title: Pisa syndrome (pleurothotonus): report of a multicenter drug safety surveillance project.
abstract: BACKGROUND
  Pisa syndrome is usually regarded as a rare adverse event of neuroleptic medication. However, its frequency and predisposing factors have yet to be defined. Here, we investigated risk factors of Pisa syndrome occurring in a large population of psychiatric patients surveyed during a multicenter drug safety project.
  
  
  METHODS
  Twenty episodes of Pisa syndrome were documented in 17 patients within a population of 45,000 psychiatric patients monitored by a multicenter drug safety surveillance project (Projekt zur Uberwachung der Arzneimittelsicherheit in der Psychiatrie) between 1990 and 1997. All results were related to the epidemiologic data provided for this population and systematically analyzed regarding history of medication, current medication, comedication, and clinical course.
  
  
  RESULTS
  A constellation of putative risk factors was found in the majority of patients: previous treatment with classical neuroleptics, combined pharmacologic treatment, female gender, old age, and the presence of an organic brain disorder. Given these risk factors, Pisa syndrome was also documented with atypical neuroleptic drugs such as clozapine, olanzapine, and sertindole.
  
  
  CONCLUSIONS
  We conclude that Pisa syndrome is a very rare adverse event occurring with neuroleptic treatment. In patients exhibiting the reported constellation of risk factors, neuroleptic drugs should be administered with particular caution.
authors.affiliation: Department of Psychiatry, Ludwig-Maximilian University, School of Medicine, Munich, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Stübner
authors.forename: F
authors.initials: F
authors.lastname: Padberg
authors.forename: R
authors.initials: R
authors.lastname: Grohmann
authors.forename: H
authors.initials: H
authors.lastname: Hampel
authors.forename: M
authors.initials: M
authors.lastname: Hollweg
authors.forename: H
authors.initials: H
authors.lastname: Hippius
authors.forename: H J
authors.initials: HJ
authors.lastname: Möller
authors.forename: E
authors.initials: E
authors.lastname: Rüther
mesh_terms: D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D000367:Age Factors; D000368:Aged; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015984:Causality; D002493:Central Nervous System Diseases / Q000453:epidemiology; D015897:Comorbidity; D004359:Drug Therapy, Combination; D004421:Dystonia / Q000139:chemically induced* / Q000453:epidemiology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy; D008875:Middle Aged; D011358:Product Surveillance, Postmarketing / Q000706:statistics & numerical data; D012307:Risk Factors; D012737:Sex Factors; D013577:Syndrome
chemical_list: D014150:Antipsychotic Agents