Medical problem? Behavioral problem? How about both! (Proceedings)

Behavior is a manifestation of normal and abnormal, typical and atypical, and often related to owner's point of view. Behavioral “sign” is recognized when the animal behaves in a way considered atypical for a given environment or event

Disease is very often expressed behaviorally, and a good history taking is important. It is imperative to inquire about changes in severity and frequency. A disorder may possess both medical and behavioral components.  Both must be addressed to ensure resolution of the problem.

Medical vs. behavioral – need to consider BOTH when making a diagnosis

Medical problems can lead to behavioral problems, even after medical problem is treated.  Example: a true urinary tract infection in a cat – resolves, but cat still urinates outside of box. We must also consider behavioral component of medical problems.

Major medical symptoms

• Lethargy, anorexia.  This can be seen in almost any disease process.  Rule out medical problem first.

• Polyphagia.  Medical problem>>or may be a component of attention seeking behavior.

• Change in elimination habits, usually when eliminating inappropriately.

• Pruritis and self-mutilation.  May be medical and/or behavioral (attention-seeking, compulsive).

• Increased or decreased motor activity.  Medical or behavioral, such as hyperkinesis.  True hyperkinesis appears to be very rare.

Dermatological disease

• Causes of behaviors: Atopy/allergy; ectoparasites; trauma; dermatopathy; anal sacculitis.

• Reasons for behavioral change: ruritis; inflammation; infection; pain

• Behaviors: chronic licking (often persists after initial insult resolved, becoming a behavioral problem). 

Gastrointestinal disease

• Causes of behaviors: IBD; blockages; motility disorders; liver disease

• Reasons for behavioral change: pain; inflammation

• Behaviors: Anorexia (Behavioral cause of attention seeking/audience affected behavior for anorexia cannot be ignored.  If a dog is “picky” enough, the owner will feed it continually changing food (boiled chicken, grilled steak, etc.); vomiting; polyphagia (see endocrine also); excessive licking.

Urinary tract disease

• Causes of behaviors: FIC; infection; crystalluria; estrogen-dependent incontinence; PU/PD.

• Reasons for behavioral change:  pain/inflammation; incontinence; polyuria due to any cause

• Behaviors: urinating with intentional body posture (increased urge-polyuria vs. pollakiuria vs. stranguria vs. anuria) vs. incontinence.

Endocrine/metabolic disease

• Causes of behaviors: hyper-/hypo-thyroidism; diabetes mellitus/insipidus; hyper-/hypo-adrenocorticism; pheochromocytoma; electrolyte imbalances

• Reasons for behavioral change: alterations of hormones; dysregulation of glucose; neoplastic changes; electrolyte imbalances

• Behaviors: polydipsia/polyuria (many causes); polyphagia (many causes); disorientation, lethargy

Cardiovascular disease

• Causes of Behaviors: any form of cardiac dysfunction, acquired or genetic/congenital, related to rhythm or physical function, vascular disease

• Reasons for behavioral change: lack of oxygen to body and brain

• Behaviors: disorientation and lethargy

Sensory system diseases

• Causes of behaviors: degeneration in vision, hearing, olfaction, and taste.

• Reasons for behavioral change: unaware of surroundings; ß ability to respond to environmental cues

• Behaviors: disorientation; fearful or withdrawn behavior;visual “hallucinations”; anorexia, “picky” eating behavior

Musculoskeletal disease

• Causes/reasons for behaviors: pain; paralysis/paresis

Behaviors: increased irritability or aggression, due to pain; inappropriate elimination.

Neurological disease

Pain; seizures; circling; behavior change.

Overview

Often people confuse behavior problems with neurological problems, and vice versa.  Not many 2-year-old intact males (insert least favorite breed) with aggression problems have a brain tumor! It is important to do a complete neurological exam, especially if you suspect neurological disease. Keep in mind breed predisposition for certain problems (hydrocephalus in Chihuahuas)

May be a sudden change in behavior, or may be a slower onset behavior, and it depends on disease, animal's coping mechanism, and the critical mass of a space occupying lesion that causes the animal to start to decompensate.

Seizures are the most common presenting sign for brain tumors, but also see behavior changes (apathy, aggression, “hallucinations”, compulsive behaviors).

Now…reverse your thinking…behavioral causes of medical problems

Dermatological disease

Behaviors and causes: chronic licking (acral lick dermatitis); chewing/licking feet; tail-chasing --  Attention-seeking behavior; anxiety, displacement; “compulsive” behavior

Gastrointestinal disease

Behavior and causes: Anorexia or polyphagia (attention-seeking behavior, compulsive behavior); vomiting (stress, anxiety); pica (attention-seeking behavior, compulsive behavior); dementia, head pressing, uncontrolled barking (attention-seeking behavior, cognitive dysfunction; compulsive behavior)

Urinary tract disease

Behaviors and causes: squat urinating – inappropriate elimination (primary behavioral problem or secondary to medical problem/stress/FIC, cognitive dysfunction); vertical marking – marking behavior (stress/anxiety/territorial behavior).

Endocrine/metabolic disease

Behaviors and causes: polydipsia/polyphagia (stress/anxiety, attention-seeking behavior); increased activity (normal behavior for young animal, stress/anxiety)

Sensory system diseases

Behaviors and causes: disorientation (cognitive dysfunction); fearful or withdrawn behavior (obviously fearful or anxious animal to specific stimuli, generalized stress/anxiety); aggression (multiple behavioral causes of aggression); visual “hallucinations” (attention-seeking behavior; compulsive behavior); anorexia, “picky” eating behavior.