Diagnosing and treating compulsive disorder (Proceedings)

Obsessive Compulsive Disorder (OCD-DSM IV)

Obsession: "...persistent idea, thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress".

Compulsion: "...repetitive behaviors (e.g. hand washing, ordering, checking) or mental acts (e.g. praying, counting, repeating words silently) the goal of which is to prevent or reduce anxiety or distress, not to provide pleasure or gratification".

Does animal obsess? We do not know. Thus, we use the term compulsive disorder for animals.

Similarity in Characteristics

• Repetitive behaviors observed in human OCD and CD in animals

• Hand-washing vs. excessive licking

Categories of CDs

• Oral

• Locomotory

• Hallucination

• Aggression

• Vocalization

Compulsive Disorder in Cats

• Locomotion

• Freezing

• Dashing off

• Sudden agitation and skin ripple (feline hyperesthesia)

• Ducking

• Circling

Oral

• Wool sucking

• Chewing legs or feet

• Chewing or licking objects

• Pica

• Over grooming (feline psychogenic alopecia)

Aggression

• Self directed aggression (attacking its tail or leg)

Vocalization

• Persistent miaowing

• Howling

"Hallucination"

• Avoiding imaginary objects

• Staring at "shadows"

• Startling

Compulsive Disorder in Dogs

• Oral

• Excessive self licking

• Alopecia

• Acral lick dermatitis (acral lick granuloma)

• Flank sucking (Doberman Pinschers)

• Self mutilating (Large breeds)

• Air licking

• Licking objects

Locomotory

• Tail chasing (German Shepherd Dogs)

• Spinning (Bull Terriers)

• Shadow and light chasing

• Pacing

• Checking hind ends (Miniature Schnauzers)

Hallucinatory

• Staring

• Chasing imaginary prey

• Fly chasing (snapping)

Aggression

• Aggressive to humans or objects

• Vocalization

• Prolonged monotonous barking

Cause- prolonged, repeated frustration and stress

• Environmental causes

• Over stimulation

• Stressful stimulation

• Under stimulation

• Physical lesions or irritations (allergy, surgery)

Genetic of OCD and CD

• Human OCD can run in the family

• People who have first degree relatives with OCD have nearly 5 fold increase in life time prevalence of OCD (Nestadt et al, 2000; Lougee et al, 2000)

• Breed predisposition

• German shepherd :tail chasing

• Doberman : flank sucking

• Bull terrier : spinning

• Large breed dogs : acral lick dermatitis

Pharmacological Response in animals

• Tricyclic antidepressant (TCA)

• Clomipramine for canine acral lick dermatitis (Rappoport et al, 1992)

• Clomipramine for other types of CDs (Hewson et al, 1998)

• Clomipramine for excessive licking/chewing in rabbits

• Selective serotonin reuptake inhibitor (SSRI)

• Fluoxetine (Rappoport et al, 1992, Wynechack, 2000) for canine acral lick dermatitis

• Fluoxetine for all types of CD (Irimajiri et al, 2005)

Others for animals

Opioid antagonists: effective for tail chasing dogs (Brown et al 1987, Dodman et al 1988)

Pathophysiology of OCD

• Dopamine and repetitive behaviors

• High dose of dopamine will reliably induce stereotypic behavior in many animals (Cabib, 1993, Goodman et al, 1990)

• Increased DA release is the characteristic arousal response of the mesoaccumbens system. Mesoaccumbens DA hyperactivity may promote stereotypies (repetitive behaviors). (Cabib 1993)

• Serotonin and OCD-40 to 60% of OCD patients respond to SRI treatment (McDougle et al, 1997)

Serotonin and Dopamine Interaction

• 5-HT innervation of dopaminergic cell bodies and terminals regulate DA neuronal firing and DA release (Quist et al, 2001)

• Opioid System

• Naltrexone, Naloxone, Nalmefen reduced stereotypies in sows (Cronin et al. 1985)

» Effect mostly on mu opioid receptors

• Nalmefene suppressed cribbing in horses (Dodman,1987)

Diagnosis

• There is no definitive diagnostic test

• Exclusion of medical causes

• Physical exam, CBC, serum chemistry, other special examinations

• Behavior history

• Observation of the behavior

» Conscious, aware of surroundings

» Usually able to interrupt

» No post-ictal phase

» Doesn't depend on owner's presence

• Treatment

• Identify and remove cause of conflict and desensitize to stress inducing situation

• Reduce general stress in the environment

• Interact with dog with predictable and calm fashion

• Provide consistent routine

• Avoid punishment as much as possible unless the punishment can meet the 3 rules of punishment (appropriate, consistent, immediate)

• Provide sufficient exercise and activity

• Medication-See paper for Serotonin and norepinephrine reuptake inhibitors to treat behavior problems

• All medications are extra label use.

• None are 100% effective

• SRI (serotonin reuptake inhibitors) will not show their effect for about 4 to 8 weeks

Behavior Modification

• Desensitization and counter-conditioning

• Identify the stress and make it non-stressful

• When supervised, as soon as the animal performs the compulsive behavior, distract the behavior,

• give a command that the animal knows, reward with food for responding to a command

• Training with food reward

• Basic obedience training

• Structured game (hide and seek, etc)

• Clicker training

• Treatment Summary

Identify and remove cause of conflict and desensitize to stress inducing situation

• Reduce general stress in the environment

• Medication

• Behavior modification

Prognosis

• Owners are often frustrated. It is important to have follow up calls and follow up visits frequently.

• Medication will reduce the frequency and the duration of the behavior but will not cure the animal. Inform the owner that behavior modification is important

• If there is no improvement 4 to 6 weeks after starting the treatment, changing or giving additional medication may be recommended

• If there is no improvement, ask how much they have been trying behavior modification, training and management

» Increase the dose of current medication

» Change medication

» Clomipramine ? fluoxetine

» Add medicine to the current SRIs

» Benzodiazepine, Buspirone, or combine TCA and SSRI in low doses

Crowell-Davis SL and Murray T 2006. Veterinary Psychopharmacology. Blackwell Publishing.