Phobias Flashcards
1
Q
What are the origins of Noise and Storm Aversion?
A
-
Developmental
- _Lack of exposur_e in the first few months of life
- Sensitized exposure chronically to arousing noises
-
Learned
- Traumatic experience associated with a sound
- Socially mediated exposure to another individual with noise aversion
2
Q
What are the statistics of Noise and Storm aversion?
A
- 49% of dogs show aversion to noise
- Most common triggers:
- Fireworks
- Gunshots
- Thunder
- ⅓ of owners with dogs with noise phobia seek medical advice
- Exposure to fireworks, vehicle noise, banging, vacuum cleaners & loud voices in dog prior to 6 months of age may reduce noise phobia
- >75% of dogs with noise phobia also have storm phobia & vice versa
- >85% of dogs with storm & noise phobias have separation anxiety
- Motion sickness is common comorbid condition with noise phobia
3
Q
What is noise reactivity?
A
- An over-reaction to a noise
- Begins in the locus coeruleus of the amygdala
- Pathway is triggered easier & faster in a noise reactive patient
- takes less stimulus over time
4
Q
What is Anxiety?
A
- Reaction to an anticipated threat
- Something is not there
- Physiologic and behavioral manifestations may be displayed
5
Q
What is Fear?
A
-
Real and present danger
- “Something is there” with response influenced by learning
- Physiologic & behavioral manifestations may be displayed varying proximity of stimulus
- Example: fast heart-rate & respiration & escape with tornado moving toward vehicle & can shake it off/recover… this is expected fear
- Simple fears: specific stimulus triggers response with avoidance & exploration following exposure
- Complex Fears: A variety of triggers generate a fear response
6
Q
What is a Phobia?
A
- Excessive (panic, hysteria, catatonia) & maladaptive fear
- Usually involves short or ineffective avoidance & escape response + autonomic signs
-
No purpose / no beneficial
- Ex: fast hear rate, fast respirations, & trying to escape when the sky gets cloudy
- More resistant to treatment
-
Not able to recover spontaneously
- may take hours, days, weeks
7
Q
What are the symptoms of Noise Aversion?
A
- Escape attempts-digging & chewing
- Vocalization
- Inappropriate elimination & salivation
- Hiding / immobile & avoidance (retreating)
- less likely to seek veterinary care
- Self-trauma
- Aggression
- Owner-seeking behavior
- Not eating
- Ignoring commands
8
Q
How is Noise Aversion diagnosed?
A
- History:
- Reactivity with any component of a noise or storm (wind, noise, lightening, altered barometric pressure, atmospheric ionization, rain, clouds / darkening)
- Behavior History:
- What is the trigger
- How long to recovery
- Symptom frequency & severity
- Owners response
- Physical Examination
- CBC, Serum, Chemistry profile & urine testing, +/- thyroid evaluation
- Rule out medical/behavioral causes
9
Q
What Comorbidities are common with Noise Aversion?
A
- Older dogs with noise phobia frequently had musculoskeletal pain
- Consider pain in dogs diagnosed with noise phobia especially older dogs with no prior history of noise phobia
- Treatment:
- analgesia
- possible anxiolytics
- desensitization & counter-conditioning
10
Q
How can the environment be changed to help with Noise Phobias?
A
- Provide a secure & safe retreat where stimulus is minimized & support a location the pet selects (Sanctuary Space)
- White noise
- Ceiling fan
- Music
- Sound-proofing
- room darkening
- Kennel/blankets
- Mat training
11
Q
What behavioral management can be implement to help with noise phobias?
A
- Fear conditioning isn’t gone - positive has to outweigh the negative
- Plenty of enrichment
- Manage other anxieties
- Work with head harness & drag line training “sit” & “down”
- Teach & reward calm/relaxed behavior
- Allow the animal to cope/hide during event
- Comforting doesn’t reinforce fear
- Positive attitude/don’t show fear
- AVOID punishment - increases fear
12
Q
How can Desensitization and Counter-Conditioning be used for Noise phobias?
A
- Begin with scary stimulus at low volume (not causing symptoms)
- Gradual volume increase
- Move slowly & gradually to increased volume (if no symptoms)
- 5 - 10 minute sessions daily
- Provide special treats, massage or play during noise
13
Q
What medications can be used for Noise Phobias?
A
- Dexmedetomide Oromucosal gel - Sileo
- Imepitoin - Pexion
- Benzodiazepines
- Clonidine
- Trazodone
- Gabapentin
- Acepromazine
- TCAs
- SSRI’s
14
Q
What is Dexmedetomide oromucosal gel - Sileo?
A
- Centrally actin norepinephrine blocker
- Anxiolytic effect
- FDA-Approved canine noise aversion treatment
- Give 30 minutes before event
- Side effects - vomiting, excessive sedation
- Avoid with cardiovascular disease, respiratory, liver or kidney disease, shock, debilitation, dental or gingival disease
- Owner must wear gloves to administer
15
Q
What is Imepitoin - Pexion ?
A
- A partial agonist at the benzodiazepine binding site of the GABAA receptor
- Binds to receptor 600x less than diazepam (lessen side effects & development of dependence/abuse)
- Action is neuronal inhibition 2-3 hours after a dose
- anxiolytic
- Anti-convulsant
- FDA approved for treatment of noise aversion in dogs (not available in USA)
- Side-effects: lethargy, ataxia, increased appetite, vomiting
16
Q
What Benzodiazepines are used for Noise Aversion?
A
- GABAA agonists (inhibitory neurotransmitter)
- Give 30 minutes to 1 hour prior to event (but can work during event)
- Anxiolytic
- Anti-panic
- Drugs:
- Alprazolam (favorite because of longer half life)
- Lorazepam
- Diazepam (short duration of effect-rescue drug if in an event)
- Risks sleepiness, ataxia, behavioral disinhibition (avoid with aggression) idiopathic excitement, human abuse
17
Q
What is Clonidine?
A
- Centrally acting norepinephrine blocker (alpha 2 agonist)
- reduced sympathetic outflow from the central nervous system (gave prior to the event to be effective)
- Side effects: low blood pressure, low heart rate, drowsiness, constipation (avoid cardiovascular & kidney disease)
18
Q
What is Trazodone?
A
- Serotonin antagonist/reuptake inhibitor human medication
- Effect in 45-2.5 hours in dogs & repeated up to every 8 hours
- must give prior to event to be most effective
- Side-effects: sleepiness, behavioral disinhibition, rarely GI upset
- Document client discussion of risks & closely monitor if utilizing two serotonin enhancing drugs together
19
Q
What is Gabapentin?
A
- Unknown anxiolytic properties in dogs & cats
- Trial to gauge effect (usually about 2 hours prior in dogs & cats & must give prior to event to be most effective)
- May see sedation, ataxia, and rarely GI side effects
20
Q
What is Acepromazine?
A
- Phenothiazine tranquilizer
- Blocks dopamine receptors in the brain dulling awareness & reduces motor function
- Tranquilizes in 45-60 minutes & lasts up to 8 hours
- Not an anxiolytic
- Should not be used alone to manage noise phobias
- Can be combined with other anxiolytics
- Low doses initially & increase for additional sedation
21
Q
What are Tricyclic Antidepressants (TCA’s)?
A
- None FDA approved for noise phobias in dogs or cats
- 4-8 weeks to effect
- Options:
- Clomipramine
- Amitriptyline
22
Q
What are Selective Serotonin Re-uptake Inhibitors (SSRI’s)?
A
- None FDA approved for noise phobias in dogs or cats
- 4-8 weeks to effect
- Options
- Fluoxetine
- Sertraline
- Paroxetine
23
Q
What are the Alternative Therapies for Noise Aversion?
A
- Headphones
- mutt muffs
- Auditory distraction
- white noise, music, etc.
- Decreased electrical charge
- Storm Defender Cape
- Decreased visual input
- Doggles
- Thundercap
- Pressure/swaddling wraps
- AnxietyWrap
- Thundershirt Insanely Calm
24
Q
How can owners be supported?
A
-
Set expectations
- Formulate environmental & behavioral management plans
- Medications may be needed & may be multi-modal or multiple anxiolytics together
- Desensitization & Counterconditioning takes months
- Some pets require medication forever
-
Empathize
- Owners have a range of emotions when caring for fearful pets
