Stiff-person syndrome presenting as eating disorder: a case report.

OBJECTIVE: To report a case of a 35-year-old female initially treated for anorexia nervosa who was found to have Stiff-Person Syndrome (SPS). METHOD: Case report. RESULTS: The patient reported panic attacks at meal times that were found to consist of tetanic contractions of the axial musculature. Swallowing initiated reflexive painful muscle spasms that consequently resulted in cibophobia and significant weight loss. Her serum tested positive for anti-glutamic acid decarboxylase antibodies, and she subsequently improved with appropriate treatment for SPS. DISCUSSION: SPS has not been previously reported in the context of eating disorders, although it has been linked to other psychiatric disorders. Often the psychiatrist may be the first physician to diagnose SPS. We present this case to alert practitioners to the potential co-morbidity and symptom overlap between SPS and eating disorders, to aid in early recognition and appropriate treatment of this rare illness.

Treating depression and achieving remission.

Despite all the advances in understanding the biological underpinnings of depression and the extensive armamentarium of antidepressants remission is a difficult goal to achieve. This in turn impacts the social and occupational functioning and the quality of life. There are several hurdles to achieving remission including accuracy of diagnosis, partial response, suboptimization of the medication, and failure to capture residual symptoms. There is an urgent need to implement strategies to achieve remission including destigmatizing mental illness, educating patients, their families, optimizing treatments, exploring novel interventions and addressing residual symptoms.