title: Olanzapine as a possible replacement choice for paliperidone-induced Pisa syndrome: a case report.
abstract: OBJECTIVE
  The aim of this paper is to present a case of paliperidone-induced Pisa syndrome and provide treatment experience.
  
  
  METHODS
  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.
authors: Resident, Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors: Chang-Chih
authors: CC
authors: Tsou
authors: Attending Physician, Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, and; Professor, Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan hsy@ndmctsgh.edu.tw.
authors: San-Yuan
authors: SY
authors: Huang
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001569:Benzodiazepines / Q000008:administration & dosage*; D004409:Dyskinesia, Drug-Induced / Q000209:etiology; D004421:Dystonia / Q000139:chemically induced; D006801:Humans; D008297:Male; D000077152:Olanzapine; D000068882:Paliperidone Palmitate / Q000009:adverse effects*; D011569:Psychiatric Status Rating Scales; D012563:Schizophrenia, Paranoid / Q000188:drug therapy*; D013577:Syndrome
chemical_list: D014150:Antipsychotic Agents; D001569:Benzodiazepines; D000077152:Olanzapine; D000068882:Paliperidone Palmitate
keywords: Pisa syndrome; dopaminergic–cholinergic imbalance; olanzapine; paliperidone