Small Animal Sampler Separation Distress Syndrome From Blackwell’s Five-Minute Veterinary Consult – Canine and Feline, Sixth Edition. by Deborah F. Horwitz Chapter 236: Vomiting From The Feline Patient, Fifth Edition. Edited by Gary D. Norsworthy. Chapter 12: Pharmacologic and Clinical Principles of Adjunct Analgesia From Analgesia and Anesthesia for the Ill or Injured Dog and Cat, First Edition. by Karol A. Mathews, Melissa Sinclair, Andrea M. Steele, and Tamara Grubb. 1208 Blackwell’s Five-Minute Veterinary Consult Separation Distress Syndrome commonly reported. Destruction targets windows and doors and/or owner possessions. Other signs include behavioral depression, BASICS anorexia,r drooling, hiding, shaking, panting, DIAGNOSIS DEFINITION pacing, attempts to prevent owner departure, DIFFERENTIAL DIAGNOSIS A distress response of dogs (occasionally cats) and self-trauma from lick lesions. Diarrhea Vocalization: response to outdoor separated from the person or persons to and vomiting are occasionally noted. Signs influences,r territorial displays, play with other whom they are most attached, usually their of strong pet-owner attachment may ber pets in the home or fears. Destructive owner(s). The separation may be real (the present: excessive attention-seeking behaviors behaviors: occur both whenr the owner is owner is gone) or perceived (the pet is just and following behaviors but not necessary for present and absent (e.g., territorial destructive separated from the owner). In other cases the diagnosis. Frequently owners report displays at windows and doors; destruction pet may be distressed because some excessive, excited,r and prolonged greeting due to fear-producing stimuli such as noises fear-inducing event has occurred while home behavior upon return. Separation distress and thunderstorms). Housesoiling: alone such as thunderstorms or loud noises behavior(s) usually occursr regardless of the inadequate housetraining,r illness, endocrine resulting in distress responses during other length of owner absence, often within dysfunction, cognitive decline. Licking due departures. The resulting distress may be 30 minutes of owner departure. Specific to primary dermatologic conditions.r evident by episodes of destruction, triggers that are predictive of possibler Fear-based conditions that mimic separation vocalization, and elimination. Separation departure may initiate the anxiety response: anxietyr behaviors. Barrier frustration: dogs anxiety is a subset of separation-related getting keys, putting on outer garments, or unable to be confinedr in crates or behind problems that may have different underlying packing the car. May occur on every barriers but who are fine if not confined. motivations including fear, anxiety, departure and absencer or only with atypical Underlying medical conditions including overattachment to owner(s), and lack of departures or after-work, evening, or weekend endocrinopathies,r sensory decline, pain and appropriate stimulation or interactions. departures; the reverse pattern may also be cognitive dysfunction syndrome. seen. May also only occur when fear-inducing PATHOPHYSIOLOGY CBC/BIOCHEMISTRY/URINALYSIS stimuli are present such as noises or storms. Unknown In cats, elimination problems in the owner’s Abnormalities, if present, suggest alternate diagnosis or concurrent medical disease. SYSTEMS AFFECTED absencer may be linked to separation-related Behavioral—escape attempts, howling, anxiety. Some animals initially show signs in OTHER LABORATORY TESTS whining,r depression, hyperactivity. the presencer of acute fear or anxiety inducing Endocrine testing if indicated based on Cardiovascular—tachycardia. Endocrine/ events such as thunderstorms or fireworks history and results of CBC and biochemistry Metabolic—increasedr cortisol levels,r stress- when home alone but may recur with future panel induced hyperglycemia. Gastrointestinal— departures even in the absence of stimuli. IMAGING inappetence, gastrointestinalr upset. Distress may also be initiated by a change in MRI or CT if neurologic disorders are Musculoskeletal—self-induced trauma dailyr routine or in the household (e.g., suspected resultingr from escape attempts. Nervous— moving). DIAGNOSTIC PROCEDURES adrenergic/noradrenergic overstimulation.r Physical Examination Findings Behavioral history Video recordings of the Respiratory—tachypnea. Skin/Exocrine— Usually normal. Injuries incurred in petr when home aloner to verify diagnosis. acralr lick dermatitis. Oral—dentalr damage escaper attempts or destructiver activities. Questionnaires targeting cognitive decline during escape attempts. Skin lesions from excessive licking. Rare arer advisable for geriatric dogs. Skin biopsies GENETICS casesr of dehydration from drooling orr if a dermatologic condition is suspected.r diarrhea due to stress. None known CSF tap if neurologic disorders are INCIDENCE/PREVALENCE CAUSES suspected.r Endoscopy with biopsies if Speculated that 7–28% of companion dogs Specific causes are unknown. Speculated gastrointestinalr signs are persistent. experience some degree of separation distress causal factors include: syndrome. May be different entities with In owner departure and absence. Lack of younger dogs and senior dogs experiencing appropriater pet-owner interactions. r S different underlying pathology. Prolonged contact with humans without TREATMENT SIGNALMENT learningr to be alone. Improper or incomplete early separationr from the bitch ACTIVITY Species (French behavior school). Traumatic Regular, scheduled daily exercise and playtime Primarily dogs; possible in cats episodes during owner absence.r Change in are beneficial. Mean Age and Range household routine. Medical issuesr DIET Any age, most commonly in dogs contributing to anxietyr including endocrine No dietary changes are necessary unless > 6 months; may be another increase in dysfunction, pain, sensory decline or diarrhea is also present. prevalence in dogs > 8 years. cognitive decline. CLIENT EDUCATION SIGNS RISK FACTORS General Comments General Comments Suspected but not proven risk factors: Set realistic expectations of the time course of Destruction, vocalization, and elimination in adoptionr from humane shelters, extended time with preferred person such as during treatment and the need for behavior the absence of the owner alone are not modification to have successful resolution of diagnostic for separation anxiety or separation vacation or illness, boarding, lack of detachment when young. Geriatric animals the problem. Problem behavior may take distress. weeks or months to resolve depending on Historical Findings seem to be overrepresented.r Possible correlation between separationr anxiety and severity and duration of the problem. Destruction, vocalization (whining, other anxiety disorders including noise Treatment components include the following. howling,r barking), and indoor elimination are phobias. Canine and Feline, Sixth Edition 1209 (Continued) Separation Distress Syndrome Independence Training departure and absence without anxiety. Fluoxetine Teach the dog to be more independent of Departures must be just like real departures SSRI—approved for use in the treatment of ther owner(s). All attention is at owner (ownerr must do all components of departure, separationr anxiety in dogs. initiation—ownerr begins and ends attention including leaving in the car if that is how he Dosage: 1–2 mg/kg PO q24h. sessions. No attention on pet demand. or she usually departs). Owner will leave a r Administer in conjunction with a behavior Have ther pet earn attention and food, treat safety cue (radio or television on, ring a bell) modificationr plan. orr toy rewards, by performing a task such as on planned departures only (must not be used Side effects: lethargy, decreased appetite, “sit.” Decrease following behavior while the on departures where length of absence is not weightr loss, and vomiting. ownerr is home. Owner must not ignore the controlled, such as work departures). Initial Drugs For Acute Anxiety At Departure dog, but give attention in a predictable and departures must be very short, 1–5 minutes.r While waiting for an SSRI or TCA to calm manner—requesting a sit or other calm Length of absence is slowly increased at provider anxiety relief, the use of short-term behavior before petting, throwing a ball etc. If 3–5r minute intervals if no signs of distress anxiolytics and pheromones is advisable in the dog is jumping, whining, pawing at the were evident at the shorter interval (excited many cases. owner they should not receive attention for greetings, barking etc.). Increase in interval Benzodiazepines: alprazolam for panic at that excited behavior but the owner should must be variable; intersperser short ownerr departure (dog, 0.01–0.1 mg/kg) wait until the dog is calm before interaction. (1–3 minute) with longer (5–20 minute) 30 minutes prior to departure. Some dogs Teach the dog to calmly stay in another departures. If destruction, elimination, or experience paradoxical excitement with locationr away from the owner and create a vocalizationr occur, departure was too long. benzodiazepines, changing dosages or safe haven for the dog to settle and relax on Use video recordings to assess pet anxiety. If switching to another one may help. command. The dog must be able to be calm departures and absences are continued evenr Polyphagia is also common with and relaxed when the owner is home for though distress behaviors are present, the dog benzodiazepine administration. gradually longer times and gradually