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Role of Drugs in Behavioural Therapy (view source)
Revision as of 15:31, 2 September 2014
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Any underlying medical cause for problem behaviours should be ruled out before any pharmacological intervention<ref name="Overall">Overall, K.L., 2003. Medical differentials with potential behavioural manifestations. Veterinary Clinics of North America: Small Animal Practice 33, 213–229.</ref>.
Any underlying medical cause for problem behaviours should be ruled out before any pharmacological intervention<ref name="Overall">Overall, K.L., 2003. Medical differentials with potential behavioural manifestations. Veterinary Clinics of North America: Small Animal Practice 33, 213–229.</ref>.
==Use of Drugs in Animals==
==Use of Drugs in Animals==
It must be remembered that all of the current psychoactive medications licensed for use in humans have been discovered using testing in animal models of anxiety, fear, phobia, compulsion etc. Almost all have been tested in small animal species that are kept as pets, particularly rodents and dogs. This does not mean that clinically effective doses are known for these species, or even that equivalent behaviour disorders are naturally occurring in them. However, it has provided support for the use of psychoactive medications in veterinary patients which has ultimately led to licensing of some products for veterinary use.
It must be remembered that all of the current psychoactive medications licensed for use in humans have been discovered using testing in animal models of anxiety, fear, phobia, compulsion etc. Almost all have been tested in small animal species that are kept as pets, particularly rodents and dogs. This does not mean that clinically effective doses are known for these species, or even that equivalent behaviour disorders are naturally occurring in them. However, it has provided support for the use of psychoactive medications in veterinary patients which has ultimately led to licensing of some products for veterinary use.
Typical situations in which psychoactive medication can be a useful adjunct to behavioural modification techniques include:
*When fear or anxiety is great:
:*When fear or anxiety are very intense:
:*Making therapy difficult or dangerous, bearing in mind the risk of disinhibition.
:*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.
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==
Depression, anxiety, fear and phobia may be associated with genuine long-term neurotransmitter and synaptic changes in the CNS, but these changes are reversible through new learning in combination with medication.
An example of a typical approach to fear using behavioural modification would be:
*Identify all fear provoking stimuli
*Identify the threshold for the fear response (e.g. distance from target)
*Establish a gradient of stimuli (distance, appearance of person etc). This should be used to understand approach-avoidance behaviour.
*Control the pet’s environment to reduce stress (prevent exposure in uncontrolled situations)
*Desensitisation and counter-conditioning: desensitise using gradually increasing exposure to fear-eliciting stimulus at a level below which fear is evoked, use counter-conditioning to replace fear with another incompatible emotional response to the same stimulus.
In such a case, medication that reduces the intensity of fear, and increases exploratory behaviour would facilitate desensitisation and counter-conditioning.
A similar approach is used for anxious behaviour:
*Identify contexts and situations that elicit anxiety.
*Desensitise and counter-condition contexts and situations that elicit anxiety.
In such a case, an anxiolytic medication, such as an SSRI drug, can be used to facilitate desensitisation and counter-conditioning. This will reduce hyper vigilance and arousal so that the cat settles more quickly in the environment.
In the human behaviour field, psychoactive medication is extensively used in combination with cognitive and behavioural approaches to treat problems relating to fear, phobia and anxiety. In the veterinary behaviour field there are only a very few drugs which have been properly tested under controlled trials. For the majority of other medications there is minimal available data and information is extrapolated from use in the field of human psychiatry. When using drugs which are not licensed for veterinary use, it is important to consider that drug metabolism and effects vary between species. <ref name="Merck">Merck Veterinary Manual - [http://www.merckmanuals.com/vet/behavior.html Behaviour] (10th Edition) 2011 The Merck Publishing Group</ref>.
==References==
==References==