See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/283450347

Separation Anxiety Disorder (SAD): A Case Report of Treatment with

Phytotherapy

Conference Paper · May 2015

CITATIONS READS

0 3,491

3 authors:

Fernanda Stumpf Tonin Fabio Brasil

Universidade Federal do Paraná Universidade Federal do Paraná
123 PUBLICATIONS   756 CITATIONS    10 PUBLICATIONS   15 CITATIONS   

SEE PROFILE SEE PROFILE

Roberto Pontarolo
Universidade Federal do Paraná
325 PUBLICATIONS   2,737 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Efficacy and Safety of Interferon-Free Therapies For Chronic Hepatitis C Patients Coinfected With Hiv: Syatematic Review of Clinical Trials View project

“Translation and cross-cultural adaptation into Brazilian Portuguese and validation of the oral anticoagulation knowledge assessment questionnaire (Oral
Anticoagulation Knowledge Tool - AKT)” View project

All content following this page was uploaded by Fabio Brasil on 19 August 2016.

The user has requested enhancement of the downloaded file.

Separation Anxiety Disorder - SAD: A Case Report of Treatment with Phytotherapy

Fernanda Stumpf Tonin1; Fábio Brasil1; Roberto Pontarolo1

1
Pharmaceutical Sciences Postgraduate Program, Federal University of Parana, Curitiba,
Brazil

http://braincongress2015.hospedagemdesites.ws/programacao/tl.php?id_atividade=13373

Objective

To describe a case of an infant with Separation Anxiety Disorder (SAD) presenting to an herbal
medicine for treatment

Clinical features

We report a 4-year–old boy who presented with headache, abdominal pain, vomiting,
tachycardia, dyspnea especially when separated from his parents. The child was unable to attend
school camps or sleep at his own bed because of anxiety and fear. The clinical picture was
complicated after the use of classical treatment with benzodiazepine: the patient began to show
self-harm behavior and aggressiveness.

Intervention/outcome

The use of Valerian extracts and behavioral psychotherapy were the selected approaches instead
benzodiazepine. After one week the patient already presented general improvement of general
symptoms and three months later Valerian was gradually suspended and the child was dismissed
from psychotherapist.

Conclusion

In this single case report the use of Valerian was effective and safe in the treatment of SAD`s
symptoms and may be considered as an adjunct therapy to psychiatric disordes.

Key indexing terms: Separation anxiety disorder, Cognitive behavior therapy, Case reports,
Phytotherapy
Introduction

The Separation Anxiety Disorder (SAD) is a psychological condition, exclusively diagnosed in

childhood and adolescence, most commonly at ages between 7 and 8 years old. It is considered
an early onset when it occurs before 6 years of age. In this disorder an individual experiences
excessive anxiety regarding the separation from home or from people whom the individual has
strong emotional attachment (e.g. parents, substitutes) for a minimum period of four weeks.
According to the American Psychology Association, SAD is the inappropriate and excessive
display of fear and distress when faced with situations of separation from a specific figure. In
this scenario, serotonin reuptake inhibitors and benzodiazepines are the most recommended and
prescribed drugs for the pharmacological treatment of SAD.1,2

Case report

The following is a case report in which the classical treatment was inappropriate:

A 4-years-old, male, 20kg, only child, born normal birth and without complications during
routine checkups, presented some problems after the first day of school in kindergarten. He
began to show episodes of headache, abdominal pain, vomiting, tachycardia, dyspnea, occurring
once or twice a day and ceased in less than 10 minutes. Since then, he could no longer be alone
in his room and slept only in his parent`s bed. He also followed his mother all day long and
refused to go to school.

After two weeks of those symptoms, he was taken for medical consultation with his pediatrician
who accompanied the patient since his birth. Complete blood count, THS, free T4, urea,
creatinine, transaminases, electrolytes, parasitological stool, partial urine, electrocardiogram and
radiographs of the chest and abdomen were requested. The results of all of these tests were
normal. Therefore, it was instituted clonazepam oral solution (drops) at a dose of 0.3 mg every
12 hours for the treatment of the main symptoms.

However, after five days, the patient experienced worsening of the clinical symptoms. The child
began to show tremors, started to scratching and biting herself and weep bitterly. Thereby, he
was transferred to psychiatric services.

In psychiatric consultation, the infant was lucid, cooperative, with good hygiene, self oriented,
with hypervigilance, adequate intelligence and thought acceleration. However, he presented
phobia when separate from his mother, which became clear when I asked the mother to leave
the office and the patient immediately showed tachycardia, dyspnea and vomiting.

The main approach was to suspend the benzodiazepine, start behavioral psychotherapy and
phytotherapy with oral aqueous extract of Valeriana officinalis (Valerian) at the dose of 100mg
in the morning, afternoon and evening. It was suggested that the drops of the herbal medicine
were diluted in juice due to the bitter taste of the extract.

After one week, on the return visit to the psychiatry, the mother reported that there was general
improvement of symptoms, but the child began to show disturbed sleep and nocturnal enuresis.
The conduct was to suspend the nighttime dose of Valerian. After that, the child presented
significantly melioration of all psychic and autonomic symptoms, remaining only discrete basal
anxiety. In a week the child was already sleeping normally in his room and had returned to
 school and normal activity. Within a month he began to follow behavioral psychotherapy and
three months later he was dismissed from psychotherapist. Two weeks before that, the treatment
with Valerian had gradually been suspended.

Discussion

Although the diagnosis of SAD requires minimal four weeks symptomatology2 the severity of
psychiatric symptoms and everyday injury functions of the patient required immediate
treatment.

As consequence of the increased risk of severe adverse effects and only modest benefits over
placebo, Jureidini et al.3 after meta-analysis, recommend prescribing antidepressants for
children and adolescents only in extreme and necessary cases. Thus, the pediatrician took a
appropriate approach when prescribing the benzodiazepine clonazepam.

However, children have an increased risk for paradoxical rage reactions to benzodiazepines,
which can be explained by a serotonin disinhibition mechanism4. Self-harm associated with
benzodiazepines and experienced by the patient is also reported in literature5.

In this case, the therapeutic use of herbal plants such as Valerian is presented as an effective and
safer alternative to antidepressants and benzodiazepines. Furthermore, phytotherapy has very
low potential to cause addiction or adverse effects in children6 . However, its short half-life and
diuretic effect should be taken into consideration7, which explains in this report the fact that the
removal of the evening dose of the extract has improved side effect enuresis.

Conflict of interest

The authors declare that they have no conflitc of interest

References

1. Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock's Comprehensive Textbook of Psychiatry.
9th ed. Hardcover, 2009.

2. American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental

Disorders. 5th ed. Hardcover, 2013.

3. Jureidini JN, Doecke CJ, Mansfield PR, Haby MM, Menkes DB, Tonkin AL. Efficacy and
safety of antidepressants for children and adolescents. BMJ. 2004;328:879-83.

4. Mancuso CE, Tanzi MG, Gabay M. Paradoxical reactions to benzodiazepines: literature

review and treatment options. Pharmacotherapy. 2004;24:1177-85.

5. Berman ME, Jones GD, McCloskey MS. The effects of diazepam on human self-aggressive
behavior. Psychopharmacology. 2005;178:100–6.

6. Müller SF, Klement S. A combination of valerian and lemon balm is effective in the
treatment of restlessness and dyssomnia in children. Phitomedicine. 2006;13:383-7.

7. Sharma M, Jain UK, Patel A, Gupta N. A comprehensive pharmacognostic report on valerian.

IJPSR. 2010;1:6-40.

View publication stats