Changes

Typical situations in which psychoactive medication can be a useful adjunct to behavioural modification techniques include:

Typical situations in which psychoactive medication can be a useful adjunct to behavioural modification techniques include:

:*When fear or anxiety are very intense:

:*When fear or anxiety are very intense and is interfering with learning and the response to behavioural therapy.

:*Making therapy difficult or dangerous, bearing in mind the risk of disinhibition.

:*Where conditions eliciting fear or anxiety are unavoidable in normal life.

:*Where conditions eliciting fear or anxiety are unavoidable in normal life.

:*Where the animal is suffering as a result of chronic anxiety or repeated fearful experiences.

:*Where chronic anxiety or repeated fearful experiences are impairing the animal's welfare.

*When the prognosis is likely to be improved:

:*When the prognosis is likely to be improved by the use of medication.

:*Condition is longstanding or severe and therefore less likely to respond to behaviour modification.

:*Where distraction is difficult (e.g. severe stereotypy/compulsion).

:*Where distraction is difficult (e.g. severe stereotypy/compulsion).

:*If speed of recovery is critical (threat of legal action, eviction etc).

:*If speed of recovery is critical (threat of legal action, eviction etc).

When considering whether to incorporate psychoactive drugs into a treatment program for problem behaviour, there are several conditions which should be met:

When considering whether to incorporate psychoactive drugs into a treatment program for problem behaviour, there are several conditions which should be met:

#A sensible diagnosis should be arrived at.  

#A diagnosis, and ruling out of causative medical problems.  

#The clinician should have knowledge of the neurochemistry relating to the condition.

#The clinician should have knowledge of the neurochemistry relating to the condition.

#The clinician should have an awareness of the supposed mechanism of action of the selected drug.

#The clinician should have an awareness of the supposed mechanism of action of the selected drug.

#The clinician must have a clear understanding of any potential side effects.

#The clinician must have a clear understanding of any potential adverse effects, contraindications and drug interactions (which the owner should be informed about).

#Both the clinician and owner need to have a clear idea of how the selected medication will change the behavioural pattern which is a problem. Owners must be informed of potential side effects and warn the clinician if there is even the slightest problem. As medication for behavioural conditions is often long-term, owner awareness and compliance is very important.

#Both the clinician and owner need to have a clear idea of how the selected medication will change the pattern of problematic behaviour.

#Confidence in the compliance of the client, especially with respect to management intended to prevent damage to people or property.

These guidelines are important to ensure the correct use of drugs within the behavioural field as administration of medication is always long-term in comparison to most other drug use and they help the owner take-part in the process of evaluation as to the effectiveness of the drug prescribed <ref>Overall, K.L., 2004. Paradigms for pharmacologic use as a treatment component in feline behavioral medicine. Journal of Feline Medicine and Surgery 6, 29-42.</ref>.

These guidelines are important to ensure the correct use of drugs within the behavioural field, as administration of medication is always long-term in comparison to most other drug use and they help the owner take-part in the process of evaluation as to the effectiveness of the drug prescribed <ref>Overall, K.L., 2004. Paradigms for pharmacologic use as a treatment component in feline behavioral medicine. Journal of Feline Medicine and Surgery 6, 29-42.</ref>.

Before any drug is prescribed, a comprehensive behavioural and medical history should be compiled. In older animals, those suffering from cardiac or endocrine disorders as well animals which are already on treatments for any existing conditions, extreme care should be taken. All animals should undergo a complete physical examination as well as blood tests. For a cat, a complete blood count, serum biochemistry profile and urinalysis, ideally with culture and sensitivity form a complete laboratory work up <ref name="Overall" />. In addition in older cats thyroid levels should be tested and if cardiac disease is a worry a lead II ECG should be performed to exclude the existence of cardiomyopathy. This also provides a baseline for cardiac side effects of medications to be measured against <ref>Nattal, S., Mittleman, M., 1984. Treatment of ventricular tachyarrhythmias resulting from amitriptyline toxicity in dogs. Journal of Pharmacology and Experimental Therapeutics 231, 430–435.</ref>.

Before any drug is prescribed, a comprehensive behavioural and medical history should be compiled. In older animals, those suffering from cardiac or endocrine disorders as well animals which are already on treatments for any existing conditions, extreme care should be taken. All animals should undergo a complete physical examination as well as blood tests. For a cat, a complete blood count, serum biochemistry profile and urinalysis, ideally with culture and sensitivity form a complete laboratory work up <ref name="Overall" />. In addition in older cats thyroid levels should be tested, and if cardiac disease is a worry a lead II ECG should be performed to exclude the existence of cardiomyopathy. This also provides a baseline for cardiac side effects of medications to be measured against <ref>Nattal, S., Mittleman, M., 1984. Treatment of ventricular tachyarrhythmias resulting from amitriptyline toxicity in dogs. Journal of Pharmacology and Experimental Therapeutics 231, 430–435.</ref>.

==Combining behavioural therapy with medication==

==Combining behavioural therapy with medication==