Difference between revisions of "Risk Assessment and Prognosis of Feline Aggression"

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==Risk Assessment of Aggression==
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{{KeyPoints
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As with dogs, there is little scientific data to provide a reliable means of prognostication, but the same basic issues remain when considering safety during the treatment of feline aggression problems:
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|points = <br>
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*Will the cat bite [again]?
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*Cat bites are not trivial; they often become infected and can cause severe disfigurement to the hands and face.
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*What harm may it do if it does?
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*Aggression is usually predictable, based on the pattern of events and stimuli that precede it, unless the stimuli are internal and not obvious to the observer (such as pain).
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*Can the cause for the aggression be treated?
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*To safely treat aggressive cats the motivation for the behaviour must be understood and the pattern of stimuli and events that elicit aggression must be identified.
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*What ongoing risk will the cat present after treatment?
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}}
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*Whilst treatment proceeds, can people and animals be kept safe from the cat?
 
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*Are the owners willing and capable of accepting and safely managing the immediate and long-term risks?
 
  
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There is also a need to consider the amount of warning that precedes an attack and how often such attacks may occur. Infrequent but severe attacks that occur without much warning represent a genuine threat to safety and carry a poor prognosis.  
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==Human Injury Caused by Cat Bites and Scratches==
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There is limited data available on the prevalence of cat bite/scratch injuries. One Italian study using emergency department treatment records found a rate of 17.9 cases of cat bites/scratches per 100,000 admissions, compared with 58.4 per 100,000 for dog bites<ref>Ostanello, F., Gherardi, A., Caprioli, A., La Placa, L., Passini, A., Prosperi, S. (2005) Incidence of injuries caused by dogs and cats treated in emergency departments in a major Italian city. Emerg Med J 2005;22:260–262.</ref>. Whereas dog bites cause crush, laceration and puncture wounds that become infected on 3-18% of occasions, cat bites usually cause a penetrating injury and 28-80% result in an infection that more often involves [[Pasteurella multocida|''Pasteurella multocida'']] and/or [[Staphylococcus aureus|''Staphylococcus aureus'']]<ref>Davies, H.D. (2000) When your best friend bites: A note on dog and cat bites. Can J Infect Dis. 11(5). 227-229</ref>. Human facial injuries due to cat bites are particularly serious, as surgical repair cannot be carried out until microbial infection is eliminated and damaged tissue debrided. Injuries to the hands and feet can result in serious complications, such as osteomyelitis. Another factor is the rising incidence of sharing of methicillin resistant ''Staphylococcus aureus'' between animals and their owners, with infection cycling between the animal and its various human acquaintances, which could become a significant problem in infected cat bites<ref>Oehler, R.L.,  Velez, A.P., Mizrachi, M., Lamarche, J., Gompf , S. (2009) Bite-related and septic syndromes caused by cats and dogs. Lancet Infect Dis. 9.439–47.</ref><br><br>
 +
Cat scratch disease is a common and mostly benign condition caused by post-scratch infection with the gram negative bacteria ''Bartonella henselae'' or ''Bartonella quintana''<ref name ="Klotz">Klotz, S.A., Ianas, V., Elliott, S.P. (2011). "Cat-scratch Disease". Am Fam Physician. 83(2). 152–5.</ref>. Symptoms are usually seen within 7-14 days of injury, but can take up to 2 months to appear. Symptoms include headache and joint and muscular pains, but severe cases can result in meningioencephalitis or endocarditis<ref name="Klotz"/>. Cats are generally less likely to cause injury to people than dogs, as their primary response to threat is escape and avoidance. The greatest risk of injury is when handling cats, but some cats will actively seek out and attack people.
  
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As with dogs, there is an absolute necessity to follow up and manage these cases and to make sure that clients do not place themselves or others at risk. Predictability of aggressive behaviour is critical, as is preparing the owner with a plan of action should aggression be seen.  
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==Risk Assessment==
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Risk assessment in [[Feline Aggression - Overview|aggression]] is a subject that requires proper investigation. There is also little scientific data to provide a reliable means of prognostication. However, the following factors should be taken into account:
 +
* Frequency of aggressive incidents, which have resulted in physical injury, in the past.
 +
* Level of physical damage caused in previous incidents.
 +
* Predictability of aggressive incidents (what events and stimuli elicit aggression, and whether the cat provides adequate warning of its actions).
 +
* Manageability of the behaviour: what measures can be taken to minimise risk of injury.
  
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In many cases cats show inhibited behaviour and subtle initial signs of fear or anxiety. Clients must be able to identify these in order to fully understand the cat’s behaviour.
+
If bites/scratches have been frequent and unpredictable and with little warning, and it is difficult to institute measures that alleviate risk of injury, then risk is high.
 +
Unless the damage caused by previous bites has been minimal, and the underlying cause for the aggression can be treated effectively then the prognosis is poor.
  
 +
Making an assessment of the owner's willingness and ability to comply with treatment and management instructions is critical; poor compliance can lead to serious injury.
 +
After a problem has been successfully treated, there may still be an ongoing risk of incidents, and risk management may need to be continued for the remainder of the cat's life.
 +
 +
In many cases cats show inhibited behaviour and subtle initial signs of [[Feline Fear and Stress|fear or anxiety]]. Clients must be able to identify these in order to fully understand the cat’s behaviour.
  
 
==Predictability==
 
==Predictability==
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As with dogs, the apparent predictability of attacks is of crucial importance in managing and treating aggressive cats. Very rarely is aggression truly unpredictable, unless the stimulus that triggers it is an internal one that is not obvious to the observer e.g. certain kinds of pain or medical disorders. Once the pattern of the cat’s behaviour has been established, then management is much easier and it is also possible to identify any departures from this pattern, which might indicate that the problem is expanding or getting more dangerous.
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The apparent predictability of attacks is crucial to the safe management and treatment of aggressive cats. '''It is very rare for aggression to be truly unpredictable''', unless the animal has an impulse control disorder or the stimuli that elicit or contribute to aggression originate internally (e.g. pain or dysphoria). However, the behavioural changes that warn of an aggressive attack are often missed or misinterpreted by owners, leading to an escalation of behaviour that surprises the owner.
  
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Signs to Predict Aggression
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====Discerning Patterns Associated with Aggression====
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Aggression is often labelled as ‘unpredictable’ when this is rarely the case. Usually there is a discernable pattern to the cat’s behaviour:
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To safely treat aggressive cats, the motivation for every aggressive incident must be thoroughly understood and a pattern of behaviour identified if possible. The owner should be asked to describe what happened at each event, and not to interpret what happened. The first priority is to use this information to prevent injury.<br><br>
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*Any warnings the cat has given [eye contact, posture, growling, hissing].
 
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*Any avoidant behaviour the cat has carried out, including freezing.
 
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*Timing [certain times of day].
 
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*Relationship to events or activities [territorial trigger, arrival of a visitor, play, grooming, feeding, owner departure from the house, etc].
 
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*Presence of certain stimuli [a noise, another cat, unfamiliar people, etc].
 
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*Relationship  to the actions of a person [raised hand, shouting/shrieking, sudden movements, cornering the cat, picking the cat up].
 
  
−
To safely treat aggressive cats, the motivation for every aggressive incident must be thoroughly understood and a pattern of behaviour identified if possible. The owner should be asked to describe what happened at each event, and not to interpret what happened. The first priority is to use this information to prevent injury. If attacks were truly unpredictable then this would constitute a serious and unavoidable risk that would not be acceptable.
+
Signs that a cat is becoming likely to react aggressively include:
 +
* Avoidant behaviour: Running away or hiding, struggling whilst being held and freezing.
 +
* Signs of increased arousal: Pupillary dilation, increased respiratory rate (including panting), trembling, agitation.
 +
* Defensive signals: Flattened or rotated ears, low body posture, body rigidity, growling, hissing, spitting, tail thrashing, rolling onto back.<br>
 +
Owners should be taught to identify the above signs and react appropriately (stop handling the cat, move away and avoid eye contact).<br><br>
 +
 
 +
It is then important to identify contexts, stimuli, and events that are associated with aggression:
 +
* Contexts: Particular places where aggressive incidents have occurred.
 +
* Stimuli: Noises, movements, unfamiliar people, other cats.
 +
* [[Feline Aggression Towards People|Human actions/interactions]]: Handling, grooming, picking up or cornering the cat. Shouting/shrieking at the cat, pushing the cat away, sudden movements, threats (raised hand).
 +
* Interactions with other [[Feline Aggression Towards Cats|cats]]: Play, grooming, competition around resources (food, water, latrines, cat doors).
 +
* Relationship to events or activities: Arrival of a visitor, entry of another cat, play, grooming, feeding, owner departure from the house.
 +
* Timing: The times of day when aggressive incidents, or near misses, have tended to occur.<br><br>
 +
 
 +
One problem with aggressive dogs and cats is that the actual number of aggressive incidents may not be large enough to properly identify a pattern. However, "near misses" are as important as actual aggressive attacks; once owners understand the signs that are typical of the build up to an aggressive attack they can usually provide a much more extensive list of incidents that came close to an attack. This is a better guide to the underlying cause of the problem and the triggers for aggression.<br><br>
 +
If the pattern of aggressive incidents is inconsistent, with the same events leading to completely different patterns of response from the cat, then it is likely that there is either an underlying medical cause, or unidentified stressors are altering the cat's state of emotion and arousal so that it responds variably.
  
 
==Prognosis==
 
==Prognosis==
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Prognosis depends upon the owner’s commitment to carry out what may be a lengthy course of behavioural therapy, along with making potentially permanent changes in the cat’s husbandry and environment.
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Prognosis depends upon:
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In cases where cats are being asked to live in large feline groups with several unrelated individuals it is important to consider the welfare implications for the cats concerned and in cases of inter-cat aggression within the household, re-homing should be considered as a viable treatment option rather then a sign of therapeutic failure. Despotic cats that terrorise the neighbourhood carry a poor prognosis unless there is considerable co-operation between owners with regards to confinement, either permanent or on a rota basis.  
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The '''owner’s commitment''' to carry out what may be a lengthy course of behavioural therapy, alongside making potentially permanent changes to the cat’s husbandry and [[Effect of Environment on Feline Behaviour|environment]].<br><br>
 +
 
 +
'''Owners often find it difficult to be objective regarding progress''' in cases of feline aggression and there can be a considerable difference between actual change and the owner’s perception of alterations in the cat’s behaviour. It is therefore essential to persuade owners to keep a daily diary and to record all aggressive incidents, together with notes about the context or trigger for the behaviour. Likewise a record should be kept of affiliative behaviour between cats, and between cats and people, because a shift in the balance between these types of behaviour is a strong indicator of change.
 +
 
 +
==References==
 +
<references/>
  
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The nature of the aggressive behaviour is important. Defensive behaviour has a better prognosis because it is possible to reduce the perception of threat and to provide the cat with alternative opportunities to deal with fear [such as through escape or avoidance behaviour].  Offensive aggression carries a more guarded prognosis unless full recovery from some medical underlying pathology can be achieved. Hyperthyroid cats, for example, carry a good prognosis for reform once the underlying pathology has been treated.
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<br><br>
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{{Jon Bowen written
 +
|date = July 4, 2014
 +
}}
  
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Other indicators of a good prognosis include selection of alternative coping strategies, such as retreating and hiding, in cats that are fearful or anxious and improvements in effective feline communication between warring cats in the same household. Decrease in both the intensity and the frequency of the aggressive incidents should be seen as favourable prognostic signs. Owners often find it difficult to be objective regarding progress in cases of feline aggression and there can be a considerable differential between actual change and the owner’s perception of alterations in the cat’s behaviour. It is therefore essential to persuade owners to keep a daily diary and to record all aggressive incidents, together with notes about the context or trigger for the behaviour. Likewise a record should be kept of affiliative behaviour because a shift in the balance between these types of behaviour is a strong indicator of change.
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{{Ceva}}
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{{OpenPages}}
  
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[[Category:To Do - Behaviour]][[Category:Feline Aggression]]
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[[Category:Feline Aggression]]

Latest revision as of 09:47, 16 July 2015

Key Points

  • Cat bites are not trivial; they often become infected and can cause severe disfigurement to the hands and face.
  • Aggression is usually predictable, based on the pattern of events and stimuli that precede it, unless the stimuli are internal and not obvious to the observer (such as pain).
  • To safely treat aggressive cats the motivation for the behaviour must be understood and the pattern of stimuli and events that elicit aggression must be identified.

Human Injury Caused by Cat Bites and Scratches

There is limited data available on the prevalence of cat bite/scratch injuries. One Italian study using emergency department treatment records found a rate of 17.9 cases of cat bites/scratches per 100,000 admissions, compared with 58.4 per 100,000 for dog bites[1]. Whereas dog bites cause crush, laceration and puncture wounds that become infected on 3-18% of occasions, cat bites usually cause a penetrating injury and 28-80% result in an infection that more often involves Pasteurella multocida and/or Staphylococcus aureus[2]. Human facial injuries due to cat bites are particularly serious, as surgical repair cannot be carried out until microbial infection is eliminated and damaged tissue debrided. Injuries to the hands and feet can result in serious complications, such as osteomyelitis. Another factor is the rising incidence of sharing of methicillin resistant Staphylococcus aureus between animals and their owners, with infection cycling between the animal and its various human acquaintances, which could become a significant problem in infected cat bites[3]

Cat scratch disease is a common and mostly benign condition caused by post-scratch infection with the gram negative bacteria Bartonella henselae or Bartonella quintana[4]. Symptoms are usually seen within 7-14 days of injury, but can take up to 2 months to appear. Symptoms include headache and joint and muscular pains, but severe cases can result in meningioencephalitis or endocarditis[4]. Cats are generally less likely to cause injury to people than dogs, as their primary response to threat is escape and avoidance. The greatest risk of injury is when handling cats, but some cats will actively seek out and attack people.

Risk Assessment

Risk assessment in aggression is a subject that requires proper investigation. There is also little scientific data to provide a reliable means of prognostication. However, the following factors should be taken into account:

  • Frequency of aggressive incidents, which have resulted in physical injury, in the past.
  • Level of physical damage caused in previous incidents.
  • Predictability of aggressive incidents (what events and stimuli elicit aggression, and whether the cat provides adequate warning of its actions).
  • Manageability of the behaviour: what measures can be taken to minimise risk of injury.

If bites/scratches have been frequent and unpredictable and with little warning, and it is difficult to institute measures that alleviate risk of injury, then risk is high. Unless the damage caused by previous bites has been minimal, and the underlying cause for the aggression can be treated effectively then the prognosis is poor.

Making an assessment of the owner's willingness and ability to comply with treatment and management instructions is critical; poor compliance can lead to serious injury. After a problem has been successfully treated, there may still be an ongoing risk of incidents, and risk management may need to be continued for the remainder of the cat's life.

In many cases cats show inhibited behaviour and subtle initial signs of fear or anxiety. Clients must be able to identify these in order to fully understand the cat’s behaviour.

Predictability

The apparent predictability of attacks is crucial to the safe management and treatment of aggressive cats. It is very rare for aggression to be truly unpredictable, unless the animal has an impulse control disorder or the stimuli that elicit or contribute to aggression originate internally (e.g. pain or dysphoria). However, the behavioural changes that warn of an aggressive attack are often missed or misinterpreted by owners, leading to an escalation of behaviour that surprises the owner.

Discerning Patterns Associated with Aggression

To safely treat aggressive cats, the motivation for every aggressive incident must be thoroughly understood and a pattern of behaviour identified if possible. The owner should be asked to describe what happened at each event, and not to interpret what happened. The first priority is to use this information to prevent injury.

Signs that a cat is becoming likely to react aggressively include:

  • Avoidant behaviour: Running away or hiding, struggling whilst being held and freezing.
  • Signs of increased arousal: Pupillary dilation, increased respiratory rate (including panting), trembling, agitation.
  • Defensive signals: Flattened or rotated ears, low body posture, body rigidity, growling, hissing, spitting, tail thrashing, rolling onto back.

Owners should be taught to identify the above signs and react appropriately (stop handling the cat, move away and avoid eye contact).

It is then important to identify contexts, stimuli, and events that are associated with aggression:

  • Contexts: Particular places where aggressive incidents have occurred.
  • Stimuli: Noises, movements, unfamiliar people, other cats.
  • Human actions/interactions: Handling, grooming, picking up or cornering the cat. Shouting/shrieking at the cat, pushing the cat away, sudden movements, threats (raised hand).
  • Interactions with other cats: Play, grooming, competition around resources (food, water, latrines, cat doors).
  • Relationship to events or activities: Arrival of a visitor, entry of another cat, play, grooming, feeding, owner departure from the house.
  • Timing: The times of day when aggressive incidents, or near misses, have tended to occur.

One problem with aggressive dogs and cats is that the actual number of aggressive incidents may not be large enough to properly identify a pattern. However, "near misses" are as important as actual aggressive attacks; once owners understand the signs that are typical of the build up to an aggressive attack they can usually provide a much more extensive list of incidents that came close to an attack. This is a better guide to the underlying cause of the problem and the triggers for aggression.

If the pattern of aggressive incidents is inconsistent, with the same events leading to completely different patterns of response from the cat, then it is likely that there is either an underlying medical cause, or unidentified stressors are altering the cat's state of emotion and arousal so that it responds variably.

Prognosis

Prognosis depends upon: The owner’s commitment to carry out what may be a lengthy course of behavioural therapy, alongside making potentially permanent changes to the cat’s husbandry and environment.

Owners often find it difficult to be objective regarding progress in cases of feline aggression and there can be a considerable difference between actual change and the owner’s perception of alterations in the cat’s behaviour. It is therefore essential to persuade owners to keep a daily diary and to record all aggressive incidents, together with notes about the context or trigger for the behaviour. Likewise a record should be kept of affiliative behaviour between cats, and between cats and people, because a shift in the balance between these types of behaviour is a strong indicator of change.

References

  1. ↑ Ostanello, F., Gherardi, A., Caprioli, A., La Placa, L., Passini, A., Prosperi, S. (2005) Incidence of injuries caused by dogs and cats treated in emergency departments in a major Italian city. Emerg Med J 2005;22:260–262.
  2. ↑ Davies, H.D. (2000) When your best friend bites: A note on dog and cat bites. Can J Infect Dis. 11(5). 227-229
  3. ↑ Oehler, R.L., Velez, A.P., Mizrachi, M., Lamarche, J., Gompf , S. (2009) Bite-related and septic syndromes caused by cats and dogs. Lancet Infect Dis. 9.439–47.
  4. ↑ 4.0 4.1 Klotz, S.A., Ianas, V., Elliott, S.P. (2011). "Cat-scratch Disease". Am Fam Physician. 83(2). 152–5.



This article has been written and expert reviewed by Jon Bowen BVetMed DipAS(CABC) MRCVS.

Date reviewed: July 4, 2014


The creation of this content was made possible by Ceva Santé Animale as part of the feline behaviour project. Ceva logo.jpg


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