Diagnosis and Management of Patients Presenting with Behavior Problems

Inflammation and Behavior Changes in Dogs and Cats

Sickness is a normal response to infections or stress triggered by proinflammatory cytokines that drive local and systemic inflammatory responses. Proinflammatory cytokines act on the brain causing the so called "sickness behavior,"which is thought to improve recovery but can become maladaptive in the long term. Chronic inflammation characterizes many diseases and there is some evidence that dogs and cats experience age-associated increases in inflammation, a condition named "inflammaging." A complex and multifactorial relationship exists between these inflammatory mechanisms, pain, and psychological illness that may complicate veterinary diagnosis and affect the outcome.

Urinary neurotransmitter analysis and canine behavior assessment

Behavioral problems are highly prevalent in domestic dogs, negatively affecting the quality of life of dogs and their owners. In humans and dogs, neuropsychological or neurobehavioral disorders can be associated with deviations in various neurotransmitter systems. Previous evidence has revealed correlations between urinary neurotransmitters and various behavioral disorders; however, a causal relationship has not yet been conclusively demonstrated. Non-invasive urinary neurotransmitter analysis may identify specific biomarkers, which enable a more differentiated assessment of canine behavioral disorders in the future and contribute to more effective neuromodulatory treatment decisions and monitoring. This approach could offer new insights into underlying pathomechanisms of canine neurobehavioral disorders. This study assessed urinary neurotransmitter levels and the descriptive behavior profile of 100 dogs using established rating scales (Canine Behavioral Assessment and Research Questionnaire, Attention Deficit Hyperactivity Disorder Rating Scale, Dog Personality Questionnaire, Canine Cognitive Dysfunction Rating Scale), and explored relationships between these variables. No correlation was found between urinary neurotransmitters and the assessed behavior profiles; however, age-, sex- and neuter-related influences were identified. The lack of correlation could be explained by the many confounding factors influencing both behavior and urinary neurotransmitter excretion, including age, sex and neuter status effects, and methodological issues e.g., low discriminatory power between anxiety and aggression in the descriptive behavior evaluation. Urinary neurotransmitter testing could not be validated as a tool for canine behavior evaluation in this study. However, reliable assessment methods with low susceptibility to human biases could be valuable in the future to support behavioral-phenotype diagnoses.

Broadening the Veterinary Consultation: Dog Owners Want to Talk about More than Physical Health

Few veterinary professionals use formal quality of life (QOL) assessment tools despite their recommendation from veterinary governing bodies to enable holistic welfare assessments and target welfare improvement strategies. Perceived barriers include resistance from owners, and this study aimed to elucidate understanding of dog owner engagement with conversations and tools relating to QOL. An online survey that investigated owner experience, comfort, and opinions about vet-client discussions on topics connected to canine health and well-being, including QOL, was completed by 410 owners. Almost all owners (95.8%) were reportedly comfortable discussing QOL, yet only 32% reported their vets had addressed it. A high proportion of owners (70.8%) expressed interest in assessment tools, but only 4.4% had experienced one, none of which were QOL tools per se. Semi-structured interviews of a sub-set of four owners provided a more in-depth examination of their experience of a health and well-being assessment tool. Thematic analysis generated three themes: 'Use of assessment tools supports client-vet relationship and empowers owners', 'Owners want to talk about holistic dog care', and 'Owner feelings on the wider application of assessment tools'. Overall, our findings suggest that owners want to broaden the veterinary consultation conversation to discuss QOL and are interested in using tools, and therefore veterinary perceptions of owner-related barriers to tool application appear unfounded. Indeed, tool uptake appears to improve the vet-client relationship and boost owner confidence.

Welfare worries: a preliminary, cross-sectional study of general practice, small animal veterinarians perceptions and management of canine and feline behaviour problems

Behavioural disease is one of the leading reasons for euthanasia in shelter dogs and cats. Information acquired via a survey of veterinarians (n = 59) was used to understand the way canine and feline behaviour problems are viewed and managed by nonshelter, small animal general practice veterinarians. Participants (20%, n = 12) felt that the following diseases were more of a welfare issue than behaviour problems: food sensitivity, osteoarthritis, puppy/kitten farms, skin disease, nutritional disease, parasitic disease, dental disease, obesity, in-breeding, over-population, neoplasia, greyhound racing, hyperthyroidism and renal disease. Behaviour problems in dogs and cats were not ranked in the top four welfare problems by 40% (n = 23) of respondents. Behaviour case follow-up was poorer than physical health case follow-up. Respondents (20%, n = 12) felt that veterinarians should 'possibly' be able to identify behaviour problems in dogs and cats, and 54% (n = 32) felt that this was 'absolutely' their professional responsibility. Twelve percent (n = 7) would reschedule behaviour appointments that had been booked in for them. Behaviour was more likely to be seen as a welfare issue by more experienced veterinarians and also, those with shelter experience. Half of respondents felt reluctant to discuss behaviour problems with clients because of deficiencies in behaviour knowledge. Eighty percent (n = 47) felt their education equipped them poorly or extremely poorly in dealing with behaviour problems in dogs and cats. Consideration should be given for the inclusion of adequate behavioural medicine content in veterinary medicine curriculum to allow for graduates to possess a basic level of training and competency in this discipline.

Mortality Resulting from Undesirable Behaviours in Dogs Aged Three Years and under Attending Primary-Care Veterinary Practices in Australia

Simple Summary

There is increasing evidence that undesirable behaviours (UBs) in dogs can compromise the welfare of both canine companions and their associated humans. Indeed, in a recent UK study of patient records from primary-care veterinary practices, UBs emerged as the predominant cause for mortality in young dogs. The current companion study of dogs attending veterinary practices in Australia from 2013 to 2018 reports a comparable proportion of mortality (29.7%) due to UBs among dogs aged three years and under. The most commonly reported UB was aggression. Neutered dogs and purebred dogs (and specifically Australian Cattle Dogs and American Staffordshire terriers) had an elevated risk of death ascribed to at least one UB. The risk factors associated with these UBs are also reported, including interventions applied by the attending clinician (if any). The results highlight the influence of UBs on dog welfare in Australia, and infer the benefits of educating dog owners and veterinary professionals in modifying and managing UBs.

Abstract

There is increasing evidence that undesirable behaviours (UBs) in dogs can compromise the welfare of both canine companions and their carers. Veterinarians are regularly consulted about affected animals and may be asked to euthanase the more severely affected individuals. A recent study of veterinary records showed that UBs were the predominant cause of mortality in young dogs in the UK. This companion study from Australia reports the proportion of mortality due to UBs among dogs aged three years and under that attended veterinary practices from 2013 to 2018. Deidentified patient records were extracted from the VetCompass Australia database and manually assessed to reveal the prevalence and type of UBs reported. The results reveal that 29.7% of the 4341 dogs that died at three years of age or under had deaths ascribed to at least one UB, and that the most commonly reported UB was aggression. Neutered dogs had 2.5× the odds of death due to an UB compared to intact dogs, and crossbred dogs were found to have 1.43× the odds of a UB related death compared to purebred dogs. The breeds at highest risk were Australian cattle dogs (odds ratio (OR) 4.77) and American Staffordshire terriers (OR 4.69). The attending veterinarian referred behaviour cases to a behaviourist or dog trainer in 11.0% of all UB cases, and attempted pharmacological therapy in 5.9% of cases. The results reveal how often UBs affect dogs and their owners in Australia, and infer the beneficial impact that educating dog owners and veterinary professionals in modifying and managing UBs may have.

Veterinary Behavior: Assessment of Veterinarians' Training, Experience, and Comfort Level with Cases

Studies of US animal shelters consistently indicate that behavior is often a major reason for relinquishment and, thereby, euthanasia of millions of dogs and cats annually. Even though this is an area in which veterinarians can intervene to support the human-animal bond, prior research has documented that they frequently do not bring the topic up during appointments. This study explored veterinarians' training in animal behavior and behavioral medicine, along with their level of comfort in treating common behavioral problems. An online survey of practicing veterinarians (N = 1,085) found that only 42.8% felt they'd received a significant amount of training in this field during veterinary school, but the majority reported participating in continuing education sessions about behavior. Almost all respondents reported seeing patients with behavioral issues (99.6%), even when the initial appointment was made for other reasons. Participants felt most comfortable discussing inappropriate elimination and begging for food but were least comfortable treating issues involving aggression. Most veterinarians treat their own behavior cases, using a combination of behavior modification techniques and medication. Only 22.1% refer cases needing behavioral therapy to a specialist. Given the prevalence of behavioral problems in companion animals and the potential for early veterinary intervention to play a significant role in animal health, it is important for veterinary schools to include this topic in their curricula. At present, 73% of schools require a course in animal behavior. The release of the new Competency-Based Veterinary Education framework is anticipated to support a greater teaching emphasis in this area.

A Review of Medical Conditions and Behavioral Problems in Dogs and Cats

Not all animals behave identically when faced with the same situation. These individual differences in the expression of their behavior could be due to many factors, including medical conditions. These medical problems can change behavior directly or indirectly. The aims of this review are to describe the state of the art of the relationship among some medical and behavioral problems, and to propose new lines of investigation. The revision is focused on the relation between behavioral problems and pain, endocrine diseases, neurological problems, vomeronasal organ alterations, and cardiac disorders. These problems represent a diagnostic challenge from a practical point of view. The most common sign of pain in animals is a change in behavior. Although the relation of pain to behavioral problems has been widely studied, it is not absolutely clear. As an example, the relation between sleep disorders and pain is poorly known in veterinary medicine. New studies in humans and laboratory animals show that a reciprocal relationship does, in fact, exist. More specifically, the literature suggests that the temporal effect of sleep deprivation on pain may be stronger than that of pain on sleep. Some behavioral problems could modify the sleep-awake cycle (e.g., cognitive dysfunction). The impact of these behavioral problems on pain perception is completely unknown in dogs and cats. Thyroid hormones play an important role, regarding behavioral control. Both hypothyroidism and hyperthyroidism have been related to behavioral changes. Concerning hypothyroidism, this relationship remains controversial. Nonetheless, new neuro-imaging studies provide objective evidence that brain structure and function are altered in hypothyroid patients, both in laboratory animals and in humans. There are many neurological problems that could potentially change behavior. This paper reviews those neurological problems that could lead to behavioral changes without modifying neurological examination. The most common problems are tumors that affect central nervous system silent zones, mild traumatic brain injury, ischemic attacks, and epilepsy. Most of these diseases and their relationship to behavior are poorly studied in dogs and cats. To better understand the pathophysiology of all of these problems, and their relation to behavioral problems, may change the diagnostic protocol of behavioral problems.

Owner perceptions and management of the adverse behavioural effects of fireworks on companion animals: an update

Aims: To provide updated results on the adverse behavioural effects of fireworks on companion animals in New Zealand, measures that owners use to mitigate these effects, and opinions on a ban on the sale of fireworks. Method: A cross-sectional survey of companion animal owners in New Zealand was conducted between 2 November and 5 December 2016 using an online survey. The survey was modelled after a similar study conducted in 2006. Owners were asked to provide information on the types and severity of behaviours observed in their animals that were frightened by fireworks, what they did for their frightened animals and whether they would support a ban on the sale of fireworks. Results: There were 4,293 respondents who completed the online survey and they owned 15,871 companion animals, of which 11,750 (74.4%) were frightened of fireworks. For the 7,464 fearful animals with individual data available, the most commonly reported adverse behaviours were hiding (5,287; 70.8%), shivering (4,058; 54.3%) and cowering (3,324; 44.5%). Owners reported that 345 animals had been physically injured as the result of fireworks. Of 3,682 owners with frightened animals, 2,649 (71.9%) had not sought help or treatment for their animal. Frightened animals were mostly kept inside (3,479/7,464; 46.%) or comforted (2,112/7,464; 28.2%). Of all 4,325 respondents, 3,631 (84.0%) were supportive of a ban on the private sale of fireworks, with 370 (8.6%) against and 315 (7.3%) undecided. Owners with ≥1 animal that was fearful towards fireworks were more likely to support a ban (3,137/3,412; 91.9%) than owners whose animals were not afraid (466/561; 83.1%) (OR = 2.32; 95% CI = 1.80-2.98). Conclusion and Clinical Relevance: Among respondents to this survey, many owners of companion animals reported that their animals were adversely affected by fireworks, but few of them sought advice about strategies to mitigate the impacts. The majority of respondents supported a ban on the private sale of fireworks. Campaigns to raise public awareness of treatment strategies for managing fear behaviours during anticipated fireworks displays may be beneficial.

Development of a laboratory model to assess fear and anxiety in cats

Objectives The objectives of this study were: (1) to develop a laboratory-based model to assess fear and anxiety in cats using the feline open-field test (OFT) and the feline human interaction test (HIT); and (2) to validate the model using diazepam, a known anxiolytic. Methods Laboratory-housed cats (n = 41) were first classified as fearful, mildly fearful or non-fearful by a technician familiar with the cats and also by veterinary behaviorists (GL, JL), by assessing the cats' behavior in their home rooms. In experiment 1, each cat's behavior was assessed in an OFT and an HIT. In experiment 2, after administration of the anxiolytic diazepam, a subset of the cats was re-tested. Results In experiment 1, the OFT revealed significant group effects on two measures: duration of inactivity, and vocalization. Fearful animals had significantly longer periods of inactivity than non-fearful animals. Non-fearful and mildly fearful cats vocalized more frequently than fearful cats. In the HIT, fearful cats travelled less than non-fearful and mildly fearful cats. Fearful and mildly fearful animals had significantly longer durations of inactivity, and non-fearful and mildly fearful cats had a significantly higher frequency of vocalization compared with fearful cats. In experiment 2, in the OFT, treatment with diazepam caused an increase in distance travelled, shorter durations of inactivity, and more frequent inactivity and vocalization. In the HIT, diazepam increased distance travelled and decreased duration of inactivity. Fearful cats spent significantly less time near the human compared with non-fearful cats, and this persisted under diazepam. Conclusions and relevance The feline OFT and feline HIT can be used jointly to assess the effects of medications or other therapies on fear and anxiety in the domestic cat.

Blindness and behavioural changes in the cat: common neurological causes

PRACTICAL RELEVANCE

Blindness and behavioural changes occur relatively commonly in cats, either separately or in combination, causing devastating consequences for the cat and owner. Blindness can be caused by primary ophthalmic, metabolic or intracranial disease. Similarly behavioural changes may be the primary result of intracranial or systemic disease, but also occur secondarily to visual deficits or changes in interaction with the external environment (ie, non-medical problems). The anatomical pathways involved in vision are very close to those involved in behavioural regulation. It is, therefore, likely that a brain lesion (especially a forebrain lesion) that causes blindness will also cause behavioural abnormalities.

CLINICAL CHALLENGES

In cases of partial or unilateral blindness, obvious visual deficits may not be apparent to the owner or clinician. Rather, the visual impairment may manifest more subtly as changes in behaviour, reluctance to jump or unwillingness to go outside. Similarly, behavioural problems may be episodic and, hence, a cat presenting with behavioural disturbances may appear clinically normal on evaluation. Behavioural changes are unlikely to be noticed unless marked and associated with bilateral blindness or advanced systemic illness.

AUDIENCE

This article discusses these two major disorders separately, with the aim of highlighting for the clinician some of the important aspects of the general clinical and neurological examination that can be performed to identify these challenging cases.