Behavior Problems

CHAPTER 13 Behavior Problems

Anxiety, Fear, and Phobia,

Onychectomy and Behavior,

Behavioral concerns of cat owners can be categorized into two main areas: problem behaviors and behavioral problems. It is important that veterinarians distinguish between the two so that they can recommend appropriate management and treatment programs.

Problem behaviors are classified as behaviors that are part of the cat’s normal behavioral repertoire but are unacceptable to the owner or community. Although it is considered problematic by owners, the behavior itself is normal. The behavior may be exhibited because of the owner’s failure to understand feline behavioral needs, lack of knowledge of feline social structure, or insufficient training of the cat. For example, a cat that jumps onto a kitchen counter may be doing this as part of the cat’s normal preference to be up high, and there may be a lack of other, more appropriate locations in the house (e.g., shelves). It is also possible that the cat has never been taught that sitting elsewhere, such as on a scratching post or play center, is the behavior preferred by the owner.

Behavioral problems, on the other hand, fall into two categories: (1) behaviors that may be normal for the cat to exhibit but are excessive in duration or intensity and exhibited in response to stimuli that should not elicit this response and (2) behaviors that are abnormal and thus indicate that the cat is unwell and should be considered as mental health issues. Behavioral problems are generally maladaptive for the cat as well as problematic for the owner or community. Examples include compulsive disorders, self-mutilation, and phobias.

Although these two categories are not mutually exclusive, classifying any unacceptable behavior in this way helps determine not only what advice should be given but also where to refer the client, if necessary.

The most common problems that cat owners report include some of the risk factors for surrender. These problems include aggression, house soiling, scratching, and fear- and anxiety-related behaviors.¹⁴ Some of these are normal behaviors and as such cannot be eliminated entirely. In fact, it is possibly detrimental to the cat’s welfare to try to stop these normal behaviors. However, steps can be taken to manage the behaviors.

Some of these unacceptable, destructive, and nuisance behaviors are exacerbated by a lack of physical as well as mental activity. Cats are highly intelligent, active, social animals that need activity, company, and stimulation. Educating owners about the basic needs of cats should help address many behavioral concerns.

Veterinarians working in companion animal practice are increasingly recognizing that fear and anxiety are the underlying factors for many of the behavioral problems presented. The actual prevalence of anxiety-related conditions is unknown, but they are probably the most common class of behavioral disorders in pets. Anxiety disorders make up well over 90% of veterinary patients presented for referral.⁴ Many cases that present in general practice with recurrent medical issues such as vomiting, diarrhea, or skin problems may be caused or influenced by underlying anxiety issues.

The way an animal behaves depends on three key factors: its genetic predisposition, previous experiences, and its environment. None of these factors acts in isolation. All need to be taken into consideration when dealing with animals that have behavioral issues.

All behavioral problems require a systematic approach so that the best outcome is achieved for the patient. Use of a questionnaire, which is sent to the owner and filled in before the consultation, is one useful approach. The veterinarian is then prepared to ask specific questions about the behaviors during the consultation and begin to evaluate the environment, social interactions, and behavior of the cat. This permits the veterinarian to determine the possible cause (or causes) and prognosis (likelihood of success) and devise a treatment and management program.

The more detailed the information that is provided, the more specific the recommendations that can be made. The process of evaluating this behavioral history in the context of other clinical information about the cat may take a significant amount of time, often 2 to 3 hours. Most cats that have behavioral problems cannot be cured much as diabetes is managed not cured. However, with environmental management, behavior modification, and sometimes medication, the cat’s quality of life can be greatly improved and the bond with its owners restored.

Anxiety, Fear, and Phobia

Overview

Although the terms anxiety and fear are often used interchangeably, they are not the same. Fear is related to the specific behaviors of escape and avoidance, whereas anxiety is the result of threats that are perceived to be uncontrollable or unavoidable. Both fear and anxiety may be adaptive in some circumstances, whereas phobias are maladaptive. The prefrontal cortex, amygdala and limbic system, and hypothalamus (hypothalamic–pituitary–adrenal axis) is thought to be involved in the regulation of fear. Serotonin, noradrenaline, dopamine, and gamma-aminobutyric acid (GABA) are neurotransmitters involved in the development of fear and anxiety. Serotonin has been identified as a mediator of fear and anxiety.

Fear

Fear is a physiologic, behavioral, and emotional reaction to potentially injurious stimuli. The fear response is a complex physiologic response that involves several areas of the brain. Cognitive, musculoskeletal, and neuroendocrine responses occur when an animal perceives a frightening situation.³ Experiencing fear is a survival mechanism and an adaptive response that usually occurs in response to a specific stimulus. Fear is often connected to pain or a traumatic event. For example, if a cat falls down a flight of stairs, it may develop a fear of stairs.

Fear-evoking situations lead to activation of the locus ceruleus, the key noradrenergic area of the brain. This stimulates neurotransmission in the noradrenergic pathways projecting to the cerebral cortex, limbic system, and spinal cord and prepares the cat physiologically to deal with the threat.

Various emotional stages of fear correspond with the physiologic effects of the sympathetic nervous system: the flight, fight, or freeze responses. The muscles used for physical movement are tightened and primed with oxygen and glucose in preparation for a physical fight-or-flight response. For example, a cat may try to run away from a fear-evoking stimulus (e.g., a veterinarian). However, if cornered, it may freeze or become defensively aggressive. There is also a fourth emotional response: the fiddle response (displacement behavior). In this case the cat faced with the fear-evoking stimulus may yawn or lick its lips.

The physiologic reaction results in increased heart rate, increased respiratory rate (panting), sweating, trembling, pacing, and possibly urination and defecation.

Cats exhibit changes in body posture and activity when afraid and may engage in an avoidance response such as fleeing or hiding. A fearful animal may assume body postures that are protective, such as lowering the body and head, placing the ears closer to the head, widening the eyes, and tucking the tail under the body. If the animal perceives a threat, the response can also include elements of defensive aggression. Whether an animal fights or flees when fearful or defensive depends on its genetic predisposition, its previous experiences, and its current environment. Normal fear is adaptive and transient.

Phobia

A phobia is defined as an irrational, intense, persistent fear of certain situations, activities, things, or people. The fear (or panic) response is out of proportion to the stimulus and is maladaptive. Animals with phobias do not habituate to the stimulus, even after many harmless contacts, and the response does not decrease with time.

Common phobias in animals involve noises and places. Phobic responses are physiologic, behavioral, and emotional responses similar to fear, but they are extremely exaggerated.

Anxiety

Fear should be distinguished from anxiety, which typically occurs without any external threat. Anxiety is defined as the anticipation of future danger or misfortune. The threat may be real or imagined, and the response of the cat may be normal or abnormal depending on the context. Anxiety may also be an adaptive response to a specific threat in some circumstances. However, whereas fear is usually of acute onset and transient in duration, anxiety is a more chronic state of nonspecific apprehension. Dysregulation of fear pathways plays a key role in anxiety. The changes in the activity of neurotransmitters in anxiety disorders results in changes across many neurochemical systems, including the seratonergic, noradrenergic, dopaminergic, and GABAergic systems. Because these systems are closely integrated, changes in one system elicit effects in another. Corticotrophin-releasing factor (CRF) has been identified as a stress neurotransmitter that effects changes in the serotonergic system through changes to receptor function that contribute to the onset of anxiety.⁹

Chronic anxiety leads to sympathetic arousal and is usually accompanied by signs of hypervigilance, such as scanning; autonomic hyperactivity, such as gastrointestinal upsets; and increased motor activity, such as pacing.

Anxiety can occur after sensitization to a specific stimulus and can then become generalized to other situations. It may also be nonspecific in origin. It is problematic to the cat when it is out of context and occurs at a constant and elevated level or interferes with normal functioning. Although panic attacks are not experienced by every animal that suffers from anxiety, they are relatively common. Panic attacks usually come without warning, and although the fear is generally irrational, the perceived danger is very real.

Anxiety-Related Disorders

Anxiety-related disorders in cats may include excessive self-grooming, changes in appetite, and inappropriate elimination (e.g., urine spraying). Stress or anxiety in cats may manifest in many ways. The following are the most commonly seen behavioral signs:

• Changes in appetite (e.g., a decrease in appetite, pica)

• Changes in grooming habits (i.e., an increase or decrease)

• Changes in elimination (e.g., urine spraying, nonspraying marking)

• Changes in social interactions (e.g., vocalization)

• Changes in physical activity (i.e., an increase or decrease)

Many factors are reported to result in anxiety in cats. These include environmental changes such as moving house, a new baby or spouse, separation from the owner, an excessive number of cats in the household or area, presence of new cats in the area, loss of territory, punishment by the owner, lack of stimulation, and even the presence of attacking birds (e.g., magpies). However, it may not be possible to determine all factors. Medical conditions such as hyperthyroidism have also been associated with feline anxiety, as have some medications.

Feline anxiety disorders include some types of aggression, separation anxiety, noise phobias, pica, and obsessive–compulsive disorders (OCDs). Diagnosis is based on a complete behavioral history and thorough physical examination. It may involve complete blood work, dermatologic and neurologic workup, and radiography or other imaging modalities to rule out contributing or concurrent medical factors.

Treatment usually involves behavior-modification techniques, environmental management, and the use of psychotropic medications. Medications that influence serotonin metabolism, such as the selective serotonin reuptake inhibitors (SSRIs) and the tricyclic antidepressants (TCAs) have been used in the treatment of anxiety-related disorders (see Chapter 14). Anxiolytic medication (e.g., benzodiazepines) has also proved useful in some cases in combination with TCAs and SSRIs, especially if the cat has phobias or experiences panic attacks. The owner should set realistic goals and recognize that in most cases the behavioral problem can be successfully managed but not necessarily eliminated. This will require a lifetime commitment from the owner. Punishment is not recommended because it serves to further increase the anxiety as well as impede learning of appropriate behavior.

Obsessive–Compulsive Disorders

In cats OCDs include stereotypes and self-directed behaviors. These are defined as being constant and repetitive in form, appearing to serve no obvious purpose, and interfering with the animal’s normal functioning. OCDs are often derived from otherwise normal behaviors such as grooming, eating, or walking, but they are abnormal in that they are excessive in duration, frequency, or intensity in the context in which they are performed. Thus some causes of overgrooming, pica, and vocalization may be considered part of the OCD complex.

The anatomic focus of OCD is believed to be the limbic system. Computed tomography indicates that the basal ganglia near the caudate nucleus are involved. Dopaminergic, serotonergic, and opioid pathways are thought to be involved in compulsive and self-injurious behaviors. Aberrant serotonin metabolism and possibly endorphin metabolism are also thought to contribute. Increased dopamine in the basal ganglia and relative increase in serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) in the cerebrospinal fluid (CSF) have also been detected.^12,^15b

Diagnosis is based on a complete behavioral history and thorough physical examination. It may involve complete blood work, dermatologic and neurologic workup, and radiography or other imaging modalities to rule out contributing or concurrent medical factors (e.g., seizures).

Treatment usually involves behavior-modification techniques; environmental management; and in most cases, the use of psychotropic medications. Medications that influence serotonin metabolism, such as the SSRIs and the TCAs, have been used in the treatment of OCD (see Chapter 14).^12a,15a

The cat should not be punished because its behavior is not deliberate and it may serve to further increase the anxiety and thus the behavior.

Overgrooming

Grooming is a normal behavior of cats and serves many purposes, including cleaning, removing parasites, regulating body temperature, and alleviating stress. It is often seen after punishment or after aggressive encounters between cats. Normal adult cats spend about 30% to 50% of their waking hours grooming. Currently, feline hyperesthesia, overgrooming, self-mutilation, and psychogenic alopecia are considered to be part of the anxiety response.

Clinical Signs

Hair loss and discoloration occur only on the parts of the body that can be reached by the teeth and tongue. This hair loss is usually most noticeable around the sides and rump, back legs, and groin. The head and back of the neck may still have a normal hair coat. Usually, the alopecia is nonsymmetrical, and the skin may look normal.

Hair can be removed by plucking, barbering, or just licking and excoriation. The plucked hair has evidence of shearing. In some cats the grooming becomes excessive, and self-mutilation and ulceration occur in the affected areas. Secondary bacterial infections may then occur that also need treatment. Occasionally, the overgrooming is so severe that ulcers develop in the mouth (tongue and pharynx), making eating very difficult or even impossible.

Differential Diagnoses

Many conditions, such as flea allergy, dietary allergy, and sensitivity to dust mites, have been known to trigger the initial grooming episodes. These must be eliminated as causes or contributing factors. In the case of fleas, treatment must be instigated even when no evidence of fleas is seen.¹⁸

Conditions causing pain, such as feline lower urinary tract disease (which may lead to abdominal grooming), as well as any source of trauma or infection, must be eliminated as contributing factors.

Management

Treatment of any concurrent or underlying medical problem, such as fleas, or resolution of food allergy by changing the diet is essential. If anxiety is suspected as a factor, the cause of the anxiety should be minimized or removed, if possible. Pain should always be a consideration in feline patients and should be addressed in any management program.

The cat should be provided with a regular, predictable routine. This includes feeding and playing at a set time each day. In many cases medication is also necessary. Medications that influence serotonin metabolism, such as the SSRIs and the TCAs, have been used in the treatment of anxiety-related disorders. Other anxiolytic medications have also proved useful in some cases. At this stage the comparative effectiveness of each medication remains to be evaluated and may depend on the underlying factors or eliciting causes.

Complete blood work, including a biochemistry panel, should be done before administering medication to determine a baseline, especially for liver and kidney parameters. Many cats may require medication for a prolonged period (at least 6 to 12 months, to allow hair regrowth and for the condition to be assessed), and then slow withdrawal of medication should be attempted. If cats require longer-term or lifetime medication, monitoring of a biochemistry panel should be carried out every 6 to 12 months or more often if indicated by clinical signs.

Punishment is not effective in changing these behaviors. It serves only to increase the anxiety, as well as impede learning of non-anxious behavior, and should be avoided.

Pica

Pica involves the ingestion of non-nutritive substances. However, eating substances other than food is not always abnormal. Consumption of plant material may be caused by lack of access to grass or vegetation or normal investigatory behavior. Young cats in particular may chew, but not necessarily ingest, nonfood substances as part of their normal exploratory behavior.

Clinical Signs

Cats have been reported to ingest many substances, including soil, rubber, paper, wood, string, house plants, wool, and fabric. Individual cats tend to ingest one type of substance only. Some of these behaviors may be more annoying than damaging until they start interfering with the cat’s normal functioning.

Fabric-eating cats appear to start by eating woolen fabrics (Figure 13-1). They may then proceed to other fabrics, such as cotton, silk, and synthetics, but this is not always the case. While the cat is chewing, it appears to be totally engrossed. The cat pulls and tugs on the wool and then grinds it with its molars. Quite large quantities can be ingested, and this is a problem if blankets, socks, and sweaters are eaten because these items may cause an intestinal obstruction.

FIGURE 13-1 Fabric eating is a form of pica often seen in Siamese cats. If large quantities are ingested, intestinal obstruction may occur.

This behavior is reportedly more common in oriental breeds such as Siamese and Burmese, although it has been reported in all breeds, as well as nonpedigreed cats. No gender predisposition for wool eating has been reported, and the behavior can occur between the ages of 2 to 8 months to 1 to 2 years. It is believed to be more common in cats that are kept exclusively indoors. Some cats appear to grow out of it, and the problem resolves during early adulthood without treatment.^2a

The following are among the many postulated causes:

• Early weaning (at 2 to 4 weeks; feral cats may suckle until 6 months of age)

• Insufficient handling of kittens before homing

• Insufficient fiber in the diet

• Separation anxiety

• Lack of opportunity to develop exploratory and hunting behaviors

• A malfunction in the neural control of appetitive behavior

Differential Diagnoses

Several medical conditions can also lead to pica. These include hyperthyroidism, lead intoxication, dietary deficiencies, intestinal parasites, and anemia. It may also be normal investigative behavior, which is more common in young cats.

Management

It is important that medical conditions be addressed. If the behavior is causing problems, the cat must be kept away from potentially harmful ingestible materials. Taste deterrents such as Grannick’s Bitter Apple or chili pepper have been reported as helpful in deterring some cats. These substances may be more potent if they are paired with a distinctive scent such as eucalyptus oil or cologne to provide an additional (olfactory) cue that the substance is to be avoided. The cat learns to associate the smell of the oil with an unpleasant taste, and eventually the scent alone is sufficient to make the cat avoid the material. This technique appears to deter some cats if the behavior is of recent origin and the substances ingested are limited.

Establishing a predictable routine appears to help many cats by minimizing stress. This may mean having set times to feed the cat and play or otherwise interact with the cat. Providing an enriched environment by supplying the cat with toys and other forms of mental and physical stimulation has also been reported to be helpful. Planting an indoor garden with grass, catnip, or cat mint can provide a safe source of vegetation (fiber), as well as a means of enriching the cat’s environment. The following suggestions may also help:

• Allowing the cat access to dried food all day

• Increasing the fiber content of the diet by adding bran or vegetables

• Providing gristly meat and raw bones to chew on to increase time spent chewing and eating

Direct punishment is not helpful; it may increase anxiety and exacerbate the problem.

Treatment with psychotropic medication such as SSRIs and TCAs may be necessary if a diagnosis of OCD is made. Premedication blood work (complete blood count and serum biochemistry panel) is recommended to provide baseline values, especially if the cat stays on long-term or lifetime medication. These tests should be repeated every 6 to 12 months depending on the age and health status of the cat. A minimum treatment period of 6 months is recommended because some medications may take 6 to 8 weeks to reach therapeutic levels. Gradual weaning off medication may be attempted when the behavior has been successfully managed for at least 3 months.

Separation Anxiety

Separation anxiety is a term that is used to describe cats that are overly attached or dependent on people, especially family members. They become extremely anxious and show distress behaviors of vocalization, destruction, house soiling, inappetence, inactivity, and even vomiting or diarrhea when separated from their owners.

Clinical Signs

Cats with separation anxiety tend to follow their owners from room to room and begin to display signs of anxiety as soon as their owners prepare to leave. This can occur as early as when the alarm clock rings in the morning. Some affected cats also exhibit excessive attention-seeking behaviors and may seek physical contact with their owners. During these separations the cat may vocalize, eliminate, and refuse to eat or become very quiet and withdrawn. Not all cats exhibit all of the signs; however, in general, the more signs that are exhibited, the more difficult it is to manage the case. Although the behavior usually occurs every time the owner leaves, it sometimes happens only on selected departures, such as when the owner leaves for work or when the owner leaves again after coming home from work.

Differential Diagnoses

Because the separation anxiety complex involves many different signs, a complete physical examination is necessary to rule out other causes for the signs exhibited. For example, this should include other causes of elimination outside the litter box or any condition causing pain that may lead to vocalization.

Management

The aim of management is to teach the cat to cope without human company. This process may be very slow, and the owner must be patient as well as consistent. The earlier steps are taken to reduce the cat’s anxiety, the easier it should be to manage.

The first step involves teaching the cat to be relaxed while the owner is present. When the cat learns to be relaxed in one place (e.g., in its bed or special mat) rather than constantly following the owner around, it will be possible to teach the cat to accept even the shortest of separations. It can also be useful to help the cat associate a particular scent or odor with the bed or mat and being calm. Whenever the cat is lying quietly anywhere, it should always be rewarded with quiet praise.

The owner should establish a predictable routine, feeding and playing with the cat at a set time each day, and enrich the cat’s environment by providing toys (and rotating them regularly), hiding places, and play opportunities. However, care should be taken not to provide too many choices, which may exacerbate the anxiety.

Medication is often needed, especially in severe cases. Medication is often best started early in treatment rather than after the anxiety has increased to a level that makes it difficult to manage. According to studies, dogs improve about three to four times faster when antidepressant medication (e.g., clomipramine) is used in combination with behavior modification than when behavior modification is used alone.^6a The same is likely to be true for cats.

Medications that influence serotonin metabolism, such as the SSRIs and the TCAs, have been used in the treatment of anxiety-related disorders. Anxiolytic medication (e.g., benzodiazepines) has also proved useful in some cases in combination with TCAs and SSRIs, especially if the cat exhibits panic attacks. They should be given before the potentially stressful event. However, long-term use is not recommended.

The synthetic facial pheromone analog Feliway has been reported to be useful in decreasing anxiety in some cats. Physical or verbal punishment is discouraged because it increases anxiety and impedes learning of more appropriate behavior.

Complete blood work should be done before medication is administered to determine a baseline, especially for liver and kidney parameters. The cat may require medication for prolonged periods (up to 12 months) or even for life. Owners should be informed of the possibility of lifelong medication at the outset of a management program.

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Tags: The Cat Clinical Medicine and Management

Aug 26, 2016 | Posted by admin in INTERNAL MEDICINE | Comments Off

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