Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.
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96 FOCUS ON PHARMACOLOGY FOCUS ON PHARMACOLOGY Behavior Medications: Which Medication, Which Patient? Karen L. Overall, MA, VMD, PhD, DACVB University of Pennsylvania FOCUS ON PHARMACOLOGY The best treatment approaches in veterinary behavioral medicine are often multimodal. At the core of state-of-the art multimodal treatment is smart, rational, and effective use of behavioral medication. Which medication do you choose for which condition, how do you know if it is working, what are the risks, and what advantages might you gain for your patient by combining medications? The keys to effective treatment of behavioral problems are no different than for somatic medical problems: • Identify the constellation of relevant signs/changes. • Nest these within a diagnosis or diagnoses. • Understand the factors that contribute to the development and maintenance of the diagnosis. • Use your treatment to modulate these factors in a manner that can be measured and tracked by alterations in the clinical signs and profile. Unfortunately, practitioners often feel helpless in the face of behavioral complaints because the signs seem so nonspecific. As is true in internal medicine, relevant clinical signs in behavioral medicine are not specific, but too few veterinarians are taught to recognize and quantify behavioral signs and to do so as part of routine evaluation. As for all other conditions in veterinary medicine, the best and most successful treatment is early treatment. The earlier appropriate behavioral medication is prescribed, the less the patient will suffer from fear, anxiety, or aggression and the cognitive and social changes that result from these pathologic conditions. A helpful approach to understanding the thought process involved in choosing medications is to consider practical diagnostic examples, review the signs exhibited in these examples and the regions of the brain involved, and review effects of medications on those regions and on neurochemicals affecting these regions. An advantage of this approach is that the clinical signs provide a baseline against which targeted signs can be assessed for response to medication and other treatment. RECOGNIZING CLINICAL SIGNS AND COMORBID CONDITIONS Consider patients with 2 common behavioral diagnoses: separation anxiety and noise reactivity/ shutterstock.com/Anna Hoychuk