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1

Uemura, Takeshi, Yuichi Kasai, Kentaro Araki, and Atsumasa Uchida. "Pisa Syndrome." Journal of Spinal Disorders & Techniques 21, no. 6 (August 2008): 455–57. http://dx.doi.org/10.1097/bsd.0b013e3181570889.

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2

Michel, Sáenz Farret, Arias Carrión Oscar, Thalia Estefania Sánchez Correa, Pellene Luis Alejandro, and Federico Micheli. "Pisa Syndrome." Clinical Neuropharmacology 38, no. 4 (2015): 135–40. http://dx.doi.org/10.1097/wnf.0000000000000092.

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3

Stubner, Susanne, Frank Padberg, Renate Grohmann, Harald Hampel, Matthias Hollweg, Hanns Hippius, Hans-Jurgen Moller, and Eckart Ruther. "Pisa Syndrome (Pleurothotonus)." Journal of Clinical Psychiatry 61, no. 8 (August 15, 2000): 569–74. http://dx.doi.org/10.4088/jcp.v61n0805.

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4

Remington, Gary J. "The Pisa Syndrome." Journal of Clinical Psychopharmacology 8, no. 3 (June 1988): 228. http://dx.doi.org/10.1097/00004714-198806000-00025.

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5

Amore, Mario. "THE PISA SYNDROME." Clinical Neuropharmacology 15 (1992): 265B. http://dx.doi.org/10.1097/00002826-199202001-00511.

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6

Harada, Kenichi, Nobuyuki Sasaki, Hiroshi Ikeda, Norihito Nakano, Hiroki Ozawa, and Toshikazu Saito. "Risperidone-Induced Pisa Syndrome." Journal of Clinical Psychiatry 63, no. 2 (February 15, 2002): 166. http://dx.doi.org/10.4088/jcp.v63n0213b.

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7

Mascia, Marcello Mario, and Giovanni Defazio. "Cocaine-induced Pisa syndrome." Neurological Sciences 42, no. 9 (June 19, 2021): 3927–28. http://dx.doi.org/10.1007/s10072-021-05404-x.

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8

Teng, Po-Ren, and Te-Jen Lai. "Paliperidone-Related Pisa Syndrome." Journal of Clinical Psychopharmacology 33, no. 1 (February 2013): 129–31. http://dx.doi.org/10.1097/01.jcp.0000426181.89572.18.

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9

Smith, Connor, Naomi Gwynn, and Jean-Pierre Lindenmayer. "Pisa Syndrome and Aripiprazole." Journal of Clinical Psychopharmacology 40, no. 1 (2020): 99–101. http://dx.doi.org/10.1097/jcp.0000000000001162.

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10

Lee, Yen-Feng. "Antipsychotic-Induced Pisa Syndrome." Clinical Neuropharmacology 41, no. 2 (2018): 60–63. http://dx.doi.org/10.1097/wnf.0000000000000274.

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11

PILETTE, WILFRID L. "Pisa Syndrome, or Pleurothotonus." American Journal of Psychiatry 144, no. 7 (July 1987): 969—b—970. http://dx.doi.org/10.1176/ajp.144.7.969-b.

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12

Gutierrez, F., C. Losada, M. López, C. Rozados, J. M. Olivares, M. Calado, and C. Cinos. "Pysa syndrome: a case report." European Psychiatry 26, S2 (March 2011): 1243. http://dx.doi.org/10.1016/s0924-9338(11)72948-0.

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Анотація:
Pisa syndrome is known to be a condition in which there is sustained involuntary flexion of the body and head to one side and slight rotation of the trunk so the person appears to lean like the Leaning Tower of Pisa.The development of Pisa syndrome is most commonly associated with prolonged treatment with antipsychotics. Although less frequently, Pisa syndrome has been reported, in patients who are receiving other medications (such as cholinesterase inhibitors and antiemetics), in those not receiving medication (idiopathic Pisa syndrome) and also patients with neurodegenerative disorders like Alzheimer's disease and multiple system atrophy.We report a case of a 67 year- old male diagnosed with Schizophrenia for 20 years. He has been following a treatment with Clozapine 400 mg/day for 4 years. Amisulpiride was added to the established regimen of antipsychotic and increased during the last month reaching the doses of 600 mg/day. Three weeks later he was observed walking with a tilt toward the right. A first physical examination revealed sustained tonic flexion of the trunk to the right side. No deficits or mental status changes during neurological exploration were shown. We prescribed biperidene hydrochloride therapy. After 24 hour side effects disappeared.As far as we know, no many cases of amisulpride-induced Pisa syndrome in the literature have been reported. This abstract presents a case of amisulpride induced Pisa syndrome.
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13

Bicho, M., J. Coelho, C. Peixoto, and H. Fontes. "Pisa syndrome – a case report." European Psychiatry 64, S1 (April 2021): S800. http://dx.doi.org/10.1192/j.eurpsy.2021.2116.

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Анотація:
IntroductionPisa Syndrome or pleurothotonus is a form of dystonia and often can arise as a side effect of antipsychotic treatment conditioning high morbidity and limiting management options. Despite the fact that the precise mechanism remains unclear, a neurochemical imbalance in dopaminergic and cholinergic transmission but also in serotoninergic and noradrenergic transmission can be a possible pathophysiologic mechanism, which can lead to changes in the axial axis with abnormal posture and marked lateral trunk flexion and abnormal gait.ObjectivesRegarding a clinical case, the authors intend to review the relevant and current literature on the relationship between psychotropic drugs and Pisa Syndrome.MethodsDescription of a clinical case by consulting databases of current and scientifically relevant articles.ResultsThe clinical case reports a 48-year-old woman with a history of HIV and Substance Use Disorder, hospitalized for unspecific behavioral changes, characterized by mood changes, self-referential, persecutory and somatic delusional ideas, and delusions of the control of thought. She was medicated with antipsychotics and mood stabilizers, with subsequent development of an acute-onset dystonic condition, characterizing the Pisa Syndrome. In this context, the dose of antipsychotics was lowered and anticholinergics were introduced, with progressive improvement of the clinical picture.ConclusionsPisa Syndrome, previously seen as a rare adverse effect, can occur as a dystonic reaction related to the use of psychotropic drugs, so its use should be judicious. Further studies are needed to understand the extent of this association and its pathophysiological mechanisms in order to guide more rigorous therapeutic lines.DisclosureNo significant relationships.
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14

Suzuki, Toshihito, and Hisashi Matsuzaka. "Drug-Induced Pisa Syndrome (Pleurothotonus)." CNS Drugs 16, no. 3 (2002): 165–74. http://dx.doi.org/10.2165/00023210-200216030-00003.

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15

DUGGAL, HARPREET S., SWAPNA SIVAMONY, and CHANNAMALAPPA UMAPATHY. "Pisa Syndrome and Atypical Antipsychotics." American Journal of Psychiatry 161, no. 2 (February 2004): 373. http://dx.doi.org/10.1176/appi.ajp.161.2.373.

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16

Pan, Pei-Yin, Han-Wei Chou, Chih-Chieh Cheng, Yi-Chien Hsu, and Nian-Sheng Tzeng. "Pisa Syndrome Induced by Paliperidone." Journal of Neuropsychiatry and Clinical Neurosciences 26, no. 1 (January 2014): E07—E08. http://dx.doi.org/10.1176/appi.neuropsych.12110289.

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17

Bruneau, Marie-Andrée, and Emmanuel Stip. "Metronome or alternating Pisa syndrome." International Clinical Psychopharmacology 13, no. 5 (September 1998): 229–32. http://dx.doi.org/10.1097/00004850-199809000-00007.

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18

Li, Tien-Chun, Hsiu-Wen Chiu, and Hung-Hui Liu. "Pisa Syndrome During Amisulpride Treatment." Journal of Neuropsychiatry and Clinical Neurosciences 22, no. 3 (July 2010): 352.e27. http://dx.doi.org/10.1176/jnp.2010.22.3.352.e27.

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19

Pellene, Alejandro, Michel Saenz-Farret, and Federico Micheli. "Recurrent and Alternating Pisa Syndrome." Clinical Neuropharmacology 38, no. 6 (2015): 252–54. http://dx.doi.org/10.1097/wnf.0000000000000113.

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20

Sáenz-Farret, Michel, Alejandro Pellene, and Federico Micheli. "Recurrent and Alternating Pisa Syndrome." Clinical Neuropharmacology 39, no. 6 (2016): 337. http://dx.doi.org/10.1097/wnf.0000000000000183.

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21

Tinazzi, Michele, Alfonso Fasano, Christian Geroin, Francesca Morgante, Roberto Ceravolo, Simone Rossi, Astrid Thomas, et al. "Pisa syndrome in Parkinson disease." Neurology 85, no. 20 (October 21, 2015): 1769–79. http://dx.doi.org/10.1212/wnl.0000000000002122.

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22

Saxena, Shekhar. "Tardive Dystonia and Pisa Syndrome." British Journal of Psychiatry 149, no. 4 (October 1986): 524. http://dx.doi.org/10.1192/bjp.149.4.524b.

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23

van Harten, P. R. "Pisa syndrome–a confusing term." British Journal of Psychiatry 160, no. 3 (March 1992): 424–25. http://dx.doi.org/10.1192/bjp.160.3.424b.

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24

Bhattacharya, K. F., I. Giannakikou, N. Munroe, and K. Ray Chaudhuri. "Primary anticholinergic-responsive Pisa syndrome." Movement Disorders 15, no. 6 (November 2000): 1285–87. http://dx.doi.org/10.1002/1531-8257(200011)15:6<1285::aid-mds1044>3.0.co;2-u.

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25

Davidson, Michael, Peter Powchik, and Kenneth L. Davis. "Pisa syndrome in Alzheimer's disease." Biological Psychiatry 23, no. 2 (January 1988): 213. http://dx.doi.org/10.1016/0006-3223(88)90095-9.

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26

Fichtner, Christopher G. "Pleurothotonus and the Pisa syndrome." Biological Psychiatry 31, no. 5 (March 1992): 534. http://dx.doi.org/10.1016/0006-3223(92)90269-6.

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27

Yassa, Ramzy. "The Pisa Syndrome: A Report of Two Cases." British Journal of Psychiatry 146, no. 1 (January 1985): 93–95. http://dx.doi.org/10.1192/bjp.146.1.93.

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Анотація:
Ekbom et al (1972) described dystonic syndromes that appeared as a side-effect to treatment with the butyrophenone group of neuroleptic drugs. These symptoms consisted of tonic flexion of the trunk to one side, accompanied by its slight rotation, in the absence of other concomitant dystonic symptoms. They called this the ‘Pisa syndrome’. A literature survey of neuroleptic-included extrapyramidal side-effects gave little reference to this syndrome (Sovner & DiMascio, 1978; Berger & Rexworth, 1980), but two cases that fit the description of this side-effect are presented here.
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28

Erdem, Nazan Şimşek, and Sehur Sibel Özkaynak. "Chronic form of Pisa syndrome after prolonged exposure to low-dose amisulpride treatment." Ideggyógyászati szemle 74, no. 9-10 (2021): 356–60. http://dx.doi.org/10.18071/isz.74.0356.

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Pisa syndrome is a movement problem defined by tonic, sustained lateral flexion with a slight posterior rotation of the trunk. It seems to be a side effect of antipsychotic medicine in most cases. The clinical duration of Pisa syndrome can be acute, chronic, or recurrent. As far as we know, no reports are available in the literature on the chronic form of Pisa syndrome caused by low-dose amisulpride. A case of refractory tardive dystonia form of Pisa syndrome during treatment with stable low-dose amisulpride is presented in this report. Long-term, low-dosage amisulpride therapy may induce tardive dystonia even in patients with no other risk factors for dystonia.
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29

Mahmoud, Imene, Mouna Aissi, Narjes Mokni, Rim Masmoudi, Nizar Daoussi, and Mahbouba Frih-Ayed. "Syndrome de la tour de Pise (Pisa syndrome)." Revue Neurologique 173 (March 2017): S153. http://dx.doi.org/10.1016/j.neurol.2017.01.282.

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30

Santos, H., E. Dornelles, J. Pereira, and A. Vieira. "What is the Pisa Syndrome? A review." European Psychiatry 65, S1 (June 2022): S725. http://dx.doi.org/10.1192/j.eurpsy.2022.1872.

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Introduction Pisa syndrome (PS) is a type of dystonia of rare occurrence, first described in 1972 as an adverse effect of neuroleptic agents. It is used to describe a postural abnormality that includes trunk flexion in the coronal plane and axial rotation, which improves in the supine position. Objectives In this work, we aim to conduct a brief review of Pisa Syndrome aetiology, pathophysiology and treatment. Methods A non-systematic search was conducted through the PubMed database for “pisa syndrome”. Articles were screened for relevant information on PS aetiology, pathophysiology and treatment. Results Pisa syndrome has been associated as an adverse effect of multiple drugs from different classes, mainly antipsychotics, dopaminergic agents and cholinesterase inhibitors. The underlying mechanisms are not yet fully understood. Nevertheless, one of the most consensual hypothesis considers PS as a consequence of a cholinergic-dopaminergic imbalance that can be caused by antipsychotic treatment. Some factors have been associated with increased risk for developing PS such as old age and polypharmacy. PS appears to be better treated with the reduction or interruption of the agent(s) associated with its onset. Conclusions Despite its low incidence, Pisa syndrome can occur as a side effect of a number of different medications and the identification of the trigger-drug is fundamental so it can be reduced or interrupted in order to treat this condition. Disclosure No significant relationships.
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31

Praharaj, Samir Kumar, and Manu Arora. "Pisa Syndrome: Acute and Tardive Forms." Southern Medical Journal 100, no. 8 (August 2007): 853–54. http://dx.doi.org/10.1097/smj.0b013e3180f615a5.

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32

Villarejo, Alberto, Ana Camacho, Rocío García–Ramos, Teresa Moreno, Marta Penas, Raúl Juntas, and Juan Ruiz. "Cholinergic–Dopaminergic Imbalance in Pisa Syndrome." Clinical Neuropharmacology 26, no. 3 (May 2003): 119–21. http://dx.doi.org/10.1097/00002826-200305000-00004.

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33

Hung, Tai-Hsin, Yu Lee, Yung-Yee Chang, Mian-Yoon Chong, and Pao-Yen Lin. "Reversible Pisa Syndrome Induced by Clozapine." Clinical Neuropharmacology 30, no. 6 (November 2007): 370–72. http://dx.doi.org/10.1097/wnf.0b013e31805930e3.

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34

Walder, Alice, Waldemar Greil, and Pierre Baumann. "Drug-induced Pisa syndrome under quetiapine." Progress in Neuro-Psychopharmacology and Biological Psychiatry 33, no. 7 (October 2009): 1286–87. http://dx.doi.org/10.1016/j.pnpbp.2009.07.024.

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35

Scocco, Darío H., Judith N. Wagner, Juan Racosta, Anabel Chade, and Oscar S. Gershanik. "Subjective visual vertical in Pisa syndrome." Parkinsonism & Related Disorders 20, no. 8 (August 2014): 878–83. http://dx.doi.org/10.1016/j.parkreldis.2014.04.030.

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36

Amore, M., M. Cerisoli, S. Campanile, and A. Campanile. "Pisa syndrome. Report of a case." Italian Journal of Neurological Sciences 9, no. 3 (June 1988): 273–74. http://dx.doi.org/10.1007/bf02334052.

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37

Padberg, F., S. Stübner, K. Buch, U. Hegerl, and H. Hampel. "Pisa syndrome during treatment with sertindole." British Journal of Psychiatry 173, no. 4 (October 1998): 351–52. http://dx.doi.org/10.1192/bjp.173.4.351b.

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38

Suzuki, T., J. Koizumi, T. Moroji, K. Sakuma, M. Hori, and T. Hori. "Clinical characteristics of the Pisa syndrome." Acta Psychiatrica Scandinavica 82, no. 6 (December 1990): 454–57. http://dx.doi.org/10.1111/j.1600-0447.1990.tb03078.x.

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39

Iuppa, Courtney A., and Lauren A. Diefenderfer. "Risperidone-Induced Pisa Syndrome in MS." Annals of Pharmacotherapy 47, no. 9 (September 2013): 1223–28. http://dx.doi.org/10.1177/1060028013503132.

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40

Tsou, Chang-Chih, and San-Yuan Huang. "Olanzapine as a possible replacement choice for paliperidone-induced Pisa syndrome: a case report." Australasian Psychiatry 24, no. 6 (September 26, 2016): 545–47. http://dx.doi.org/10.1177/1039856216665285.

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Анотація:
Objective: The aim of this paper is to present a case of paliperidone-induced Pisa syndrome and provide treatment experience. Method: The case report is combined with a review of the literature. Results: A 37-year-old man had been diagnosed with paranoid-type schizophrenia for about 10 years. He received three-month treatment of paliperidone extended release (ER) at 6 mg per day, but showed a progressively Pisa-like physical position. We initially added an anticholinergic drug, but saw no improvement. The paliperidone ER was replaced by olanzapine at 10 mg per day, and the Pisa-like symptom improved after 1 month of the drug replacement. Conclusions: We propose olanzapine as a possible replacement choice for patients with paliperidone-related Pisa syndrome.
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41

Miletić, Vladimir, Boris Radić, and Maja Relja. "Acute Pisa Syndrome as a Neurological Emergency." Journal of Neuropsychiatry and Clinical Neurosciences 27, no. 2 (April 2015): e159-e160. http://dx.doi.org/10.1176/appi.neuropsych.14050105.

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42

Wu, Pei-Chuan, I.-Shin Shiah, Wen-Kuei Lee, Chun-Yen Chen, Yu-Cheng Kao, and Ming-Kuen Chou. "Amisulpride-associated acute Pisa syndrome in schizophrenia." Acta Neuropsychiatrica 22, no. 3 (June 2010): 163–64. http://dx.doi.org/10.1111/j.1601-5215.2010.00462.x.

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43

Wölfl, H. Rittmannsberger, H. "Pisa syndrome (pleurothotonus) in a polytoxicomanic patient." International Journal of Psychiatry in Clinical Practice 5, no. 2 (January 2001): 145–47. http://dx.doi.org/10.1080/136515001300375352.

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44

Kropp, Stefan, Ute Hauser, Hinderk M. Emrich, and Renate Grohmann. "Metoclopramide-Related Pisa Syndrome in Clozapine Treatment." Journal of Neuropsychiatry and Clinical Neurosciences 13, no. 3 (August 2001): 427–28. http://dx.doi.org/10.1176/jnp.13.3.427.

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45

Ziegenbein, Marc, Georg Schomerus, and Stefan Kropp. "Ziprasidone-Induced Pisa Syndrome after Clozapine Treatment." Journal of Neuropsychiatry and Clinical Neurosciences 15, no. 4 (November 2003): 458–59. http://dx.doi.org/10.1176/jnp.15.4.458.

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46

Nishimura, Katsuji, Yuri Mikami, Seiichi Tsuchibuchi, and Naoshi Horikawa. "Pisa Syndrome Resolved After Switching to Olanzapine." Journal of Neuropsychiatry and Clinical Neurosciences 19, no. 2 (April 2007): 202–3. http://dx.doi.org/10.1176/jnp.2007.19.2.202.

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47

Arora, Manu, Samir Kumar Praharaj, and Sukanto Sarkar. "Clozapine Effective in Olanzapine-Induced Pisa Syndrome." Annals of Pharmacotherapy 40, no. 12 (December 2006): 2273–75. http://dx.doi.org/10.1345/aph.1h325.

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48

Suzuki, Toshihito, Hirofumi Kurita, Takafumi Hori, Megumi Sasaki, Atsuomi Baba, Hiroyasu Shiraishi, and John E. Piletz. "The pisa syndrome (pleurothotonus) during antidepressant therapy." Biological Psychiatry 41, no. 2 (January 1997): 234–36. http://dx.doi.org/10.1016/s0006-3223(96)00405-2.

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49

Todisco, Massimiliano, Nicolò Gabriele Pozzi, Roberta Zangaglia, Brigida Minafra, Domenico Servello, Roberto Ceravolo, Enrico Alfonsi, Alfonso Fasano, and Claudio Pacchetti. "Pisa syndrome in Idiopathic Normal Pressure Hydrocephalus." Parkinsonism & Related Disorders 66 (September 2019): 40–44. http://dx.doi.org/10.1016/j.parkreldis.2019.06.024.

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50

Galati, Salvatore, Jens Carsten Möller, and Claudio Städler. "Ropinirole-Induced Pisa Syndrome in Parkinson Disease." Clinical Neuropharmacology 37, no. 2 (2014): 58–59. http://dx.doi.org/10.1097/wnf.0000000000000022.

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