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==Prognosis==
 
==Prognosis==
The prognosis for cats with indoor spray marking appears to be enhanced by the use of drug (fluoxetine, clomipramine) and synthetic pheromone treatment s(F3 fraction of facial mark, Feliway®), with these treatments significantly increasing the probability of a cessation or 90% reduction in spraying<ref name="Mills3" />. In a meta-analysis of treatment effect, fluoxetine appeared to be the most effective medication, but sample sizes in both of the included studies was small. Both drugs produced a large and significant increase in the proportion of cats showing a cessation or 90% reduction in spray marking (primary outcome measure). Studies suggest that a period of 8-16 weeks is required to establish efficacy of either of these drugs. In the same meta-analysis, treatment periods of 4 weeks with Feliway produced no significant increase in the proportion of cats showing a cessation or 90% reduction in spray marking (primary outcome measure). However, a large effect was detected when comparing the number of cats that reduced spraying compared with baseline (secondary outcome measure)<ref name="Mills3" />. The authors indicated that synthetic pheromones do reduce the overall incidence of spraying only after 4 weeks. This suggests that a combination of pheromone and pharmaceutical interventions, with environmental modifications, is most likely to produce a rapid response and good outcome.
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The prognosis for cats with indoor spray marking appears to be enhanced by the use of drug (fluoxetine, clomipramine) and synthetic pheromone treatments (F3 fraction of facial mark, Feliway®), with these treatments significantly increasing the probability of a cessation or 90% reduction in spraying<ref name="Mills3" />. In a meta-analysis of treatment effect, fluoxetine appeared to be the most effective medication, but sample sizes in both of the included studies was small. Both drugs produced a large and significant increase in the proportion of cats showing a cessation or 90% reduction in spray marking (primary outcome measure). Studies suggest that a period of 8-16 weeks is required to establish efficacy of either of these drugs. In the same meta-analysis, treatment periods of 4 weeks with Feliway produced no significant increase in the proportion of cats showing a cessation or 90% reduction in spray marking (primary outcome measure). However, a large effect was detected when comparing the number of cats that reduced spraying compared with baseline (secondary outcome measure)<ref name="Mills3" />. The authors indicated that synthetic pheromones do reduce the overall incidence of spraying only after 4 weeks. This suggests that a combination of pheromone and pharmaceutical interventions, with environmental modifications, is most likely to produce a rapid response and good outcome.
 
   
 
   
 
However, cats with a history of indoor marking are likely to relapse at some point in the future, because this behaviour is normal and situations outside the owner’s control may create the conditions for a new bout of marking. Typical times when marking may re-emerge are after major home redecoration or reorganisation, after a house move, or the introduction of a new stressor (new baby, new pet). Spring and summer are times when cats seek to re-establish territorial boundaries, and are therefore a time when there is an increased risk of conflict and stress between cats.
 
However, cats with a history of indoor marking are likely to relapse at some point in the future, because this behaviour is normal and situations outside the owner’s control may create the conditions for a new bout of marking. Typical times when marking may re-emerge are after major home redecoration or reorganisation, after a house move, or the introduction of a new stressor (new baby, new pet). Spring and summer are times when cats seek to re-establish territorial boundaries, and are therefore a time when there is an increased risk of conflict and stress between cats.
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