Institutional members access full text with Ovid®

Share this article on:

Anxious Depression and the Stiff-person Plus Syndrome

Čulav-Sumić, Jadranka MD, MSc; Bošnjak, Ivan MD, MSc; Paštar, Zvonimir MD; Jukić, Vlado MD, PhD

Cognitive & Behavioral Neurology: December 2008 - Volume 21 - Issue 4 - pp 242-245
doi: 10.1097/WNN.0b013e318185e6d2
Case Reports

Objective: To present the case of a patient with anxiety and depressive symptoms who developed the clinical picture of stiff-person plus syndrome (SPS-plus).

Background: 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.

Method: 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.

Results: 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.

Conclusions: 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:

Received for publication August 16, 2007; accepted July 2, 2008

© 2008 Lippincott Williams & Wilkins, Inc.