General info Flashcards
What are the categories of psychodermatological conditions?
- Psychophysiologic
- Primary psychiatric disorder
- Secondary psychiatric disorder
- Cutaneous sensory disorder
What does psychophysiologic means?
skin disorder exacerbated by emotional stress (cAD, acral lick dermatitis)
Define primary psychiatric disorder?
-primary behavioural problem with self-induced secondary skin manifestations
What are tought to be primary psychiatric disorder in dogs?
Dogs:
1. acral lick dermatitis
2. flank sucking
3. tail chewing-chasing
4. foot-nail -chewing-licking
What are tought to be primary psychiatric disorder in cats?
Cats:
1. psychogenic alopecia
2. hyperesthesia syndrome
3. tail sucking
4. feet-nail chewing
What are tought to be primary psychiatric disorder in dogs and cats?
D&C
1.self-directed attention- seeking behaviour
2. psychogenic pruritus?
Define secondary psychiatric disorders?
when skin diseases adversely affect the normal behavioural patterns and social functions
Name cutaneous sensory disorders:
- Allodynia
- Hyperalgesia
- dysesthesia
What is allodynia?
experience of pain from non-noxious stimuli
What is hyperalgesia?
exaggerated response to painful stimuli
What is dysesthesia?
behaviours in response to or to avoid unpleasnt stimuli
-feline hyperesthesia syndrome
What are self-injurious behaviours?
-volitional behaviour resulting in self-damage that appears repeatedly, consistently in the absence of any dermatological or physiologic condition
What are obessions?
persistent ideas, impulses or images
-inaapropriate and causing anxiety
-cannot be confirmed in animals
What are compulsions?
-repetitive behaviours with the goal to prevet or reduce anxiety
-stereotypic behaviours that interfere with normal function
What are stereotypic behaviours?
-sequence of movements
-serve no obvious purpose
-occur repetitively or with excessive duration
-usually they derive from behaviours that are part of normal behavioural repertoire
-most are not compulsive
What are etiopathogenesis of OCDs?
- Breed predisposition
- Lifestyle
- Individual animal
Name psychogenic skin disease in dogs?
- Acral lick dermtaitis
- Tail bitting, chewing, chasing
- Tail dock neuroma
- Flank sucking
- Self-nursing
- Anal licking
- Foot licking, nail licking
- Preputial licking
What are psychogenic skin diseases in cats
- Psychogenic alopecia-dermatitis
- Tail sucking
- Self-nursing
- Nail biting, foot chewing, nail chewing
- Head and neck excoriations (idiopathic ulcerative dermatitis)
- Indolent ulcer-like lesions, erosions on the nasal planum
- Feline hyperesthesia syndrome
What are psychogenic skin diseases in horses
- Psychogenic self-mutilation
- Neurological self-mutilation
Name trcyclic antidepressants
amitryptiline, imipramin, doxepin, chlomipramine
cADi or ICAD
What is MOA of tricyclic antidepressants
incerased serotonine and norepinephrine
Name recommended psychological drug therapy
- Trcyclic antidepressants
- SSRI (fluoxetine)
- Opiate antagonists (naloxone, naltrexone)
- Anxiolytics (benzodiazepines)
Treatment of psychogenic itch (Olivry, 2019)
single drug at recommended dose → escalate dose until side-effects → combine drugs → escalate doses
1) Treat dermatologic (inflammatory itch): glucocorticoids (oral ± topical), oclacitinib, perhaps lokivetmab
2) Add or replace with gabapentin (C: 5-10 mg/kg BID or TID; 50-100 mg/cat BID)
3) Add or replace with antidepressants: amitriptyline, clomipramine, fluoxetine, perhaps mirtazapine, perhaps carbamazepine
4) Add or replace with mu-opioid antagonist: naloxone, naltrexone
What are ddx for canine psychogenic dermatoses
- Psychomotor (partial complex) seizures (e.g. tail biting in dogs)
- Abnormal movements: myoclonus
Causes of acral lick dermatitis
- Phychogenic causes: always or almost always even if there is an underlying organic disease
- Allergic causes: it can be the only manifestation of adverse food reaction
- Neurologic causes
What neurologic causes can cause acral lick dermatitis
- Distal sensory axonal neuropathy
- Lesions in ventral spinal cord motor nerve roots
- Peripheral nerve sheath tumors: type I are characterized by hyperesthesia (nerve irritation) without neurologic deficits; usually in front legs
- Cauda equina syndrome, sciatic nerve inflammation
What is the most common place for acral lick dermatitis and rare locations
Rare location: tail, stifle, hip, lateral elbow
Site preference: left forelimb
How dg of acral lick dermatitis can be made
- Owner may be unaware of self-traumatic behaviour
- Dx from normal self-grooming: in normal grooming licking pauses and breaks and there are changes in the posture and the area groomed.
- Dx from pain or irritation: in cases with pain or irritation there is also chewing
- Clue in favour of psychogenic component: newly licked area when the original lesions has been covered by a bandage or wrap
- Biopsy selection: non-ulcerated area
- Histopathology
Histo changes of acral lick dermatitsi
follicular elongation, plasmacytic periadnexal inflammation, vertical streaking fibrosis, traumatic furunculosis; dilatation, hypertrophy, inflammation and occasional rupture of sweat glands
What is the atb treatemnt for acral lick dermatitis
Antibiotic treatment:
1. Frequency: bacteria isolated in 97% of the cases
2. Selection: based on deep tissue culture due to frequent isolation of multiple drug resistant organisms and to differences from the results of superficial cultures
3. Empirical treatment: enrofloxacin or potentiated sulfonamides (based on deep cultures)
What is the psychogenic treatment for acral lick dermatitis
- Desensitization, counterconditioning
- Drugs: tryciclic antidepressants, SSRI, benzodiazepines, phenobarbital, hydroxyzine, endorphin blockers, endorphin agonists, progestins.
-Trial periods of 5 weeks which drug is more effective.
-Selegiline= treatment of choice for chronic lesions
What are recommended treatments for the lesion of acral lick dermatitis
- Mechanical prevention of licking
- Repellents
- Topical glucocorticoids, DMSO, inj glucocorticoids
- Surgery
- laser
- cryosurgery
- Radiation
- Acupuncture
- Oclacitinib
What are causes to tail biting or tail chasing and spinning
- Genetics: autosomal recessive in bull terrier
- Psychogenic: excessive endorphin release
- Association with lethal acrodermatitis-Zn
- Psychomotor seizures: abnormal EEC in all dogs examined
- Lipids: increased serum cholesterol, HDL and LDL
What dog breed are predisposed to tail biting or tail chasing and spinning
- bull terrtier, GSD
DDX to tail biting or tail chasing and spinning
1) infection-trauma,
2) lumbosarcal stenosis-cauda equina syndrome,
3) tail dock neuroma,
4) anal sac disease
Causes of flank sucking
- Trichuriasis (not confirmed)
- Psychomotor epilepsy: treatment with phenobarbital or primidone
- Bacterial folliculitis
- cAD, food allergy
- Psychogenic (compulsive)
What age of onset, triggers and associtaed behaviours are seen with flank sucking
-Age of onset: median 8.5 months
-Triggers: inactivity > increased arousal
-Associated behaviors: fabric sucking, acral lick dermatitis, pica
Name recommended tretamemnt for self- nursing
- Spaying
- Sedation, psychological training
What causes anal licking
- Anorectal disease: inflammatory bowel disease, proctitis
- Anal sack disease, Malassezia anal sacculitis
- Malassezia dermatitis
- cAD, food allergy
DDX for psychogenic alopecia and dermatitis
- FLUTD,
- nephritis,
- anal sac diseases,
- internal parasites
Clinical DDX for psychogenic alopecia and dermatitsi
-based on distribution
1. FAD: caudal abdomen, medial-caudal thighs
2. fAD, AFR: more generalized, less symmetrical. AFR was the most common cause of the syndrome (at least for cats referred to a behaviorist)
Treatment for psychogenic alopecia and dermatits
- Glucocorticoids: for short-term (2-4 weeks) in case of neurodermatitis
- Flea control: always
- Expression of anal sacs: always
- Clomipramine: not effective
- Haloperidol
MOA and side effects of haloperidol
=dopamine antagonist
-may desensitize a-noradrenergic receptors;
-initial dose 1mg/kg BID and 1 week hospitalization;
-evaluation of response at 2 months;
side effects: hallucinations, ataxia, limb twitches.
Causes of feline hyperesteshia syndrome
- Dermatologic: FAD, atopic, food, skin infection, pansteatitis
- Neuromuscular: epilepsy, brain tumor, spinal cord disease, myopathy, toxoplasmosis
- Abnormal sensation: hyperesthesia, allodynia, alloknesis
- Behavioral: stress; compulsive, displacement behavior
What are clinical manifestations of feline hyperesthesia syndrome
- Estrus behavior: increased activity, rolling, elevation of perineum, vocalization
- Excessive licking, plucking, biting or chewing: flank, lumbar, anal, tail
- Self-mutilation: inflicted over a short period of time; tail, flanks, forelegs, paws
- Rippling of the skin, muscle spasms or twitches: dorsally
- Hard to distract the cat to stop the behavior or only temporal disruption
