Today's Veterinary Practice

MAY-JUN 2017

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97 MAY/JUNE 2017 ■ TVPJOURNAL.COM FOCUS ON PHARMACOLOGY phobia. These are commonly comorbid conditions, 1 as is the rule among anxiety disorders. 2,3 Because the development of both conditions ranges from subtle to explosive, veterinarians should screen for them at each appointment using a standardized clinical assessment tool 4 to identify and treat them early. Results of these routine clinical assessments should be recorded and evaluated to determine whether they meet diagnostic criteria ( Box 1 ). Signs of distress should be evaluated in currency and terminology that are meaningful for the individual patient because the most commonly reported behaviors (elimination, destruction, excessive vocalization) are only the most readily apparent and easily recognizable signs of anxiety for the clients and veterinary team. Drooling, panting, freezing, withdrawal, and cognitive signs of anxiety are less commonly diagnosed because they are less apparent to people, but dogs displaying them may be even more profoundly affected than dogs that show more obvious signs ( Box 2 lists signs of anxiety). Dogs that are distressed when exposed to noises or storms but do not meet the criteria for a noise phobia may best be classified as "reactive" and assessed for treatment. The risk for worsening in these dogs is nontrivial. Even the mildest signs should be treated if a dog has any history of reacting to noises. 6 Clients may insist that they can simply hold the dog while it pants and shakes or that the dog calms itself by hiding in the closet. In fact, these patients are suffering and need behavioral medication. Video is a powerful tool for accurate diagnosis and an even better way to assess response to medication and other treatment. CHOOSING MEDICATIONS ACCORDING TO PATIENT PRESENTATION When choosing medication for patients with separation anxiety, noise reactivity, or both, practitioners should be guided by expected changes in relevant signs, regions of the brain that may be affecting those signs, and distributions of neurochemical receptors in the regions that may be affected by the medication chosen. Some dogs show suites of correlated behaviors; for example, salivation appears to be more common in dogs that freeze and become immobile. If we alter the salivation, do we alter any part of the feedback system that maintains the anxiety? In fact, by BOX 1. Diagnostic Criteria for Common Behavioral Disorders 5 Separation anxiety Behavioral condition resulting in the following signs of distress exhibited by the patient only in the absence of, or lack of access to (a virtual absence), the client: • Physical (injury, uneven nail wear, scored teeth) • Physiologic (salivation, increased heart rate) • Behavioral, cognitive, or emotional (social withdrawal, agitation, lack of focus) Noise phobia • Behavioral abnormality resulting in profound, nongraded, extreme response to noise, manifested as intense avoidance, escape, or anxiety, associated with sympathetic nervous system signs. • Dogs can shut down and freeze or run without caution. • Decreased sensitivity to pain or social stimuli is often concomitant. • Once established, repeated exposure results in an invariant pattern of response, but not all dogs show a full-blown invariant response. Panic disorder/panic • Behavioral abnormality resulting in a sudden, all-or- nothing, profound, abnormal response that results in extremely fearful behaviors (catatonia, mania, escape) where the provocative stimulus may be unknown/ unclear, situational, internal, and/or generalized. • Differs from conditions involving phobias, where the provocative stimulus is more discrete and identifiable, and where the level of distress characteristic of panic may not be achieved. • The term panic disorder should be restricted to a described pattern of like events. • A panic event is a singular or infrequent event where the patient exhibits these behaviors, but the data are insufficient to determine whether the consistent pattern exists as required for panic disorder. • The risk that a patient will experience another panic event after having had one is great.

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