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2019 Added Cards > SAD Ch 15 Psychogenic Skin Disease > Flashcards

SAD Ch 15 Psychogenic Skin Disease Flashcards

1
Q

Acute stress has been associated with increase in which two activators of inflammation?

A

IL-6 and C-reactive protein

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2
Q

In human psychodermatologic disorders, what are the 6 categories based on primary causations?

A
  1. Psychosocial factors affecting primary cutaneous disorders
  2. Primary psychiatric disorders manifested by cutaneous symptoms or complaints
  3. Secondary psychiatric disorders resulting from coping with a skin disease
  4. Comorbid psychiatric disorders with skin disorders
  5. Skin disease caused by or exacerbated by psychotropic medication
  6. Psychiatric effects of dermatologic mediations
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3
Q

What types of stressful situations may cause a flare in pruritus for dogs and cats?

A

Inadequate mental stimulation
Inadequate aerobic exercise
Inadequate interaction with family or other pets
Limited access to essential resources
Social isolation
Status-related conflicts
Territorial-related conflicts
Addition or loss of family members or pets
Changes in health status of family members or pets
Changes in daily routine of family members or pets
New home/environment
Changes in physical environment
Boarding
Hospitalization

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4
Q

What are cutaneous sensory disorders?

A

The patient has symptoms as if responding to itching or some other cutaneous sensation when there is no dermatologic, neurologic, medical or psychiatric disorder detectable.

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5
Q

How are OCDs characterized?

A

Repetitive, stereotypic, ritualistic behaviors in excess of what is required for normal function, and the execution of these behaviors interferes with normal daily activities and functioning.

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6
Q

Which breeds may be predisposed to OCDs?

A

Doberman pinschers, Great Danes, Irish setters, Labrador retrievers, and GSDs
Oriental cat breeds - Abyssinian, Siamese, Burmese and Oriental

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7
Q

How is a psychogenic dermatosis diagnosed?

A

Diagnosis of exclusion. Response to tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) are supportive.

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8
Q

Which dermatoses are thought to be psychogenic in origin or to have a significant psychogenic component?

A

Acral lick dermatitis (lick granuloma)
Feline psychogenic alopecia and dermatitis
Miscellaneous psychogenic manifestations such as tail sucking (feline), tail biting (canine), flank sucking, foot licking, self-nursing, and anal licking

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9
Q

Which two behavioral drugs have been most evaluated in veterinary dermatologic diseases?

A 
Clomipramine hydrochloride (Clomicalm), a TCA
Fluoxetine hydrochloride (Reconcile), an SSRI
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10
Q

How do TCAs work?

A

Act primarily by increasing neurotransmitter levels of serotonin and norepinephrine by blocking their reuptake by the presynaptic neuronal membrane, which effectively increases their neurotransmitter activity.

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11
Q

Which TCAs are potent H1 blockers?

A

Amitriptyline and doxepin

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12
Q

What side effects should you be concerned about when using TCAs?

A

Induction of cardiac arrhythmias (promotion of heart block by slowing of cardiac conduction), and anticholinergic effects including dry mouth, urine retention, and reduced tear production.

They also lower seizure threshold and enhance MAOI toxicity in addition to having the metabolic results and side effects that are inherent to first-generation antihistamines.

Up to 30% of patients may show combination of vomiting, diarrhea, lethargy, hyper excitability, PU/PD, increased defecation, urinary retention, aggression, personality changes and anorexia.

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13
Q

Which class of antidepressants is potent inhibitors of cytochrome p450?

A

SSRIs, particularly fluoxetine.

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14
Q

T/F SSRIs and TCAs should not be used with MAOIs.

A

True

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15
Q

How long of a washout period should be used when switching between an SSRI and a TCA or vice versa?

A

2-3 weeks

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16
Q

What is the MOA of buspirone?

A

Blocks serotonin presynaptic and postsynaptic receptors and has dopamine agonist activity

17
Q

What are some adverse effects of buspirone?

A

Mild sedation, appetite stimulation, personality changes, and paradoxical excitation.

18
Q

Which anxiolytic causes an idiosyncratic hepatotoxicosis in cats that can often be fatal?

A

Diazepam

19
Q

How should diazepam use be monitored in cats?

A

Baseline serum chem, then repeat 3-5 days after starting. Watch AST and ALT.

20
Q

How are endorphins involved in pruritic behaviors?

A

Endorphins may be released or produced following self-destructive behaviors. This may initiate, perpetuate or induce pruritic behaviors or excessive grooming.

21
Q

Which opiate antagonists have shown efficacy in treating dermatoses with a psychogenic component?

A

Naloxone (Narcan) in cats with feline psychogenic alopecia

Naltrexone (Trexan) in dogs with acral lick dermatitis

22
Q

Which breeds are predisposed to acral lick granulomas?

A

Doberman, Great Dane, Labs, Irish setter, goldens, boxers, Weimaraner and GSD

23
Q

Where are acral lick granulomas most commonly seen?

A

Usually single lesion on carpus or metacarpus. Only 10% have all four legs involved. Most other lesions

24
Q

Which differentials should be ruled out when diagnosing an acral lick granuloma?

A

Neoplasia (histiocytoma, mastocytoma), pressure point granulomas, calcinosis circumscripta, bacterial furunculosis, demodicosis, dermatophytosis, mycotic or mycobacterial granulomas and underlying hypersensitivity disorders

25
Q

Describe the histopathologic changes noted in acral lick granulomas.

A

Ulcerated surface with irregular epidermal hyperplasia which may be papillate and is usually marked.
Mild perivascular accumulation of neutrophils and mononuclear cells
Dermis shows varying degrees of fibroplasia and dermal papillae show vertical streaking of fibroblasts and collagen fibrils
Moderate to marked numbers of plasma cells around epitrichial sweat glands, which are hypertrophic and contain inspissated secretions.
Hidradenitis and sebaceous gland hyperplasia.
Hair follicles are hyperkeratotic, hyper plastic and elongated with folliculitis and furunculosis.

26
Q

What are some psychological causes of acral lick granulomas?

A
  1. Dog left alone all day
  2. Dog confined for long periods of time
  3. New pet in home
  4. New baby in home
  5. Female dog in heat nearby but not accessible to male
  6. New dog in neighborhood
  7. Death in the family
  8. Long-time companion of dog has died
  9. Children or other family members have moved away
27
Q

What are some helpful corrective measures that can be taken for psychological causes of acral lick granulomas?

A
  1. More walks and human companionship. Can the owner take the dog to work?
  2. Avoidance of confinement if able
  3. A new puppy as a companion, depending on how friendly the interaction is. Not a guaranteed cure.
  4. Freedom to leave house and premises (not suitable for suburban or urban areas)
28
Q

Which class of drugs may be most effective in behavior modification for acral lick granulomas?

A

Antidepressants. Specifically fluoxetine or clomipramine.

29
Q

What classes of psychoactive drugs can be used for acral lick granulomas?

A

Antidepressants, anxiolytics, endorphin blockers, endorphin substitution (hydrocodone), progestogens (Depo-Provera)

30
Q

What are some potential side effects of progesterone?

A

Behavioral changes, acromegaly, diabetes mellitus, mammary hyperplasia and others

31
Q

When are intralesional injections indicated for acral lick granulomas?

A

Helpful in lesions smaller than 3cm diameter. Useless in large chronic lesions.

32
Q

What is a tail dock neuroma?

A

Rare disorder following some tail docking. The nerve attempts to regrow in a haphazard fashion and a neuroma develops, which stimulates pain or sensation that causes the dog to lick or chew at its tail.

33
Q

What is the treatment of choice for tail dock neuroma?

A

Surgical removal

34
Q

Which areas of the body are most commonly licked in feline psychogenic alopecia and dermatitis?

A

Areas the cat can lick easily. Caudal abdomen most commonly affected. Also medial thighs, groin, inguinal region.

35
Q

Cats with primary psychogenic dermatitis are/are not responsive to anti-inflammatory doses of glucocorticoids and are/are not responsive to clomipramine.

A

Cats with primary psychogenic dermatitis are not responsive to anti-inflammatory doses of glucocorticoids and may be responsive to clomipramine.

36
Q

What breed is predisposed to tail sucking?

A

Siamese cats

2019 Added Cards (9 decks)

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