Changes

==Diagnosis==

==Diagnosis==

In true alopecia, hairs are easily epilated in the areas that are becoming bald, but the hairs remain normal to touch. When the hairs are being removed by deliberate grooming, barbering or hair-pulling then the hairs will feel spiky and sharp because the tips have been taken off. Microscopic examination of a hair pluck will confirm the state of the hair tips. Hair loss is restricted to parts of the body that may be reached whilst grooming with the tongue. These signs are an immediate indication that the cat is not suffering from a true alopecia. Then parasitism and allergic skin disease are major differentials for overgrooming. Localised or referred pain, or deep pruritic conditions such as Notoedric mange may be a cause of overgrooming that progresses into self-harm. Feline idiopathic cystitis [FIC] has recently been found to account for the vast majority of feline lower urinary tract disease. Cats with this condition, which has behavioural and medical components, will often barber and overgroom the perineal area to create a bald groin and abdomen. They may also bite and chew the skin in this area. Cats with overgrooming and hair loss that is chiefly restricted to this area should be investigated as potential cases of FIC. Feline hyperaesthesia can cause frantic bouts of self-biting and hair pulling, but this is accompanied by other signs that differentiate the condition from compulsive overgrooming or self-mutilation.

In true alopecia, hairs are easily epilated in the areas that are becoming bald, but the hairs remain normal to touch. When the hairs are being removed by deliberate grooming, barbering or hair-pulling then the hairs will feel '''spiky''' and '''sharp''' because the tips have been taken off. Microscopic examination of a hair pluck will confirm the state of the hair tips. '''Hair loss is restricted to parts of the body that may be reached whilst grooming with the tongue'''. These signs are an immediate indication that the cat is not suffering from a true alopecia. Parasitism and allergic skin disease are major differentials for overgrooming. Localised or referred pain, or deep pruritic conditions such as Notoedric mange may be a cause of overgrooming that progresses into self-harm.  

 

Feline idiopathic cystitis [FIC] has recently been found to account for the vast majority of feline lower urinary tract disease. Cats with this condition, which has behavioural and medical components, will often barber and overgroom the perineal area to create a bald groin and abdomen. They may also bite and chew the skin in this area. Cats with overgrooming and hair loss that is chiefly restricted to this area should be investigated as potential cases of FIC. [[Feline Hyperaesthesia|Feline hyperaesthesia]] can cause frantic bouts of self-biting and hair pulling, but this is accompanied by other signs that differentiate the condition from compulsive overgrooming or self-mutilation.

Target areas for overgrooming include the flanks and abdomen, but it must be remembered that barbering of groin fur can be a sign of lower urinary tract disease.

Target areas for overgrooming include the flanks and abdomen, but it must be remembered that barbering of groin fur can be a sign of lower urinary tract disease.

====Clinical Signs====

====Clinical Signs====

The clinical signs are characterised by exaggerated licking and chewing movements, with pawing at the mouth. Typically the discomfort is unilateral or worse on one side and can be episodic or continuous. In the episodic version the distress usually occurs after eating and lasts between 5 minutes and 2 hours. There is a short prodromal period of anxiety preceding the episode. The cat will claw at its face, attempting to claw at, catch and pull at its own tongue. The aetiology of this condition is being investigated but several separate causes have been identified. Some cases appear to be associated with oral disease, which can be divided into 4 groups  

The clinical signs are characterised by '''exaggerated licking and chewing movements, with pawing at the mouth'''. Typically the discomfort is '''unilateral''' or worse on one side and can be episodic or continuous. In the episodic version the distress usually occurs after eating and lasts between 5 minutes and 2 hours. There is a short prodromal period of anxiety preceding the episode. The cat will claw at its face, attempting to claw at, catch and pull at its own tongue. The aetiology of this condition is being investigated but several separate causes have been identified. Some cases appear to be associated with oral disease, which can be divided into 4 groups  

#Mouth ulceration, especially as a consequence of Calici virus infection or primary vaccination  

#Mouth ulceration, especially as a consequence of Calici virus infection or primary vaccination  

#Recent routine dental treatment including extraction.  

#Recent routine dental treatment including extraction.  

Treatment of, or natural resolution of the lesions can result in improvement, however many cases have recurrences which proved more difficult to successfully treat.  

Treatment of, or natural resolution of the lesions can result in improvement, however many cases have recurrences which prove more difficult to successfully treat.  

Removal of retained dental roots left after feline erosive neck lesions have caused teeth to break off, or when teeth have been inexpertly extracted, has benefited some cats. Cats with this pattern of self-mutilation can cause themselves great harm and demand the most thorough medical investigation.

Removal of retained dental roots left after feline erosive neck lesions have caused teeth to break off, or when teeth have been inexpertly extracted, has benefited some cats. Cats with this pattern of self-mutilation can cause themselves great harm and demand the most thorough medical investigation.

====Psychogenic Causes====

====Psychogenic Causes====

Psychogenic causes for hair loss and self-injury should only be considered once all medical causes have been eliminated. However, stress is known to alter immune function, either exacerbating auto-immune disease or allergy, or causing immune suppression. The precise effect appears to depend upon the type of stress the individual experiences. Living in a stressful social or physical environment will therefore contribute to the worsening of many of the medical conditions that are differentials for compulsive overgrooming. Success in the treatment of these conditions may improve if the cat’s living conditions are improved.

'''Psychogenic causes for hair loss and self-injury should only be considered once all medical causes have been eliminated'''. However, stress is known to alter immune function, either exacerbating auto-immune disease or allergy, or causing immune suppression. The precise effect appears to depend upon the type of stress the individual experiences. Living in a stressful social or physical environment will therefore contribute to the worsening of many of the medical conditions that are differentials for compulsive overgrooming. Success in the treatment of these conditions may improve if the cat’s living conditions are improved.

==Treatment==

==Treatment==

====Drug Therapy====

====Drug Therapy====

Medical therapy with psychoactive medication is indicated in cases of compulsive self-mutilation or severe self-grooming. The SRI drug Clomipramine may be given once daily. Initially the lower dose rate may be used, with an increase if there is limited improvement after 4-6 weeks. As with other compulsive problems, it is useful for clients to make an assessment of the number and severity of self-grooming bouts seen during the 7-14 day period before treatment, as a baseline. Drug therapy should be gradually phased out over approximately 4-8 weeks, once the cat’s full coat has been restored and a period of 6-8 weeks without further overgrooming has elapsed. Successful drug therapy should produce around 70% reduction in the behaviour and an increase in normal activity as a substitute.

Medical therapy with psychoactive medication is indicated in cases of compulsive self-mutilation or severe self-grooming. The Serotonin Reuptake Inhibitor (SRI) drug '''Clomipramine''' may be given once daily. Initially the lower dose rate may be used, with an increase if there is limited improvement after 4-6 weeks. As with other compulsive problems, it is useful for clients to make an assessment of the number and severity of self-grooming bouts seen during the 7-14 day period before treatment, as a baseline. Drug therapy should be gradually phased out over approximately 4-8 weeks, once the cat’s full coat has been restored and a period of 6-8 weeks without further overgrooming has elapsed. Successful drug therapy should produce around 70% reduction in the behaviour and an increase in normal activity as a substitute.

If specific events or stimuli are associated with signs of anxiety, fear or directly with bouts of excessive grooming, then these may be desensitised and counter-conditioned. Relapses are common, but may be managed effectively using the same methods as for initial treatment. Response to successive courses of the same SRI or SSRI drug may diminish, so that it is sometimes better to treat relapses with a different psychoactive drug from the same class. Any additional underlying factors that may have initiated another period of self-mutilation should then be identified and resolved.

If specific events or stimuli are associated with signs of anxiety, fear or directly with bouts of excessive grooming, then these may be desensitised and counter-conditioned. Relapses are common, but may be managed effectively using the same methods as for initial treatment. Response to successive courses of the same SRI or Selective Serotonin Reuptake Inhibitor (SSRI) drug may diminish, so that it is sometimes better to treat relapses with a different psychoactive drug from the same class. Any additional underlying factors that may have initiated another period of self-mutilation should then be identified and resolved.

In cases of feline oro-facial pain syndrome medical treatment is dependant on the underlying disease, if there is one. In a recent study some cases with gingivitis appeared to respond to antibiotics, although spontaneous remission could not be ruled out. NSAIDs provided effective analgesia for some mildly affected cases. Opioids proved to be very useful for hospitalised cases; but anti-epileptic drugs (diazepam or phenobarbitone) gave more sustained and consistent relief. Phenobarbitone is the preferred drug because of the greater risk of idiosyncratic hepatic failure with diazepam. Occasionally life-long therapy is required. Some cases, especially those with chronic dental disease, responded to steroid therapy. Finally, selegiline is effective for some cases and is probably more appropriate for those with a behavioural component or contributing stressful environment. For these cases alterations to the environment and application of behavioural modification is also essential.

In cases of feline oro-facial pain syndrome medical treatment is dependant on the underlying disease, if there is one. In a recent study some cases with gingivitis appeared to respond to antibiotics, although spontaneous remission could not be ruled out. NSAIDs provided effective analgesia for some mildly affected cases. Opioids proved to be very useful for hospitalised cases; but anti-epileptic drugs (diazepam or phenobarbitone) gave more sustained and consistent relief. Phenobarbitone is the preferred drug because of the greater risk of idiosyncratic hepatic failure with diazepam. Occasionally life-long therapy is required. Some cases, especially those with chronic dental disease, responded to steroid therapy. Finally, selegiline is effective in some cases and is probably more appropriate for those with a behavioural component or contributing stressful environment. For these cases alterations to the environment and application of behavioural modification is also essential.

====Summary of Treatment for Grooming Disorders====

====Summary of Treatment for Grooming Disorders====

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[[Category:To Do - Behaviour References]]

[[Category:To Do - Behaviour References]]

[[Category:To Do - Behaviour GGP]]

[[Category:To Do - Behaviour BS]]

[[Category:Feline Compulsive Disorders]]

[[Category:Feline Compulsive Disorders]]