Diagnosing and treating compulsive disorder (Proceedings) - Veterinary Healthcare
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Diagnosing and treating compulsive disorder (Proceedings)


CVC IN BALTIMORE PROCEEDINGS


Genetic of OCD and CD

  • Human OCD can run in the family
  • People who have first degree relatives with OCD have nearly 5 fold increase in life time prevalence of OCD (Nestadt et al, 2000; Lougee et al, 2000)
  • Breed predisposition
  • German shepherd :tail chasing
  • Doberman : flank sucking
  • Bull terrier : spinning
  • Large breed dogs : acral lick dermatitis

Pharmacological Response in animals

  • Tricyclic antidepressant (TCA)
  • Clomipramine for canine acral lick dermatitis (Rappoport et al, 1992)
  • Clomipramine for other types of CDs (Hewson et al, 1998)
  • Clomipramine for excessive licking/chewing in rabbits
  • Selective serotonin reuptake inhibitor (SSRI)
  • Fluoxetine (Rappoport et al, 1992, Wynechack, 2000) for canine acral lick dermatitis
  • Fluoxetine for all types of CD (Irimajiri et al, 2005)

Others for animals
Opioid antagonists: effective for tail chasing dogs (Brown et al 1987, Dodman et al 1988)

Pathophysiology of OCD
  • Dopamine and repetitive behaviors
  • High dose of dopamine will reliably induce stereotypic behavior in many animals (Cabib, 1993, Goodman et al, 1990)
  • Increased DA release is the characteristic arousal response of the mesoaccumbens system. Mesoaccumbens DA hyperactivity may promote stereotypies (repetitive behaviors). (Cabib 1993)
  • Serotonin and OCD-40 to 60% of OCD patients respond to SRI treatment (McDougle et al, 1997)

Serotonin and Dopamine Interaction

  • 5-HT innervation of dopaminergic cell bodies and terminals regulate DA neuronal firing and DA release (Quist et al, 2001)
  • Opioid System
  • Naltrexone, Naloxone, Nalmefen reduced stereotypies in sows (Cronin et al. 1985)

Effect mostly on mu opioid receptors

  • Nalmefene suppressed cribbing in horses (Dodman,1987)

Diagnosis

  • There is no definitive diagnostic test
  • Exclusion of medical causes
  • Physical exam, CBC, serum chemistry, other special examinations
  • Behavior history
  • Observation of the behavior

Conscious, aware of surroundings
Usually able to interrupt
No post-ictal phase
Doesn't depend on owner's presence
  • Treatment
  • Identify and remove cause of conflict and desensitize to stress inducing situation
  • Reduce general stress in the environment
  • Interact with dog with predictable and calm fashion
  • Provide consistent routine
  • Avoid punishment as much as possible unless the punishment can meet the 3 rules of punishment (appropriate, consistent, immediate)
  • Provide sufficient exercise and activity
  • Medication-See paper for Serotonin and norepinephrine reuptake inhibitors to treat behavior problems
  • All medications are extra label use.
  • None are 100% effective
  • SRI (serotonin reuptake inhibitors) will not show their effect for about 4 to 8 weeks

Behavior Modification

  • Desensitization and counter-conditioning
  • Identify the stress and make it non-stressful
  • When supervised, as soon as the animal performs the compulsive behavior, distract the behavior,
  • give a command that the animal knows, reward with food for responding to a command
  • Training with food reward
  • Basic obedience training
  • Structured game (hide and seek, etc)
  • Clicker training
  • Treatment Summary

Identify and remove cause of conflict and desensitize to stress inducing situation

  • Reduce general stress in the environment
  • Medication
  • Behavior modification

Prognosis

  • Owners are often frustrated. It is important to have follow up calls and follow up visits frequently.
  • Medication will reduce the frequency and the duration of the behavior but will not cure the animal. Inform the owner that behavior modification is important
  • If there is no improvement 4 to 6 weeks after starting the treatment, changing or giving additional medication may be recommended
  • If there is no improvement, ask how much they have been trying behavior modification, training and management

Increase the dose of current medication
Change medication
Clomipramine ? fluoxetine
Add medicine to the current SRIs
Benzodiazepine, Buspirone, or combine TCA and SSRI in low doses

Crowell-Davis SL and Murray T 2006. Veterinary Psychopharmacology. Blackwell Publishing.


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Source: CVC IN BALTIMORE PROCEEDINGS,
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