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. 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.  

In true [[Alopecia and Hypotrichosis|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 [[Feline Scabies|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 Syndrome|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.

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 Syndrome|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 [[:Category:Urological Diseases - Cat|lower urinary tract disease]].

Feline orofacial pain syndrome is a condition involving gross self-mutilation which is especially prevalent in Burmese cats although occasional cases have been seen in the domestic shorthair, Burmilla and Siamese. There may be a slight male predisposition and all ages can be affected.  

Feline orofacial pain syndrome is a condition involving gross self-mutilation which is especially prevalent in Burmese cats although occasional cases have been seen in the domestic shorthair, Burmilla and Siamese. There may be a slight male predisposition and all ages can be affected.  

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 [[Feline Calicivirus|Calici virus]] infection or primary vaccination  

#Cutting permanent teeth  

#Cutting permanent teeth  

#Dental disease, most commonly periodontal disease and dental resorptive lesions.  

#Dental disease, most commonly [[Periodontal Disease|periodontal disease]] and [[Feline Odontoclastic Resorptive Lesions|dental resorptive lesions]].  

#Recent routine dental treatment including extraction.  

#Recent routine dental treatment including [[Exodontics|extraction]].  

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

==Treatment==

==Treatment==

Given that stress and anxiety are significant factors in overgrooming, it is vital to improve the cat’s living environment. Increasing the range of activities available to the cat will use up a greater proportion of its time and energy budget, leaving less time for introverted self-appeasement. A proper assessment of inter-cat relationships within the home should be made, so that underlying psychosocial stress may be alleviated. More information is available in the chapters on feline housesoiling and feline aggression.

Given that stress and anxiety are significant factors in overgrooming, it is vital to improve the cat’s living environment. Increasing the range of activities available to the cat will use up a greater proportion of its time and energy budget, leaving less time for introverted self-appeasement. A proper assessment of inter-cat relationships within the home should be made, so that underlying psychosocial stress may be alleviated. More information is available in the sections on [[Housesoiling - Cat|feline housesoiling]] and [[Feline Aggression|feline aggression]].

====Drug Therapy====

====Drug Therapy====

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.

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 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.

If specific events or stimuli are associated with signs of [[Feline Fear and Stress|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 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.

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 [[Corticosteroids|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 [[Effect of Environment on Feline Behaviour|environment]] and application of behavioural modification is also essential.

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

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

{{unfinished}}

{{unfinished}}

[[Category:To Do - Behaviour References]]

[[Category:To Do - Behaviour References]]

[[Category:To Do - Behaviour BS]]

[[Category:JBowen reviewing]]

[[Category:Feline Compulsive Disorders]]

[[Category:Feline Compulsive Disorders]]