Patient with Progressive Supranuclear Palsy Initially Diagnosed as Anxiety and Depression

Progressive Supranuclear Palsy (PSP) encompasses a broad spectrum of syndromes related to movement and behavioral disorders. The most common symptoms include motor disturbances such as frequent falls, rigidity, bradykinesia, and ocular movements. Behavioral changes may precede these symptoms, complicating the diagnosis and delaying treatment. This case aims to highlight symptoms that may raise suspicion for PSP diagnosis and facilitate timely treatment.

The patient is a 58-year-old woman with neuropsychiatric symptoms such as disinhibition and depressive symptoms, initially diagnosed as anxiety and depression, and later, in the presence of psychotic symptoms, as schizophrenia. Eight years after the onset of symptoms, she consulted a psychiatric hospital, where alterations in affect, psychomotor function, and neurological examination were found. A simple brain magnetic resonance imaging showed suggestive signs of PSP, and treatment was initiated with haloperidol and levodopa/carbidopa, resulting in partial improvement of symptoms.

Due to the multiple psychiatric symptoms presented by PSP, it is often misdiagnosed as a primary psychiatric disorder, leading to delayed management and exposing patients to possible adverse effects of unnecessary treatments.