Changes

===Psychoactive Drug Therapy===

===Psychoactive Drug Therapy===

Medication can be very effective; a study by Landsberg & Wilson found that cats treated with clomipramine at a mean dose of 0.54mg/kg showed a 75% reduction in spraying within 4 weeks<ref>Landsberg, G.M., Wilson, A.L. (2005) Effects of clomipramine on cats presented for urine marking. J Am Anim Hosp Assoc. 41(1), 3-11.</ref>. In a meta-analysis of the effectiveness of treatments used for indoor spray marking both fluoxetine and clompiramine were found to reduce spraying by at least 90%<ref>Mills, D.S., Redgate, S.E., Landsberg, G.M. (2011) A Meta-Analysis of Studies of Treatments for Feline Urine Spraying. PlosOne. 6(4), 1-10.</ref>

Medication can be very effective; a study by Landsberg & Wilson found that 20 out of 25 cats treated with clomipramine at a mean dose of 0.54mg/kg showed a reduction in spraying within 4 weeks<ref>Landsberg, G.M., Wilson, A.L. (2005) Effects of clomipramine on cats presented for urine marking. J Am Anim Hosp Assoc. 41(1), 3-11.</ref>. In a meta-analysis of the effectiveness of treatments used for indoor spray marking both fluoxetine and clompiramine were found to reduce spraying by at least 90%<ref>Mills, D.S., Redgate, S.E., Landsberg, G.M. (2011) A Meta-Analysis of Studies of Treatments for Feline Urine Spraying. PlosOne. 6(4), 1-10.</ref>

Psychoactive drug therapy is often prescribed for cats with indoor marking problems. However, to be successful, the '''underlying reasons for the indoor marking must also be addressed'''. Medication does have a role in longstanding cases where the number of marked sites is large, or when marking has become habitual, or there is an emotional problem that may benefit from temporary drug support. Analysis of the general emotional state of the animal is important. SRI/SSRI drugs such as fluoxetine and clomipramine are beneficial for cats that are habitual indoor markers, or show a pattern of anxious, reactionary spraying. Selegiline benefits behaviourally-inhibited cats that will not explore their environment, or that display fearful reactions followed closely by reactionary spraying when they see certain cats lurking outside the home. These drugs will not help confident cats that show no signs of anxiety or fear and are merely using spray marks, albeit inappropriately, as part of a calmly considered strategy to control territory in the house. Hormonal preparations have no role in the treatment of indoor marking.

Psychoactive drug therapy is often prescribed for cats with indoor marking problems. However, to be successful, the '''underlying reasons for the indoor marking must also be addressed'''. Medication does have a role in longstanding cases where the number of marked sites is large, or when marking has become habitual, or there is an emotional problem that may benefit from temporary drug support. Analysis of the general emotional state of the animal is important. SRI/SSRI drugs such as fluoxetine and clomipramine are beneficial for cats that are habitual indoor markers, or show a pattern of anxious, reactionary spraying. Selegiline benefits behaviourally-inhibited cats that will not explore their environment, or that display fearful reactions followed closely by reactionary spraying when they see certain cats lurking outside the home. These drugs will not help confident cats that show no signs of anxiety or fear and are merely using spray marks, albeit inappropriately, as part of a calmly considered strategy to control territory in the house. Hormonal preparations have no role in the treatment of indoor marking.

* Individual cats are showing signs of chronic anxiety (SRI/SSRI) or inhibition of normal behaviour (Selegiline).

* Individual cats are showing signs of chronic anxiety (SRI/SSRI) or inhibition of normal behaviour (Selegiline).

* The case is longer than 6 months duration.

* The case is longer than 6 months duration.

* Response to environmental change has been incomplete.

* Response to environmental change has been incomplete.

* Spraying is a reaction to specific fear (Selegiline).

* Spraying is a reaction to specific fear (Selegiline).

* A rapid resolution is demanded and the client can be relied upon to complete environmental modification.

* A rapid resolution is demanded and the client can be relied upon to complete environmental modification.

Risks of using psychoactive drugs include:

Problems with using psychoactive drugs include:

* Disinhibition of aggression: SRI/SSRI/benzodiazepine drugs.

* Disinhibition of aggression: SRI/SSRI/benzodiazepine drugs.

* Clients may assume that changes in behaviour are solely due to medication, so that they do not comply with behavioural therapy or environmental modification.

* Poor owner compliance: owners may not give medication consistently, or they may rely on its effects and fail to introduce the prescribed environmental modifications.

* There may be a relapse if drugs are withdrawn before environmental and social factors have been remedied.

* Relapse: This is likely if drugs are withdrawn before environmental and social factors have been remedied. Relapse is seen in 80% of cats treated for indoor marking with benzodiazepine drugs, so this class of drug is no longer recommended.  

* Potential adverse effects of drugs: fatal hepatic disease after oral benzodiazepine administration, cardiovascular effects of SSRI/SRI drugs.

* Potential adverse effects of drugs: fatal hepatic disease after oral benzodiazepine administration, cardiovascular effects of SSRI/SRI drugs.

* Interactions with concurrent medication or disease: drugs that affect the function of cytochrome P450 can interfere with the metabolism of SRI/SSRI drugs (e.g. Cimetidine). SRI drugs should be used with care in cats with thyroid disturbance, or with bladder disease (risk of outflow obstruction).

* Interactions with concurrent medication or disease: drugs that affect the function of cytochrome P450 can interfere with the metabolism of SRI/SSRI drugs (e.g. Cimetidine). SRI drugs should be used with care in cats with thyroid disturbance, or with bladder disease (risk of outflow obstruction).