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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 and Behavioral Neurology: December 2008 - Volume 21 - Issue 4 - p 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.