title: Anxious depression and the stiff-person plus syndrome.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Department of Integral Psychiatry, Psychiatric Hospital Vrapce, Zagreb, Croatia. damir_sumic@yahoo.com
authors.forename: Jadranka
authors.initials: J
authors.lastname: Culav-Sumić
authors.forename: Ivan
authors.initials: I
authors.lastname: Bosnjak
authors.forename: Zvonimir
authors.initials: Z
authors.lastname: Pastar
authors.forename: Vlado
authors.initials: V
authors.lastname: Jukić
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D018692:Antimanic Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001007:Anxiety / Q000523:psychology*; D001323:Autoantibodies / Q000032:analysis; D001921:Brain / Q000000981:diagnostic imaging; D002524:Cerebellar Ataxia / Q000209:etiology; D003863:Depression / Q000523:psychology*; D005260:Female; D005968:Glutamate Decarboxylase / Q000276:immunology; D006801:Humans; D018020:Lithium Compounds / Q000627:therapeutic use; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D016750:Stiff-Person Syndrome / Q000523:psychology*; D013315:Stress, Psychological / Q000209:etiology / Q000523:psychology; D014057:Tomography, X-Ray Computed; D005680:gamma-Aminobutyric Acid / Q000502:physiology
chemical_list: D000893:Anti-Inflammatory Agents; D000928:Antidepressive Agents; D018692:Antimanic Agents; D014150:Antipsychotic Agents; D001323:Autoantibodies; D018020:Lithium Compounds; D005680:gamma-Aminobutyric Acid; D005968:Glutamate Decarboxylase; D008775:Methylprednisolone