{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T16:28:44Z","timestamp":1775147324627,"version":"3.50.1"},"reference-count":13,"publisher":"American Association of Psychiatric Pharmacists (AAPP)","issue":"3","license":[{"start":{"date-parts":[[2020,5,27]],"date-time":"2020-05-27T00:00:00Z","timestamp":1590537600000},"content-version":"vor","delay-in-days":26,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,5,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Stiff-person syndrome (SPS) is a neurologic disorder characterized by muscle stiffness, rigidity, and muscle spasms, and it can increase a patient's risk for falls. It is recognized as a rare disease with limited clinical guidelines to manage the condition and its symptoms. Currently, there is even less clinical guidance for the management of common comorbid conditions in these patients. This patient case report aims to evaluate the efficacy of various medications for symptom management in a patient with SPS and comorbid psychiatric disorders, specifically bipolar I and panic disorder. Throughout the patient's course of treatment, various medications were trialed, including fluoxetine, hydroxyzine, valproic acid, propranolol, and clonazepam. Ultimately, fluoxetine, hydroxyzine, and propranolol were discontinued due to adverse drug reactions and incomplete symptom resolution. The patient's bipolar I disorder was adequately managed with valproic acid. Once the clonazepam was changed from as-needed to scheduled dosing, the patient's panic disorder and anxiety-triggered spasms were well controlled. The efficacy of benzodiazepines, specifically high doses of diazepam, in alleviating muscle spasms and anxiety in SPS has been demonstrated in the literature. Case reports including patients with SPS that are prescribed selective serotonin reuptake inhibitors provide controversial evidence as some studies report exacerbation of SPS symptoms with prolonged use. As this case report and literature review suggest, patients with SPS and comorbid panic disorder and anxiety-triggered spasms may benefit from the use of benzodiazepines. The use of other medication classes for the treatment of other comorbid psychiatric disorders in a patient with SPS is lacking evidence.<\/jats:p>","DOI":"10.9740\/mhc.2020.05.095","type":"journal-article","created":{"date-parts":[[2020,5,7]],"date-time":"2020-05-07T20:12:53Z","timestamp":1588882373000},"page":"95-99","source":"Crossref","is-referenced-by-count":11,"title":["Stiff-person syndrome in a patient with comorbid bipolar and panic disorders: A case report and literature review"],"prefix":"10.9740","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4660-9810","authenticated-orcid":false,"given":"Karishma","family":"Patel","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3703-7937","authenticated-orcid":false,"given":"Lauren","family":"Stummer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5093-7772","authenticated-orcid":false,"given":"Krina","family":"Patel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"4719","reference":[{"issue":"15","key":"2020060309453602600_i2168-9709-10-3-95-b01","first-page":"421","article-title":"Progressive fluctuating muscular rigidity and spasm (\u201cstiff-man\u201d syndrome); report of a case and some observations in 13 other cases","volume":"31","author":"Moersch","year":"1956","journal-title":"Proc Staff Meet Mayo Clin"},{"issue":"8","key":"2020060309453602600_i2168-9709-10-3-95-b02","doi-asserted-by":"publisher","first-page":"840","DOI":"10.1136\/jnnp-2014-309201","article-title":"Stiff-person syndrome: insights into a complex autoimmune disorder","volume":"86","author":"Baizabal-Carvallo","year":"2015","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"2","key":"2020060309453602600_i2168-9709-10-3-95-b03","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1007\/s11940-009-0013-9","article-title":"Stiff person syndrome: advances in pathogenesis and therapeutic interventions","volume":"11","author":"Dalakas","year":"2009","journal-title":"Curr Treat Options Neurol"},{"issue":"10","key":"2020060309453602600_i2168-9709-10-3-95-b04","doi-asserted-by":"publisher","first-page":"444","DOI":"10.4088\/jcp.v58n1007","article-title":"Psychiatric consultations in stiff-man syndrome","volume":"58","author":"Tinsley","year":"1997","journal-title":"J Clin Psychiatry"},{"issue":"4","key":"2020060309453602600_i2168-9709-10-3-95-b05","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1136\/jnnp.74.4.462","article-title":"Specific phobia is a frequent non-motor feature in stiff man syndrome","volume":"74","author":"Henningsen","year":"2003","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"2020060309453602600_i2168-9709-10-3-95-b06","article-title":"Treatment of patients with panic disorder","author":"American Psychiatric Association [Internet]","year":"2019"},{"issue":"1","key":"2020060309453602600_i2168-9709-10-3-95-b07","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/bdi.12025","article-title":"Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013","volume":"15","author":"Yatham","year":"2013","journal-title":"Bipolar Disord"},{"issue":"4","key":"2020060309453602600_i2168-9709-10-3-95-b08","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1097\/WNN.0b013e318185e6d2","article-title":"Anxious depression and the stiff-person plus syndrome","volume":"21","author":"Culav-Sumi\u0107","year":"2008","journal-title":"Cogn Behav Neurol"},{"issue":"3","key":"2020060309453602600_i2168-9709-10-3-95-b09","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1016\/j.cpr.2006.10.002","article-title":"Treatment of specific phobia in adults","volume":"27","author":"Choy","year":"2007","journal-title":"Clin Psychology Rev"},{"issue":"9","key":"2020060309453602600_i2168-9709-10-3-95-b10","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1177\/0706743716659417","article-title":"Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 3","volume":"61","author":"Kennedy","year":"2016","journal-title":"Pharmacological Treatments. 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