Pisa Syndrome (Pleurothotonus): Report of a Multicenter Drug Safety Surveillance Project

Background: Pisa syndrome is usually regarded asa rare adverse event of neuroleptic medication. However, itsfrequency and predisposing factors have yet to be defined. Here,we investigated risk factors of Pisa syndrome occurring in alarge population of psychiatric patients surveyed during amulticenter drug safety project.

Method: Twenty episodes of Pisa syndrome weredocumented in 17 patients within a population of 45,000psychiatric patients monitored by a multicenter drug safetysurveillance project (Projekt zur Uberwachung derArzneimittelsicherheit in der Psychiatrie) between 1990 and 1997.All results were related to the epidemiologic data provided forthis population and systematically analyzed regarding history ofmedication, current medication, comedication, and clinicalcourse.

Results: A constellation of putative riskfactors was found in the majority of patients: previous treatmentwith classical neuroleptics, combined pharmacologic treatment,female gender, old age, and the presence of an organic braindisorder. Given these risk factors, Pisa syndrome was alsodocumented with atypical neuroleptic drugs such as clozapine,olanzapine, and sertindole.

Conclusion: We conclude that Pisa syndrome is avery rare adverse event occurring with neuroleptic treatment. Inpatients exhibiting the reported constellation of risk factors,neuroleptic drugs should be administered with particular caution.