (biscuits). The owner should also create a “treat jar”; a plastic container with a lid that is filled with A, B, and C treats and a bell placed on top. The pet is taught to “come” to the ringing sound and told to sit after which it will receive a treat from inside the jar.

The dog is taught two baseline tasks. To get the pet’s attention, we teach the pet to look at the owner using a phrase such as “watch me” or “focus”. The animal should maintain eye contact for several minutes but remain neutral and relaxed. A leash and head collar should be used for additional control. The task is first practiced in neutral, quiet surroundings until well performed, and then distractions can slowly be added.

The second is a command that allows you to leave or end the situation. For problems on walks, the dog is taught a phrase such as “let’s go” or “follow me” and to turn 180 degrees and briskly walk the other way. This should be performed quickly, but without anxiety or tension. Again, this is first practiced in a quiet location so that the response is quick and reliable each and every time. When the problem occurs indoors, the pet is taught a “go to your mat” command to send the dog to a quiet location to settle and relax. This training is done in slow steps, first taking the dog to the location and getting it to sit or down and stay with gradual increase in time. The dog is rewarded for relaxed breathing, body posture and facial expressions. In some cases, this mat may need to be in a room with a door that can be securely closed and/or locked or a crate. If the pet is not crate trained this can be attempted if the owner is willing to take the time to teach the pet how to be confined.

All of these steps must be in place before conditioning training can begin. Again, while this pre-training is taking place the stimuli known to cause the problem behavior must be avoided. This may mean curtailing walks, confining the dog when visitors come over, not allowing the dog outside in the yard unattended and off leash, not allowing aggressive displays at windows, doors and fences. The dog should be able to focus and then leave on command or settle in their place, before you begin the conditioning.

Actual training sessions for aggression on walks To help with control the pet should be wearing a flat collar or head collar and a leash that is held by a responsible adult. Initial sessions begin with the stimulus at the predetermined distance at which little or no response is noted. The owner must have the highly desired treat available and ready. The pet is asked to “focus” and the owner will begin feeding the treat regardless of what the pet does as long as they are not lunging or barking. They can look at the stimulus. As the stimulus gets closer to the predetermined spot where undesirable behavior is going to begin, you must quickly but calmly exit the situation using the “let’s go” command. Do several repetitions at the same distance. Knowing the response gradient is absolutely essential

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to setting up successful training sessions. The goal is to help the pet learn that the arrival of the stimulus predicts the desired treat and in the absence of the stimulus the treat is not forthcoming. We want the dog to learn to associate the sight of the stimulus with something pleasant.

The owner must not attempt to remain longer than the dog can behave. If the dog becomes very reactive, the stimulus was too close or too intense and future sessions must have better control of the stimulus intensity. Unwanted responses occur when you either do not have good control over the stimulus or did not accurately define your response gradient. You may need to be quite a distance away for the dog to be calm and controlled. Without control of the stimulus it is unlikely that the dog will learn the wanted responses because they will be too emotionally stimulated. Remember, the dog learns best when calm.

Punishment must be avoided, if the pet does not respond well to the stimulus you must immediately leave and realize that something about the set up of the training session was incorrect. You cannot punish away an emotion such as fear, anxiety or aggression. When you do punish the pet in these situations you are punishing what they are doing at the time and this can have several unintended consequences. You may change the outward expressions of the behavior such as barking, lunging, growling without any effect on the underlying emotion. This can result in a dog that does not signal but bites unexpectedly. Or, fear or anxiety toward the stimulus may actually increase since the stimulus results in punishment and bad things happening to the pet. In this scenario that intensity of the responses may actually increase rather than decrease as the pet attempts to get the stimulus to leave to avoid a bad outcome, i.e. punishment.

Limit the number of exposures within a training session. You want the dog to be successful and end each session on a positive response. If the dog does extremely well in a given training session, then they should receive a big reward and end the session. This treatment can often help decrease the arousal level so that the dog can be controlled during the situation.

Treatment of territorial aggression

Aggression toward people may only be exhibited when people enter the dog’s property, or what the dog considers his territory. Dogs may get highly aroused at the sight of people on their territory and may even attempt to jump fences, go through windows or doors to get to the intruder. Certainly, it is easier to prevent this type of aggression than to treat it. Dogs should not be allowed to engage in prolonged aggressive displays at windows, doors and fences at other dogs or people. Owners should strive early in the dog’s life to get control of barking and other territorial displays. Some dogs that act territorial are actually fearful and this can often be determined in the history taking, concentrating on body postures and pet response to intruders who do enter the house or yard.

Treatment for territorial aggression has several components. First, in the home the dog can be taught a "quiet" command so that barking displays can be halted. This is often best accomplished using a leash and head collar for control. Alternately, visual access could be blocked to decrease the arousal level. The dog should not be allowed outdoor or window access without supervision since engaging in the behavior is very reinforcing when the stimulus leaves, causing it to continue and perhaps escalate. The cornerstone of treatment is to counter condition and desensitized the dog to the approach of people in its territory. The use of a head collar and/or muzzle is necessary for owner confidence and control. This is accomplished by first teaching the dog a command incompatible with barking and lunging, such as a sit/stay. Food rewards are often helpful in the beginning so that the dog is relaxed and compliant. Then the dog is gradually exposed to people near the territory and praised for good behavior. At first it may be necessary to use people that the dog knows and recognizes and progress to unknown people3.

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Teaching a new response to the doorbell and visitors to the home Until the new behavior is mastered, it is important to avoid the full strength stimulus

(stranger coming up to the front door). If someone comes to the door, the dog should be safely and securely confined. Daily training exercises should be short, 5-10 minutes in duration using highly delectable food rewards. Training will focus on teaching the dog to settle on command, teaching a new response to the approach of people to the door, rewarding good behavior.

Start the training with no distractions present (nobody at door, house quiet, other pets elsewhere). The dog should be taught to go to a greeting spot (mat, rug, bed) on voice command; the spot should be within sight of the front door but a few feet away from it. It is often useful to use a head collar and leash and/or place the dog in a tie down for additional control. Before proceeding to the next step the dog should reliably go to the greeting spot and hold the sit/stay for 10 seconds when there are no distractions.

Set up daily exercises with one family member handling your dog and the other family member being a “visitor”. The family member playing the “visitor” should have spent time with the dog just prior to doing the training exercises. The dog should be on leash or there should be some type of barrier across the door that allows full visualization of the “visitor” but no access (screen door/baby gate) to the outdoors.

Have the “visitor” approach the open door and either knock gently or ring doorbell. The handler should give the command to your dog to go to the greeting place and sit/stay. The correct behavior is rewarded with a food tidbit and praise. Since the stimulus level is low (familiar person, recently seen them) the dog should be able to perform the desired behavior and be rewarded. If the dog isn’t compliant, give no reward and reduce the intensity of the exercise (maybe leave out knocking/doorbell ringing) at the next attempt.

Repeat until the dog is very obedient about going to the greeting location every time the “visitor” approaches the open door and knocks/rings. Then close the door slightly so that it is open 3/4 of the way and repeat entire sequence. Continue gradually closing the door over multiple sessions until the “visitor” can approach a closed door and knock/ring and the dog will hold a sit/stay at the greeting place as they enter the home.

After this has been successfully completed with the family member as the “visitor”, try to recruit a less familiar person to be the “visitor”. Return to the open door and repeat until your dog will hold the sit/stay even with a non-family member knocking/ringing bell of a closed door and then entering the house. At this time, the entering “fake visitor” can shake the treat jar and give the dog a reward.

Using Classical counter-conditioning to the doorbell

In other situations, it may be necessary to change the emotional state of the dog when they hear the doorbell before any training can begin. This is especially useful for dogs that are extremely emotionally aroused by the sound of the doorbell and bark, lunge and jump at the doors and windows.

Favored food rewards should be identified for the dog, these must be extremely delectable, generally table food. Place the dog unrestrained in another room away from the door with one family member, while another family member quietly leaves the house and comes to the unlocked front door. This person must have with them a large supply of the delectable treat. If the dog could see them from windows these must be blocked.

This person should ring the door bell and the dog is allowed to run to the door unimpeded as it usually would. As the outside person hears the dog approach, they open the door, throw the treats inside and close the door. When the dog gets to the door, if the correct food has been chosen the dog will usually eat the treats and perhaps also bark. Then the outside family member rings the bell and throws in the treats again. This technique will not work if the dog has seen the person exit the house or knows who is outside before they ring the bell.

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A training session is usually only 1-3 repetitions since when the dog realizes it is a known person at the door they may not bark. After several sessions, many dogs will decrease their barking or at least diminish emotional arousal to the doorbell so other training techniques can be utilized. At this point in time, training to sit and stay on a mat can begin and desensitization training implemented.

These training protocols may change how the dog responds to people coming to the door. If the dog is showing intense fear related aggression toward people and has bitten or threatened to bite this may not be enough to allow them to interact safely with people who come into the home. These exercises may only diminish reactivity so other training can be implemented.

Prevention of aggressive displays at windows, doors, fences and on walks Prevention is preferable to treatment. Good early socialization to other people, dogs, and people entering the home and yard may help diminish territorial and aggressive responses. Owners should strive to have good compliance with control commands such as come, sit, and stay. Teaching a quiet command is useful so that the barking can be controlled once it begins. Using a leash indoors for early teaching and control in young dogs can be particularly beneficial. References: 1. Guy NC, Luescher UA, Dohoo SE et.al (2001) A case series of biting dogs: characteristics of

the dogs, their behaviour and their victims. Applies Animal Behavior Science, 74:43-47. 2. Bain, M (2009)Aggression toward unfamiliar people and animals In: BSAVA Manual of

canine and feline behavioural medicine 2nd edition ed. D. Horwitz, D Mills, BSAVA, Gloucester UK, pp. 211-222

3. Horwitz DF, Neilson JC Blackwell’s 5 minute Veterinary Clinical Companion: Canine and Feline Behavior, Blackwell Publishing, Ames, Iowa. 2007 pp. 71-78.

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THE LINK BETWEEN HOUSE SOILING AND FELINE INTERCAT AGGRESSION

Debra F. Horwitz DVM, DACVB Veterinary Behavior Consultations

St. Louis, Missouri 63141 USA Introduction

The two most common problems in companion felines are house soiling (elimination of urine and stool outside of the litter box) and intercat aggression1 . While either can occur in a household with only one cat, often the problem occurs in a multiple cat home. An understanding of feline social behavior and communication, elimination problem behavior and feline aggression and can help with diagnosis and treatment of these two interlinked conditions.

The basis of feline social behavior While cats were generally considered asocial, they are capable of and do live in groups. These social groups tend to be matrilineal with related females (mothers, daughters, aunts) and juvenile male cats. Within these groups, individual cats will form attachments to certain individuals and actively avoid others2. These groups form around abundant food resources; dairy barns, fishing wharfs, garbage collection sites and parks provisioned by humans. Social groups formed of free roaming cats may change members with mature males and occasionally mature females leaving the group. This is in contrast to the human household where the humans artificially create social groupings and the cats do not have the ability to leave should they find the situation unpleasant. Bradshaw and Hall3 did a preliminary study observing the affliative (friendly) behavior between 25 pairs of cats who had lived together for at least a year who boarded at a cattery. Related pairs are commonly found in physical contact with one another when compared to non-related pairs of cats. Unrelated cats tended to feed separately, while littermate pairs often ate from the same bowl or side by side. Littermate pairs also groomed and rubbed one another more frequently than non-littermate pairs. While it is not possible to infer a great deal from a small study in an unfamiliar environment, this does begin to mimic relationships seen in free ranging cats. Other studies have attempted to assess whether or not cats have some sort of social ranking system for determining access to resources. An early study by Bernstein and Strack4 included 14 cats within one household, seemed to indicate that space within the household was not shared equally with certain individuals having greater access to resources than others do. While this is not necessarily evidence of a social ranking pattern, Knowles5 also found some correlations between agonistic interactions away from food and ability to control interactions at the food bowl. Others have suggested that agonistic social interactions have more to do with perception of personal space than social dominance but neither ascertain is supported in all cases. Another possible theory is that cats fight to increase individual distance between them, and is not about territory at all6. Elimination problem behavior Feline toileting in the wrong location (away from the litter box) and marking are the most common feline behavioral problems of cats. House soiling can often be precipitated by medical problems, a good physical examination and urinalyses are essential for all patients that are house soiling. Inappropriate elimination can also be a symptom of other medical abnormalities, such as hyperthyroidism, diabetes mellitus or liver disease. Studies have indicated a correlation

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between underlying social issues between household cats and urine marking and exploring relationships between cats is prudent to establish a diagnosis7. History for toileting and marking problems A complete and thorough behavioral history is essential to determine what is going on and help formulate a treatment plan. Essential points include:

Establishing the duration and progression of the problem behavior. Is this a new behavior, or a chronic one?

What type of elimination is deposited outside of the litter box; urine, stool or both? Location of the elimination, i.e. vertical deposition of urine or horizontal deposition. Information on the litter box is useful and essential. Litter box size, covered box vs.

uncovered box, litter type, number of boxes and rate of cleaning, box location must all be discussed.

A diagram of the locations of inappropriate elimination The frequency of urination or defecation outside the litter box When (time of day) the owners find the elimination outside of the litter box. What substrate (material) does the cat eliminates on; different substrates for urine

and stool? Information about the household routine and any changes in the home. How many other pets are in the household especially additional cats? Social relationship between cats in the household, including any overt signs of

aggression (hissing, growling, chasing) and covert signs of aggression (blocking, staring, supplanting from spaces)

All previous treatment attempts, behavioral, medical and pharmacological.

Diagnosis The major diagnostic categories for feline inappropriate elimination include location preference, substrate preference, litter aversion, location aversion, and marking8 . Non-litter box use can also be influenced by stress, anxiety, and litter box factors such as size, cleanliness and placement. The use of a diagnostic category will help in the formulation of a treatment plan. Aggression between household cats Fights can occur between cats that have lived together for some time perhaps due to a change in social status or a traumatic event, fights may be the sequel to redirected aggressive behavior or another anxiety producing event, aggression may occur with the introduction of another cat, or due to illness or social changes within the home. Fear, anxiety and territorial responses all contribute to intercat aggression within a household. In all situations, contributory medical factors must be ruled out, identified and treated. History taking History taking should collect information regarding the daily routine, pet-owner interactions and how resources are allocated within the home. All participants in the aggressive behavior must be identified. Detailed descriptions of several selected aggressive episodes will help to identify triggers, participants, owner responses and possible treatment options. Aggressive behaviors include blocking access to territory, staring, chasing, hissing, growling, biting and attacks, facial expressions and body postures. Identify any treatment options already tried and discuss implementation and effect they may have had on the problem behavior. Examine the ongoing behaviors of the cats involved noting signs of anxiety, fear and defensive behaviors (hiding, inappetence, lack of evidence of grooming) to determine the effect of treatment and resolution on these signs. Examine litter box use by all cats within the home since social issues often contribute to non-litter box usage or urine marking behaviors.

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Diagnosis After a behavioral history is taken, attempt to reach a diagnosis. Common diagnostic categories include territorial aggression, social status aggression, redirected aggression, fear aggression, defensive aggression, irritable aggression, defensive aggression, offensive aggression and intermale aggression. Factors that lead to house soiling due to aggression Chasing and overt aggressive threats such as growling, hissing, biting may be evident. However, threats between cats can be covert including blocking access to locations, staring or supplanting. In territorial disputes, one cat (the aggressor) will usually chase another (the victim). These chases are accompanied by vocalizations such as hissing, growling and yowling. This may result in one cat living in a restricted area to keep away from the aggressor. Therefore, it may be necessary to create separate areas for food, resting places and litter boxes for each cat in order to create harmony. Essential elements in treatment of house soiling linked to aggression between cats Within a multiple cat household, there should be multiple litter boxes, food bowls, water bowls and resting areas. These should not be clustered together, but placed throughout the environment keeping in mind how the various cats access the space available to them. Some cats may only have access to certain household areas and if resources are not within those areas anxiety and house soiling may result. When multiple cats share litter boxes the size and cleanliness of those boxes may become an issue. Research has indicated that when given a choice, cats prefer clumping litter materials to clay materials and larger size boxes. Litter boxes must be scooped out daily, and totally emptied, washed and refilled every 10-14 days. In order to create harmony, it may be necessary to keep fighting cats separated unless supervised or using structured introductions. Introductions can be accomplished using food or play and the goal is to associate pleasant things with the presence of each cat. It also might be helpful for the aggressor to wear an approved cat collar with a large bell that will forewarn the victim of their approach allowing the victim to escape. Re-introducing fighting cats Immediately after a fight, create separate spaces for isolation of fighting cats where they can

stay while the owner works on introductions. This must be a secure area with a door that latches completely and/or locks. In the room the cat must have a feeding/watering site; a litter box; perches at different vertical heights, hiding spots, scratching posts/pads, toys, etc. Make sure to remove all items of value or those that might be dangerous to the cat (e.g. plants, electric cords, strings) and any target items that may encourage inappropriate elimination (e.g. plush bath mats).

A pheromone diffuser, Feliway®, should be placed in the isolation areas and in the other parts of the home.

To facilitate re-introductions identify favored activities/treats for all cats involved in the problem behavior.

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Encourage play through the door. One option is to create a dumbbell toy under the door that separates the cats by tying two toys together with heavy string and place one toy on each side of the closed door.

Facilitate scent transfer between cats. Use a common piece of material to pet each cat every day; wiping the towel against the cheek area and the base of the tail alternating from one cat to the other.

Do not allow overt persistent aggression such as hissing and growling at the barrier door. If this occurs, create a neutral zone by closing another door or creating separation using baby gates in hallways

The next step is to progress to short (<5 minutes) visual introductions. Cats are contained in some manner (in crates, on harnesses/leashes; behind doors with windows) so they can’t make physical contact but they can see each other. Try to engage cats in a favored activity in their respective locations during these visual opportunities. Perform these 2-3 times daily until all cats appear relaxed and there is no aggressive posturing. If there is aggressive posturing, the cats must be separated to avoid intimidation.

Once the cats are relaxed when they visualize each other, food introductions outside of the isolation area can begin.

Details of counter conditioning and desensitization The focus is on counter conditioning and desensitization exercises to re-introduce the cats to one another. The goal is to allow the cats to be together without any aggressive behavior (growling, hissing, chasing, staring etc.). Introductions are done slowly, using food to facilitate calm, non-anxious behavior (counter-conditioning). The cats need to be far apart or on either side of a closed door, so that they are relaxed (desensitization). Each cat is offered a delectable food treat that they will eat. For safety and control, it is often advisable that each cat wear a harness and leash. If the cats will not eat, then they are too anxious and probably too close together and should be moved further apart. If the cats still will not eat, then separate them until the next feeding. If the cats do eat at that time, they remain together while they eat and then separated. The next feeding is at the same distance. If things go well at that session, the next time the dishes can be moved closer together, but only 6-8 inches. If the cats are comfortable, sometimes they are left out but leashed far apart and under supervision so that they can groom, and then separated again. Two feedings without the expression of any aggressive or anxious behavior are done at the same distance before the bowls are moved closer together. Clients should be cautioned that this is a slow process and not to rush. Allowing the cats to interact in an aggressive manner sets the program back and makes resolution more difficult. Keep cats separated except for introductions and always supervised when they are together. It also may be helpful to switch litter pans between the cats to aid in familiarization. Another technique that may help is to rub the cats with towels and switch from one cat to the other to mix their scents. Crates or some other see through barrier can also be used for introductions to allow the cats to see one another, but not get too close. Drug therapy For some cases, the addition of psychotropic medication and pheromones can be helpful in resolving the urine spraying and the aggression. The drugs that are presently being used are not approved for use in cats and therefore are extra label drug usage. Prior to use, all animals should have physical examinations, laboratory screenings for liver and kidney function and in some cases, electrocardiograms. Signed consent and release forms are advisable. Owners should be informed of potential side effects and plan to be home to monitor their pet for the first 1-2 days of treatment. Several classes of drugs have been used to treat aggression in cats. Medications for urine spraying are detailed in another proceedings paper for this conference

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Fluoxetine and Paroxetine are selective serotonin re-uptake inhibitors used to treat aggression in cats. Selective serotonin reuptake inhibitors may take several weeks to become effective. Common side effects include constipation, urinary retention, anorexia, gastrointestinal signs, tremors, irritability and lethargy. Starting at a low dose for 1-2 weeks and gradually increasing the dose can minimize side effects. Toxicity due to serotonin syndrome is possible when more than one antidepressant is used and this should be avoided.

o Fluoxetine 0.5-1.0 mg/kg every 24 hours; o Paroxetine 0.25-.5 mg/kg every 24 hours9.

Clomipramine and Amitriptyline HCL are tricyclic antidepressants used in the treatment of aggression in cats. Clomipramine is a serotonin re-uptake inhibitor while amitriptyline and also inhibits both the reuptake of norepinephrine and serotonin. Most tricylic antidepressants have some anti-histamine actions and can interfere with thyroid medications. Clomipramine and amitriptyline must be given daily to be effective and can take 2-4 weeks to facilitate a change in behavior. Common side effects include tachycardia, urinary retention, and sedation, G.I.T. upset, mydriasis and a dry mouth. Amitriptyline is very bitter and therefore administration may be extremely difficult. Because of potential increases in heart rate, exercise caution in patients with cardiac disease and an EKG prior to use may be prudent.

o Clomipramine 0.25-0.5 mg/kg, PO every 24 hours10. o Amitriptyline 0.5-1.0 mg/kg PO q 12-24 hours9.

Medication is generally used for 6-12 weeks and if the behaviors have changed the animal is weaned off the medication by decreasing the dose 25% every 2-4 weeks while watching for a return of any aggressive indicators such as growling, hissing or chasing. If aggressive behaviors return, the pet is maintained at the same dose for several weeks to see if the animal stabilizes before attempting to decrease the dose again. CONCLUSION In all house soiling cases consider the interactions between the cats. Questions targeting the use of space, which cats spend time together sleeping and grooming and placement of resources throughout the home will help determine if these areas also must be targeted in the treatment plan. Without treating the social problems, house soiling is likely to continue and be unresolved. References

1. Denenberg, S., Landsberg, G.M., Horwitz, D., Seksel, K., A comparison of cases referred to behaviorists in three different countries. Proceedings 5th IVBM 2005 pp 56-62.

2. Crowell-Davis SL, Curtis TM, Knowles RJ Social organization in the cat: a modern understanding. Journal of Feline Medicine and Surgery 2004; 6:19-28.

3. Bradshaw JWS, Hall SL. Affiliative behavior of related and unrelated pairs of cats in catteries: a preliminary report. Applied Animal Behavior Science 1999; 63: 251-255

4. Bernstein P, Strack M Home Ranges, favored spots, time sharing patterns, and tail usage by 14 cats in the home. Animal Behavior Consultants Newsletter, July 1993; 10: 1-3.

5. Knowles RJ, Curtis TM, Crowell-Davis SL Correlation of dominance as determined by agonistic interactions with feeding order in cats. AJVR 2004; 65: 1548-1556.

6. Barry, K. “Intercat aggression in the household” AVMA Convention Notes, 1999. Veterinary Software Publishing

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7. Pryor PA, Hart BL, Bain MJ, Cliff KD, “Causes of urine marking in cats and the effects of environmental management on frequency of marking” JAVMA, 2001; 219:12: 1709-1713.

8. Horwitz, DF. “Housesoiling by cats” In: BSAVA Manual of Canine and Feline behavioral medicine. Eds. Horwitz, Mills and Heath. BSAVA, Gloucester UK, 2002, pp 97-108.

9. Mills, DS. Simpson BS(2002) “Psychotropic agents” In: BSAVA Manual of Canine and Feline Behavioral Medicine Eds. Horwitz, Mills and Heath. BSAVA, UK. pp. 237-248

10. King JN, SteffanJ, Heath SE, Simpson BS et al (2004) “Determination of clomipramine for the treatment of urine spraying in cats” JAVMA 225:6 881-887

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FELINE AGGRESSION TOWARD PEOPLE

Debra F. Horwitz DVM, DACVB Veterinary Behavior Consultations

St. Louis, Missouri 63141 USA

Overview of Feline Aggression Naturally any medical or environmental issues can influence aggressive responses. Therefore a good medical examination and behavioral history are essential for diagnosis and treatment. Historical questions should include when and where the aggressive episodes occur, who the victims are, what is the body posture and facial expression of the cat before, during and after the incident. Victim responses can influence the pattern of aggression and should be explored. Determination of the frequency of aggressive episodes will help determine both prognosis and treatment response. Finally, an attempt should be made to assess the intensity of the aggressive response, hissing, swatting, growling, chasing, wrestling, biting and scratching. Understanding feline body language will help with diagnosis. Cats use body postures to attempt to avoid outright aggression if possible. Threatening body postures include hissing, piloerection, arching of the back and side presentation. Ear posture can be helpful as well; ears turned to the side and back usually indicate defensive aggression while ears turned back and up at the ends are often offensively aggressive. Cats that are restricted in movement may chose to fight when unable to flee resulting in defensive and possible fear motivations. Ability to get away and under something or up high can influence the expression of the aggressive response. Misdirected Play related Aggression Signalment and History taking This is an extremely common behavior problem in young cats and kittens often beginning at about 12 weeks of age. Predatory play is an integral part of feline play behavior and early learning1 and probably contributes to this problem. Rough play and encouragement by people contributes to a lack of inhibition and contributes to this problem. The signs include attacking moving owner body parts, surprise attacks and perhaps biting hands when petted often without aggressive signalling such as growling and piloerection. The problem most commonly occurs in households with singleton cats less than 2 years of age, or cats housed with other animals that will not play. It can also occur in cats that are left alone for long periods of time during the day.2 Diagnosis Movement by the people in the home seems to elicit the behavior, going up and down stairs, moving under bed covers, making the bed or stepping out of the closet3. Descriptions of the body posture of the cat during episodes will help confirm the diagnosis. The contexts for the behavior and body posture of the cat can help establish a diagnosis. Treatment Treatment protocols focus on channelling the normal playful energy of the kitten or cat toward appropriate play and discouraging inappropriate play. Behavior modification alone will resolve this problem; medication is neither needed nor appropriate. The cat’s need for aerobic exercise and mental stimulation must be met. The proper use of toys; hanging toys, cat fishing rods, small wads of paper, feeder toys, boxes, and bags can all serve as stimulation for a cat. Cats and kittens may quickly habituate to the characteristics of a toy during play and the intensity of

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the play may diminish, switching to another toy after a short delay will result in a resumption of uninhibited play3. Owners should strive to offer multiple play sessions daily. Often picking up toys and rotating them every few days will keep a cat interested and increase playful activity. Owners should be discouraged from using their hands to play and wrestle with the kitten/cat. Interruption of attacks directed toward humans in the home is best accomplished through the use of noise distracters that will startle the cat such as; a noisemaker, a can of compressed air, a shaker can or an air horn. Once the cat stops the inappropriate behavior it is redirected to an appropriate outlet such as a toy. Awareness of where and when these attacks occur and anticipating them is useful. A journal may help identify locations and times when attacks are likely. Owners can change the environment to prevent the attacks, or distract the cat before the attack takes place. A bell on a breakaway collar may help owners know the location of the cat and use the other techniques mentioned. Harsh physical discipline is always contraindicated. Not only can it make the problem worse, but it can also create a cat that becomes anxious and fearful of people, an extremely undesirable side effect. It is important to redirect the behavior, not punish it. Frustration related aggression Signalment and history This type of aggression is not often documented in the literature4,5 with very little agreement on diagnostic criteria. It seems to involve elements of “control” of the social situation with the humans and tend to occur most frequently toward familiar people and especially when the cat is denied something it wants or expects. This may be evident in hand reared cats or those that are very demanding and typically occurs over feeding, interaction or access to the outdoors. Diagnosis may be difficult since other forms of aggression may also be present5. Treatment Treatment is aimed at controlling the environment and making the cat more responsive to the owner by earning all things. Cats can learn basic commands such as “come” using food rewards. Commands and rewards are then used to remove the cat from certain situations. The owner must learn to identify signs of impending aggression and interrupt the behavior by leaving the situation. An aggressive cat may have its head down, its tail away from the body, possibly twitching quickly back and forth, ears with their openings pointing to the side. An inhibited cat may crouch and perhaps roll over with ears back. A frightened cat will crouch, may hiss and will flatten its ears to its head. An extremely fearful cat may arch its back, piloerect its hair, hold its tail straight up, flatten its ears and may become aggressive if cornered. In addition, direct confrontation must be avoided or else aggression may escalate. Petting related aggression Signalment and history Some cats may respond aggressively when petted. The cat will allow petting for a certain period of time and then turn and bite the owner and leave. The cat may even solicit attention but end it by biting, grabbing and running away. Usually these are inhibited bites without serious injury. Some authors speculate that the problem is with the individual cat’s threshold for attention, internal conflict between adult feline responses and juvenile responses and perhaps even hyperesthesia may play a role in the response6.

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Treatment To begin therapy, the owner needs to find the threshold that elicits the aggression and stay below it. Tail flicking and flattening of the ears and perhaps dilation of the pupils usually precede aggression and indicate a desire to end physical contact. The owner can gently stand up and allow the cat to slip off their lap ending the interaction. This may allow some cats to learn to remain calm if they wish to remain on the owner’s laps. Interactions should focus on types of interactions the cat likes best: light petting on the head but not on the body, sitting on the lap without physical contact. Cats can be conditioned to accept longer periods of contact using food rewards for good behavior. The owner pets the cat a few times staying below the irritation threshold and rewards the cat with food for good behavior. Each session tries to add in a slightly increased amount of contact and reward good behavior. Redirected Aggression Signalment and history Redirected aggression arises from the cat being in an aggressive or agitating circumstance, but unable to vent that aggression on the causative agent6. If the redirected aggression is directed toward people, usually the problem arises because the people interact with the cat when it is agitated perhaps by some other stimuli. Stimuli that can potentially cause redirected aggressive behavior include the sight, sound or odour of another cat or other animal, unusual noises, unfamiliar people, unfamiliar environments and pain5. Often avoidance of the aggression-producing situation may be possible. Treatment If avoidance of the eliciting stimulus is not an option, but the situation comes up infrequently, the owner can be instructed to stay away from the cat and not pick it up until it is calm. To calm an agitated cat put the cat in a darkened room with food; water and litter box and leave it there. Some cats may be so agitated, picking them up may be dangerous and injury to owners is possible. For those situations, herding the cat using a broom, lifting the cat with heavy gloves on or throwing a blanket over the cat so it can be lifted is safest. The cat may need to be kept in the dark for several days until it is calm. The owner can go in, turn on the light only to feed the cat and then leave. Once the cat begins to approach the owner calmly and with relaxed body postures the cat may be ready to be let out. Long periods of time may be necessary for some cats to calm down and premature interaction may cause the cat to become aggressively aroused again. Counter conditioning and desensitization to the situations that aggravate the cat is the long term approach. Fearful or defensive aggression Signalment and history taking Fear related or defensive aggression can occur both to family members in the home or to new people in the home. The cat assumes a fearful or defensive posture (crouched, ears flat, pupils dilated, piloerection and hissing, spitting or growling) and may bite if touched2. Cats without proper socialization may be at a greater risk of developing fear related aggression toward people. In situations where flight is denied and aggression rewarded by cessation of the unwanted approach the behavior can become intensified and quite strong. Early traumatic experiences, inappropriate punishment or reinforcement of the aggressive behavior can all contribute to the expression of the aggressive behavior. History taking should include who, what, when, victim, responses of victim and owner, frequency and consequences of the behavior. Diagnosis The diagnosis is based on body postures and facial expressions denoting a fearful motivation. The type of stimuli should also be included in the diagnosis.

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Treatment This type of aggression is best treated with a counter conditioning and desensitization program. To begin the program, the cat must first be taught to associate good things with calm and quiet behavior. The next step is to set up situations where the cat is calm and slowly work at getting closer to the cat using tasty food rewards to facilitate change. Distance from the cat is an important factor in the behavior modification plan and the person may need to be quite a distance away for the cat to remain calm. If the cat continues to eat in the presence of the person, then the person should try moving slightly closer. The situation must progress slowly until the cat will accept the person petting it while it eats. It is very important to move slowly and allow the cat to be calm and non-anxious or fearful during sessions. The person needs to avoid the cat at other times if that can be arranged. The goal of treatment is for the cat to experience proximity to the person without experiencing the fear. Play therapy may also be helpful in these cases. If the fear is toward visitors who come to the household, counter conditioning and desensitization can also be implemented. The cat should be on a harness and leash for safety or in a crate or carrier. Start with people that the cat knows, and reward the cat for being around them using tasty food treats. As in the previous examples, the distance to the people is an important factor and should be manipulated so that the cat is not anxious or fearful. Once the cat has mastered the technique with people it knows, you can progress to less familiar people. Counter conditioning and desensitization is a very slow process, and care must be taken to proceed slowly and only reward calm, non-anxious behavior. If the owner is unwilling or unable to carry out a desensitization program, for everyone's safety, the cat should be confined when visitors are in the home. For some cases, the addition of psychotropic medication and pheromones can be helpful in resolving the aggression. The drugs that are presently being used are not approved for use in cats and therefore are extra label drug usage. Prior to use, all animals should have physical examinations, laboratory screenings for liver and kidney function and in some cases, electrocardiograms. Signed consent and release forms are advisable. Owners should be informed of potential side effects and plan to be home to monitor their pet for the first 1-2 days of treatment. Several classes of drugs have been used to treat aggression in cats. Fluoxetine and Paroxetine are selective serotonin re-uptake inhibitors used to treat aggression in cats. Selective serotonin reuptake inhibitors may take several weeks to become effective. Common side effects include constipation, urinary retention, anorexia, gastrointestinal signs, tremors, irritability and lethargy. Starting at a low dose for 1-2 weeks and gradually increasing the dose can minimize side effects. Toxicity due to serotonin syndrome is possible when more than one antidepressant is used and this should be avoided.

o Fluoxetine 0.5-1.0 mg/kg every 24 hours; o Paroxetine 0.25-.5 mg/kg every 24 hours7.

Clomipramine and Amitriptyline HCL are tricyclic antidepressants used in the treatment of aggression in cats. Clomipramine is a serotonin re-uptake inhibitor while amitriptyline and also inhibits both the reuptake of norepinephrine and serotonin. Most tricylic antidepressants have some anti-histamine actions and can interfere with thyroid medications. Clomipramine and amitriptyline must be given daily to be effective and can take 2-4 weeks to facilitate a change in behavior. Common side effects include tachycardia, urinary retention, and sedation, G.I.T. upset, mydriasis and a dry mouth. Amitriptyline is very bitter and therefore administration may

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be extremely difficult. Because of potential increases in heart rate, exercise caution in patients with cardiac disease and an EKG prior to use may be prudent.

o Clomipramine 0.25-0.5 mg/kg, PO every 24 hours8. o Amitriptyline 0.5-1.0 mg/kg PO q 12-24 hours7.

Medication is generally used for 6-12 weeks and if the behaviors have changed the animal is weaned off the medication by decreasing the dose 25% every 2-4 weeks while watching for a return of any aggressive indicators such as growling, hissing or chasing. If aggressive behaviors return, the pet is maintained at the same dose for several weeks to see if the animal stabilizes before attempting to decrease the dose again.

1 Bateson, P, Martin, P. (1988) Behavioral development in the cat In: The Domestic Cat: The Biology of its behavior. Eds. D. Turner, P. Bateson. Cambridge University Press, pp.9-22. 2 Borchelt, PL, Voith, VL. (1982) Diagnosis and Treatment of Aggression Problems in Cats” Veterinary Clinics of North America: Small Animal Practice, 12:4, pp. 665-671. 3 Hall S.L., Bradshaw J.W.S., Robinson I.H. (2002)Object play in adult domestic cats: the role of habituation and disinhibition. Applied Animal Behavior Science. 79: 263-271. 4 Heath, S (2009) Feline Aggression In: BSAVA Manual of Canine and Feline Behavioral Medicine Eds. Horwitz, Mills and Heath. BSAVA, UK. , pp.228. 5 Landsberg, G, Hunthausen, W, Ackerman, L (2003) Feline Aggression In: Handbook of Behavior Problems of the dog and cat 2nd edition, Saunders, Philadelphia, pp. 427-453. 6 Beaver, B (1994). The Veterinarian’s Encyclopedia of Animal Behavior ,Iowa State University Press, Ames, Iowa, pp.224 7 Mills, DS. Simpson BS(2002) “Psychotropic agents” In: BSAVA Manual of Canine and Feline Behavioral Medicine Eds. Horwitz, Mills and Heath. BSAVA, UK. pp. 237-248 8 King JN, SteffanJ, Heath SE, Simpson BS et al (2004) “Determination of clomipramine for the treatment of urine spraying in cats” JAVMA 225:6 881-887

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AN UPDATE ON MEDICATIONS USED IN BEHAVIORAL MEDICINE

Debra F. Horwitz DVM, DACVB Veterinary Behavior Consultations

St. Louis, Missouri 63141 USA

Introduction The use of psychopharmacology in behavioral medicine is an evolving discipline. At the present time, in the United States only three medications are approved for the treatment of behavioral disorders (Reconcile®, Clomicalm® and Anipryl®). While medication can be useful in the treatment of phobic, panic and anxiety disorders, the level of strong evidence for certain interventions may be lacking. When considering the use of medication in a specific case it is essential to determine your diagnosis, which cases and patients are good candidates for drug therapy and what medication to utilize, the dosage and length of therapy. Finally, medication alone is rarely if ever appropriate as a sole treatment modality because it will not change the relationship to the stimulus or learned responses therefore concurrent behavior therapy is always recommended. Diagnosis Many texts are available that detail how to take a history and diagnose behavior problems in companion animals (see reading list at the end of the paper). Without a proper diagnosis using medication at best may not be helpful and in the worst case harmful. The conditions that benefit from the addition of medication include anxieties (separation anxiety1,2, global anxiety), fears, phobia (noise and storm phobia3), urine marking in cats4,5, and selected cases of aggression in dogs and cats (extremely impulsive, explosive aggression). Determining if medication is appropriate Once a diagnosis has been established, which cases and patients make good candidates for medication? It is essential to initially rule out any medical causes of the unwanted behavior by a good physical examination, laboratory testing (for baseline values prior to medication) and perhaps imaging studies. Make sure your diagnosis is established, and a behavior modification plan is in place and being implemented by the owner. Ascertain if there are any contraindications for drug usage including; poor safety measures in place, high risk of injury to humans or other animals, the home shows poor compliance for following recommendations. Medication is indicated when the animals welfare is compromised which may occur in severe fears, anxieties and phobias and when the addition of medication will enhance the behavioral modification process. It is also appropriate to inform clients when medication is being used in an “off label” or non approved manner. Medication for acute situations Certain medications work relatively quickly and are well suited in situations where immediate effect is needed. These medications can be used concurrently to provide immediate short term relief with a chronic medication that may take longer to reach efficacy. Alternately these medications may only be used in acute situations that are intermittent, situational and predictable. Some situations that fit this description include car or airline travel anxiety, specific episodic noise events for noise phobic pets, separation anxiety when the dog must be alone and chronic medication is not active or not strong enough. Benzodiazepines These are the most commonly utilized class of drug in this category. They work by enhancing GABA, an inhibitory neurotransmitter. An additional benefit is that not only do they diminish

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anxiety, but are safe with animals that have seizure disorders. Benzodiazepines have a short duration of action of 4-6 hours and must be administered 30-60 minutes prior to the trigger event. Approximately 10% of animals show excitement rather than a diminished anxiety when given a benzodiazepine, switching to another medication within the same class may help. Caution is advised when using this class of drug in animals showing fear based aggression because disinhibition of the aggression is possible. Over time tolerance may develop and higher dosages needed for the same effect. Generally this class of drug is given orally but other preparations exist. Benzodiazepines are a controlled class of medication that also has the potential for human abuse. Trazadone This is an atypical antidepressant that has recently been utilized as an event drug for additional control for anxious animals that are also on other serotonin enhancing medications. It is usually administered one hour before the onset of the event6. Limited information is available on potential side effects and long term usage. Phenothiazines This class of drug has often been utilized for anxiety situations but is not a particularly good choice. Although they incapacitate the animal, they do not affect underlying anxiety and thus are not really a useful adjunct for diminishing the underlying emotion that may be causing the behavioral problem. Medication for chronic use Daily medication is indicated in clinical cases where anxiety is underlying the primary diagnosis. The group of drugs most commonly utilized are serotonin enhancing drugs including fluoxetine, paroxetine and sertraline (Selective Serotonin reuptake inhibitors), clomipramine, and amitriptyline (Tricyclic antidepressants). This class of medication works by enhancing serotonin levels within the brain. Serotonin is a neurotransmitter that has multiple functions and receptor sites in the body. Little real information is available in animals, but in humans, low serotonin levels are associated with irritability, hostility, depression and impulsivity. Enhancing serotonin in humans has been associated with a diminishing of depression, alleviating anxiety and changing temperament. Unfortunately the behavioral effect of this class of drug is not immediate; it may take 7-31 days before a behavioral effect is noted. It is important to stress to clients that these are not event medications and they must be given daily for an effect to occur. Separation anxiety1,2 and extreme or self injurious storm and noise phobias3 respond well to serotonin enhancing medications. Underlying anxiety may be present in animals showing aggression7, compulsive disorders8,9 and urine marking and serotonin enhancing drugs may be useful in these conditions. Another syndrome, cognitive dysfunction may present with chronic behavioral changes and may benefit from the use of a MAOI selegiline. The preferred method of administration of serotonin enhancing drugs is orally. Although the use of transdermal medication has been advocated, current studies have shown only limited absorption10 and therefore the usefulness of this modality for psychotropic medication appears limited at this time. Although often used transdermally especially in feline patients, information on actual dosing levels needed is unknown at the present time. Side effects

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Side effects are possible with any medication and the client should be advised to watch the patient carefully for the first few days of medication administration. In elderly or compromised individuals beginning medication at one third to on half the recommended dosage or at an every other day dosing may be prudent. If no side effects are noted after a few weeks and if no therapeutic effect is seen, the dosage can slowly be increased to recommended levels. Tricyclic antidepressants (TCA) may have anticholinergic, antihistaminic and adrenergic side effects including dry mouth, urinary retention or GIT upset. Cardiac problems are possible but not reported in companion animals but care should be exercised in compromised individuals. This class of drug is contraindicated in animals with seizures. Selective serotonin reuptake inhibitors have a lower side effect profile and rare anticholinergic or adrenergic side effects but may cause appetite suppression and have a long half life of metabolic clearance. SSRI medications may also inhibit cytochrome P450 enzyme pathways and decrease the clearance of other medications utilizing the same pathway. SSRI’s are also contraindicated in animals with seizure disorders. Goal of therapy The goal of drug therapy is to use medication for a limited time (3-6 months) to enhance the application and administration of a behavioral modification plan. The hope is that the animal will learn appropriate new responses and behavior in the previously problematic situations. Once new behaviors are learnt and stable, weaning off medication is advised. Weaning is usually accomplished by diminishing the dosage by 25-50% weekly of semi-weekly and watch for a return of the problematic responses. If the signs return, remaining at the lower dose for several weeks may allow stabilization of the behavior and weaning can commence again. Some patients however may never be able to come off medication either because of the lack of owner compliance with behavior modification plans, genetic predisposition to anxiety or continued exposure to the causative stimuli that is unavoidable. Those patients should be evaluated on a regular basis (1-2 times yearly) for both response to medication and a recheck of laboratory values to assess liver and kidney function. Serotonin syndrome This is a potentially fatal side effect that may occur with high doses of serotonin enhancing medications or combinations of serotonin enhancing medications such as MAO inhibitors (amitraz, selegiline), other SSRI’s, TCA’s, tramadol, tryptophan, buspirone, St. John’s Wart, amphetamines, dextromethorphan and bromocriptine. Therefore, combinations of serotonin enhancing drugs must be avoided. Final word of caution With the exception of the medications mentioned in the first paragraph, most psychotropic medications are not approved for use in dogs and cats. Dosage recommendations are primarily based on anecdotal reports and are not based on placebo controlled studies. Caution should be exercised when dosing animals and supervision and re-evaluation are important components to psychotropic drug usage.

Drug Class Canine Feline Freq route

Diazepam Benzo 0.55-2.2 mg/kg 0.2-0.5 mg/kg q 6-24 H PO

Alprazolam Benzo 0.01-0.1 mg/kg 0.05 mg/kg q 8-12 H PO

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Acut

e medications dogs and cats  

Chronic medications and dosages in dogs

Drug Class Canine Freq Route Clomipramine TCA 1.0-2.0 mg/kg Q 12 H PO

Fluoxetine SSRI 0.5-2.0 mg/kg Q 24 H PO Buspirone Azapirones 0.5-1.0 mg/kg Q 8-12 H PO Sertraline SSRI 1-3 mg/kg Q 24 H PO Selegiline MAOI 0.5-1.0 mg/kg Q 24 H PO

 Chronic Medications and dosages for cats

Reading list Horwitz DF, Mills D. (2009) BSAVA Manual of Canine and Feline Behavioral Medicine second edition. British Small Animal Veterinary Association, Gloucester, UK. Horwitz DF, Neilson J, (2007) Blackwell’s 5 Minute Veterinary Consult Clinical Companion: Canine and Feline Behavior, Blackwell Publishing, Ames IA Landsberg G, Hunthausen W, Ackerman L (2003). Handbook of Behavior Problems of the Dog and Cat, 2nd edition, Saunders, Edinburgh, UK References                                                             1King JN, Simpson, BS, Overall KL et al Treatment of separation anxiety in dogs with clomipramine: results from a prospective, randomised, double-blind, placebo-controlled, parallel-group multicenter clinical trial. Applied Animal Behavior Science. 2000 67: 255-275 2 Simpson BS, Landsberg GM, Reisner IR et al Effects of Reconcile (Fluoxetine) Chewable Tablets Plus Behavior Management for Canine Separation Anxiety, Veterinary Therapeutics, 2007 8: 18-31 3 Crowell-Davis SL, Seibert LM, Sung W, et al. Use of Clomipramine, Alprazolam, and Behavior Modification for Treatment of Storm Phobia in Dogs JAVMA (2003) 222[6]:744-748 4 Pryor PA, Hart BL, Cliff KD et al (2001) Fluoxetine hydrochloride for urine marking in cats: a double blind, placebo-controlled clinical trial. JAVMA 219: 1557-1561 5 Hart BL, Cliff KD, Tynes VV, Bergman L (2005)“Control of urine marking by the use of long-term treatment with fluoxetine or clomipramine in cats” JAVMA 226: 378-382

Lorazepam Benzo 0.1-0.2 mg/kg 0.02 mg/kg q 12-24 H PO

Trazadone SARI 2-5 mg/kg Not used in cats q 8-12 H PO

Drug Class Dose Range Frequency Route Fluoxetine SSRI 0.5-1.0 mg/kg Q24H PO Paroxetine SSRI 0.25-0.5 mg/kg Q24H PO

Clomipramine9 TCA 0.25-0.5 mg/kg Q24H PO Amitriptyline TCA 0.5-1.0 mg/kg Q12-24H PO Buspirone Azapirone 0.5-1.0 mg/kg Q 12-24 H PO Selegiline MAOI 0.5-1.0 mg/kg Q 24 H PO

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                                                                                                                                                                                                6 Gruen ME, Sherman BL. 2008 Use of trazodone as an adjunctive agent in the treatment of canine anxiety disorders: 56 cases (1995-2007) JAVMA 233 (12) 1902-1907 7 Dodman NH, et al (1996) Use of fluoxetine to treat dominance aggression in dogs JAVMA 209:1585-1587 8 Hewson CJ, Luescher A, Parent JM, Conlon PD, Ball RO. (1998)Efficacy of clomipramine in the treatment of canine compulsive disorder. JAVMA 213 (12) 1760-1766. 9 Seksel K, Lideman MJ (1998) Use of clomipramine in the treatment of anxiety-related and obsessive compulsive disorders in cats.. Aust. Vet. J. Vol. 76, No. 5, pp. 317-321 10 Ciribassi J, Luescher A, Pasloske KS et al. (2003) “Comparative Bioavailability of fluoxetine after transdermal and oral administration to healthy cats” AJVR 64:8 994-998.  

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