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The Pisa Syndrome: A Report of Two Cases

Published online by Cambridge University Press:  29 January 2018

Ramzy Yassa*
McGill University and Douglas Hospital Center, 6875 Lasalle Boulevard, Verdun, Quebec, H4H 1R3, Canada


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.

Research Article
Copyright © 1985 The Royal College of Psychiatrists 

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Berger, P. A. & Rexroth, K. (1980) Tardive dyskinesia: clinical, biological and pharmacological perspectives. Schizophrenia Bulletin, 6, 102116.Google Scholar
Burke, R. E., Fahn, S., Jankovic, J., Marsden, C. D., Lang, A. E., Gollomp, S. & Ilson, J. (1982a) Tardive dystonia; late onset and persistent dystonia caused by antipsychotic drugs. Neurology (N.Y.), 32, 13351346.Google Scholar
Burke, R. E., Fahn, S., Jankovic, J., Marsden, C. D., Lang, A. E., Gollomp, S. & Ilson, J. (1982b) Tardive dyskinesia and inappropriate use of neuroleptic drugs. Lancet, i, 1299.Google Scholar
Ekbom, K., Lindholm, H. & Ljunberg, L. (1972) New dystonic syndrome associated with butyrophenone therapy. Neurology, 202, 94103.Google Scholar
Flaherty, J. A. & Lahmeyer, H. W. (1978) Laryngeal pharyngeal dystonia as a possible cause of asphyxia with haloperidol treatment. American Journal of Psychiatry, 135, 14141415.Google Scholar
Gardos, G. (1981) Dystonic reactions during maintenance antipsychotic therapy. American Journal of Psychiatry, 138, 114115.Google Scholar
Mackay, A. V. P. (1982) Clinical controversies in tardive dyskinesia. In Movement Disorders (eds. Marsden, C. D. & Fahn, S.). London: Butterworths.Google Scholar
Mann, S. C., Cohen, M. M. & Boger, W. P. (1979) The danger of laryngeal dystonia. American Journal of Psychiatry, 136, 13441345.Google Scholar
Marsden, C. D. (1976) Blepharospasm—oromandibular dystonia syndrome (Brueghel's syndrome). Journal of Neurology, Neurosurgery and Psychiatry, 39, 12041209.Google Scholar
Marsden, C. D. & Jenner, P. (1980) The pathophysiology of extrapyramidal side effects of neuroleptic drugs. Psychological Medicine, 10, 5572.Google Scholar
Marsden, C. D. Tarsy, D. & Baldessarini, R. J. (1975) Spontaneous and drug-induced movement disorders in psychotic patients. In Psychiatric Aspects of Neurological Disease (eds. Benson, D. F. & Blumer, D.). New York: Grune & Stratton.Google Scholar
Massachusetts General Hospital Newsletter (1983) Biological therapies in psychiatry. Tardive Dystonia, 6, 2223.Google Scholar
Menuck, M. (1981) Laryngeal pharyngeal dystonia and haloperidol. American Journal of Psychiatry, 138, 394395.Google Scholar
Moss, H. B. & Green, A. (1982) Neuroleptic-associated dysphagia confirmed by esophageal manometry. American Journal of Psychiatry, 139, 515516.Google Scholar
Munetz, M. R. (1980) Oculogyric crises and tardive dyskinesia. American Journal of Psychiatry, 137, 1628.Google Scholar
Nasrallah, H. A., Pappas, N. J. & Crowe, R. R. (1980) Oculogyric dystonia in tardive dyskinesia. American Journal of Psychiatry, 137, 850851.Google Scholar
Sovner, R. & DiMascio, A. (1978) Extrapyramidal syndromes and other neurological side effects of psychotropic drugs. In Psychopharmacology, a Generation of Progress (eds. Lypton, M. A., DiMascio, A. & Killam, K. F.). New York: Raven Press.Google Scholar
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