Compulsive disorders: Have you considered GI involvement? - Veterinary Medicine
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Compulsive disorders: Have you considered GI involvement?
New research stresses the need to explore a medical component to what you might think is solely a behavior problem—in this case, an underlying gastrointestinal disorder as the cause of excessive licking and fly biting.


VETERINARY MEDICINE


WHAT'S THE TAKE-HOME?

Both studies reveal that GI disease can cause the repetitive behaviors of excessive licking of surfaces or fly biting and that these behaviors were significantly reduced with appropriate medical therapy for the GI issues. Future studies evaluating medical disorders in dogs with repetitive behaviors such as spinning or tail-chasing would also be worthwhile.

However, the take-home message here is not that compulsive disorders with a primary behavioral etiology do not exist. Rather, the key is recognizing that not all compulsive behaviors are strictly behavioral. All dogs with oral repetitive behaviors should undergo a complete medical work-up to rule out GI disease before evaluation for behavioral disorders (see "Case example: Charlie, the snapping poodle" below).

If you are presented with a patient with a repetitive behavior, this questionnaire can be provided to the owner, to be completed either before or at the time of the appointment. Instruct the owner to bring a video of the pet's behavior to the appointment if possible.

The medical evaluation should include a thorough physical and neurologic examination and assessment of a complete blood count, serum chemistry profile, and urinalysis to rule out metabolic, dermatologic, orthopedic, and neurologic abnormalities.

Based on the findings of the two studies above, if the patient is a dog presenting with oral repetitive behaviors, a thorough GI workup is also indicated. Additional diagnostics to include in this situation are fecal floatation, preprandial and postprandial serum bile acid measurement, canine pancreatic lipase immunoreactivity (cPLI), abdominal ultrasonography, and endoscopy with biopsy.

Depending on the diagnosis, therapy may include a hypoallergenic diet, antibiotics, corticosteriods, antiemetics, antacids, and anthelmintic drugs. As when dealing with any set of signs in a veterinary patient, establishing a list of differential diagnoses and then allowing diagnostic tests to sort out the true etiology is always warranted before beginning therapy. However, if a thorough work-up is not possible, nonspecific treatment with antacid therapy and a hypoallergenic diet may be beneficial.

Kelly Ballantyne, DVM
John Ciribassi, DVM, DACVB
Chicagoland Veterinary Behavior Consultants
1042 Mountain Glen Way
Carol Stream, IL 60188
http://chicagovetbehavior.com/

REFERENCES

1. Overall KL, Dunham AE. Clinical features and outcome in dogs and cats with obsessive-compulsive disorder: 126 Cases (1989-2000). J Am Vet Med Assoc 2002;221(110):1445-1452.

2. Mason G, Rushen J. Veterinary and pharmacological approaches to abnormal repetitive behaviour. In: Stereotypic animal behaviour. 2nd ed. Oxfordshire, UK: CABI, 2006:;286-384.

3. Bécuwe-Bonnet V, Bélanger MC, Frank D, et al. Gastrointestinal disorders in dogs with excessive licking of surfaces. J Vet Behav 2012;7(4):194-204.

4. Frank D, Bélanger MC, Bécuwe-Bonnet V, et al. Prospective medical evaluation of 7 dogs presented with fly biting. Can Vet J 2012;53:1279-1284.

5. Plessas IN, Rusbridge C, Driver CJ, et al. Long-term outcome of Cavalier King Charles spaniel dogs with clinical signs associated with Chiari-like malformation and syringomyelia. Vet Rec 2012;171(20):501.

Case example: Charlie, the snapping poodle

Charlie, a 3-year-old 60-lb neutered male standard poodle, had begun snapping at imaginary items in the air about five months after he had been adopted from a rescue group. The behavior often occurred in conjunction with Charlie's stopping, freezing, and staring as if into space. However, the snapping behavior also occurred separately from this freezing and staring activity. Charlie was also reported to have intermittent soft stools. Treatment with potassium bromide for a possible seizure disorder did not improve the snapping or freezing behavior.

A standard diagnostic work-up—including a physical examination, complete blood count, serum chemistry profile, urinalysis, and fecal floatation—showed no abnormalities. Further work-up, including abdominal radiography and ultrasonography as well as an endoscopic examination to collect gastric and duodenal biopsy samples, was pursued. The results of these tests supported a diagnosis of lymphocytic-plasmacytic enteritis, and treatment with a hypoallergenic diet and metronidazole was instituted. Within a few weeks, the frequency of the fly snapping had diminished, and it had mostly discontinued by about two to three months after therapy began.


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Source: VETERINARY MEDICINE,
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