To present the case of a patient with anxiety and depressive symptoms who developed the clinical picture of stiff-person plus syndrome (SPS-plus).
Before the onset of typical SPS symptoms, psychiatric symptoms (like depression and anxiety) may be prominent and as such misleading, resulting in the diagnosis of a psychiatric condition.
We describe the case of a woman who initially presented with anxious depression and remained resistant to treatment with different classes of antidepressants and additional therapy with lithium and atypical antipsychotics.
Evidence of neurologic dysfunction and significantly increased levels of serum autoantibodies for glutamic acid decarboxylase supported the diagnosis of SPS. The patient appeared to benefit from short-term immunosuppressive therapy with methylprednisolone.
The authors believe that anxious depression and SPS-plus seen in this patient are the result of the same underlying autoimmune process, together forming a unique syndrome. Anxious and depressive symptoms in SPS can be explained by alterations in GABAergic neurotransmission.
Department of Integral Psychiatry, Psychiatric Hospital Vrapče, Bolnička, Zagreb, Croatia
Reprints: Dr Jadranka Čulav-Sumić, MD, MSc, Department of Integral Psychiatry, Psychiatric Hospital Vrapče, Bolnička 32, Zagreb 10090, Croatia (e-mail: firstname.lastname@example.org).
Received for publication August 16, 2007; accepted July 2, 2008