Managing Separation Anxiety: An Evidence-Based Approacheoplugin.commpartners.com/AAHA/2009/091117 Presentation Handout FINAL.pdfConference - Managing Separation Anxiety: An Evidence-Based

AAHA National Staff Meeting Web

Conference - Managing Separation Anxiety:

An Evidence-Based Approach

December 6-20, 2009

1

Managing Separation Anxiety: An Evidence-Based Approach

December 6-20, 2009By

Jacqui Neilson, DVM, DACVB

AAHA gratefully acknowledges the following for their sponsorship of this Webcast.

MANAGING SEPARATION

ANXIETY:

AN EVIDENCE BASED

APPROACH

Jacqueline C. Neilson, DVM, DACVB




December 6-20, 2009

2

Separation Anxiety (SA)

Signs of severe distress (anxiety) when an

individual is separated from other group

members

Overview

Incidence/Impact

Diagnosis

Treatment

Behavioral Modification

Drug Therapy

Pheromone Therapy

Incidence/Impact




December 6-20, 2009

3

Separation Anxiety Incidence

14% -17% dogs suffer

63 million owned dogs in US

8-11 million suffer

1 in 6

Impact of Separation Anxiety

Substantial & Serious




December 6-20, 2009

4


Dog suffers

Compromised welfare

Extreme emotional distress

Physical injury


Owner suffers

Concern for their

dog

Property destruction

Eviction

Impact of SA

Relinquishment to shelters

3/10 most commonly reported problems are

consistent with separation anxiety*

4/10 most commonly reported problems are

consistent with separation anxiety**

Euthanasia

50-70% of all dog/cat euth is due to behavioral

problems***

*Miller et al JAVMA 1996 **Kogan J App An Wel Sci 2000

*** Spencer JAVMA 1993




December 6-20, 2009

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Raider

Sadie




December 6-20, 2009

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Diagnosis

Diagnosis

Anxiety when separated from attachment figure(s)

Vocalization

Elimination

Destruction

Pacing

Panting

Etc.




December 6-20, 2009

7

Is Separation Anxiety (SA)

Normal?

Fear can be an adaptive behavior

Dogs are social animals Attachment behaviors

beneficial-serve to maintain social cohesion

Separation = distress response NORMAL

Habituation to separation NORMAL

Separation = excessive distress response SEPARATION ANXIETY

Puppy Behaviors when left home

alone

18 puppies

9 pups < 3 months of age

9 pups > 3 months of age

Videotaped for first 90

min of owner departure

Results•75% of time puppies displayed passive behaviors

•Younger pups showed more lip licking, yawning, scratching & vocalized more

•No differences bwt. crated vs. free pups

Normal puppies don’t display excessive distress

responses – if a client complains of excessive distress

response very well may be abnormal




December 6-20, 2009

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Diagnosis

Verbal history from owner

Physical examination

Diagnostic testing to rule out primary medical

problems

Bloodwork

UA/Fecal

Video during owner absences

Clinical Signs of Separation

Anxiety

Destruction

Elimination/House-soiling

Vocalization

Pacing

Panting

Salivation

Withdrawal

Anorexia

Obvious signs

Subtle signs

Diagnosis

Clinical signs of separation

anxiety are non-specific

clinical signs

Must rule out other

conditions that could cause

those clinical signs and

verify that the trigger for

the signs is separation




December 6-20, 2009

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Rule-outs for Clinical Signs

Vocalization

• Reaction to external stimuli

• Socially facilitated

• Play

• Fear induced

• Separation Anxiety

Destruction

• Play

• Exploration

• Reaction to external stimuli


House-soiling

• Lack or break in house-training

• LUTD

• PU/PD

• Urine marking

• Excitement urination


Challenging Case: Buster

Owner returned home to find destruction




December 6-20, 2009

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Buster had a noise phobia

40% dogs with noise phobia also had SA

8-50% of dogs with SA have noise phobia




December 6-20, 2009

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Comparison of behaviors when

left alone in Control vs. SA dogs

0

10

20

30

40

50

60

70

80

destruction elimination vocalization

control

SA

Flannigan G and Dodman N; JAVMA 219(4) 2001

Comparison dog attributes in

Control vs. SA dogs

0

10

20

30

40

50

60

70

80

90

follow owner

excess greeting

angst keys

angst coat shoe

Control

SA




December 6-20, 2009

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Challenging Cases: Multiple

Pets…Culprit??

Guilty Party

“Guilty” Look

Treatment

Treatment Separation Anxiety

Owner Education

Behavioral modification

Pheromone treatment

Drug treatment




December 6-20, 2009

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Owner Education

Owner Education

Behavior is anxiety driven, not spite or

disobedience

Dogs are social creatures

Normal to have distress response when separated

from companions

Excessive distress response = separation anxiety

Results in

Increased tolerance

Better treatment compliance

Basic

Advanced

Behavior Modification




December 6-20, 2009

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Basic Interventions

Be Positive

Only Reward Calm Behavior

No more drama when you come and go

Develop your dog’s independence

Basic

Verify that dog is getting enough

exercise/enrichment

Advanced

Desensitization & counterconditioning to pre-departure routine and departures

Gradual introduction of anxiety provoking stimuli and pair the stimuli with something very positive to establish a new, calm emotional state

To do properly must avoid over-threshold experiences (e.g. cannot leave dog for a period of time that triggers anxiety)




December 6-20, 2009

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Common Problems

Enthusiastic owners overwhelm dogs

Owners don’t temper their behavior to AVOID anxiety

Need to keep beneath threshold for anxiety

Common problems

Can’t avoid anxiety ridden departures

Can’t take to work

Can’t afford doggie daycare

Dog isn’t allowed in doggie daycare, etc.

Guinness

Can’t take to work

Single owner

Tried crating –escaped from crate/injuries

sustained

Used to live with other dogs – was fine

Friend drops off dog to stay with Guinness – he is

fine

Not long term solution

Owner doesn’t want another dog




December 6-20, 2009

16

If you can implement behavioral

modification…

Does It Work?

Success of Behavioral Modification

50 dogs with SA

Behavior modification (34)

Adequate exercise

Owner initiated interactions

Treats provided at departure

No punishment

Pre-departure cues altered

Departure desensitization

No Treatment-Control (16)

Blackwell E Vet Record 158, April 2006

Results

Based upon

Video footage

Owner evaluations

75% dogs with behavior modification showed improvement (often significant) @ 12 weeks

31% of control dogs had improvement (often mild) @ 12 weeks

YES, Behavioral Modification can work with TIME & EFFORT




December 6-20, 2009

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Compliance with Behavior

Modification for > 1 month

No punishment (79%)

Increase in exercise (78%)

Special toy at departure (69%)

Desensitization to departures (43%)

Uncoupling pre-departure cues (35%)

Takeuchi Y JAVMA 217 (3) 2000

Drug Therapy

Drugs

Daily medications

Event drugs




December 6-20, 2009

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Drugs – Daily Medication

Two drugs approved by the FDA to treat

canine separation anxiety when used in

combination with a basic behavioral

modification program

fluoxetine

clomipramine

Clomipramine

Tricyclic anti-depressant

Dosing

2-4 mg/kg/day

Clomipramine Study

159 dogs with SA

Basic Behavioral

Modification

Clomipramine4 mg/kg/day

56 days

Placebo

56 days




December 6-20, 2009

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Results

0

10

20

30

40

50

60

70

week 1 week 3 week 5 week 8

clomipramine

Placebo% of dogs

considered

improved

Fluoxetine

Selective serotonin reuptake inhibitor

Dosing

1-2 mg/kg/day

Fluoxetine Study

242 dogs with SA

Basic Behavioral

Modification

Fluoxetine

1-2 mg/kg/day

56 days

Placebo

56 days




December 6-20, 2009

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Results

0

10

20

30

40

50

60

70

80

1 2 3 4 5 6 7 8

Fluoxetine

Placebo

18%

72%

51%

*

*

*

*

** *

Week of Trial

% of dogs

considered

improved

42%

* p<0.05

Fluoxetine w/out Behavioral Mod

208 dogs with Sep Anxiety

1-2 mg/kg fluoxetine

/dayplacebo

14 days

baseline

6 weeks

tx

Results

0

10

20

30

40

50

60

70

1 2 3 4 5 6

% o

f d

og

s im

pro

ved

in

ov

era

ll

sep

ara

tio

n a

nxie

ty

sco

re

Week of Study

Fluoxetine

Placebo

*

* p< 0.05




December 6-20, 2009

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Most common Side Effects with fluoxetine:

lethargy (32%) and decreased appetite (27%)

Drugs: Event Drugs

Quick acting anxiolytics

Given ~ 60 minutes before onset of departure

anxiety

Lasts a few hours

Sedation possible

Alprazolam

Benzodiazepine

PRN in addition to serotonin medication

Dose

0.05-0.1 mg/kg PRN ~60 min prior to onset of

anxiety

10% dogs get hyperexcitable/agitated




December 6-20, 2009

22

Trazodone

Atypical anti-psychotic

Mixed serotonergic agonist/antagonist

PRN in addition to serotonin medication

Dose

2-5 mg/kg as PRN bolus ~60 min prior to onset of

anxiety

Long term drug use

Unknown ramifications

Examination/bloodwork every 6-12 months

Pheromone Therapy




December 6-20, 2009

23

DAP: Dog Appeasing Pheromone

Clinical study (Gaultier, Pageat)

30 dogs

DAP

placebo pill

beh. mod

27 dogs

placebo pulg-in

clomipramine (2.2-4 mg/kg BID)

beh. mod

57 dogs

with Separation Anxiety

destruction

soiling, vocalization

Results

% of Dogs

Improved or

Resolved

0102030405060708090

100

Clom

DAP




December 6-20, 2009

24

In Summary

Verify diagnosis

Behavior Modification

Consider client/pet limitations

Drug therapy

Treat early and adequately

Pheromone therapy

Questions

1. To complete the evaluation, please go to the following website:

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Your input is very important! We take feedback seriously in order to provide you with the highest quality experience possible.

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http://www.keysurvey.com/survey/278508/1427/




December 6-20, 2009

25

Questions to the Speaker

Please email your questions to [email protected] by Sunday, December 27, 2009.

Dr. Neilson will provide written responses to all of the questions and they will be posted on AAHA’s website by Friday, January 8, 2010.

AAHA gratefully acknowledges the following for their sponsorship of this Webcast.

Documents

Managing Separation Anxiety: An Evidence-Based Approacheoplugin.commpartners.com/AAHA/2009/091117 Presentation Handout FINAL.pdfConference - Managing Separation Anxiety: An Evidence-Based