Stübner S, Padberg F, Grohmann R, Hampel H, Hollweg M, Hippius H, Möller H J, Rüther E
Department of Psychiatry, Ludwig-Maximilian University, School of Medicine, Munich, Germany.
J Clin Psychiatry. 2000 Aug;61(8):569-74.
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.
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.
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.
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.
Pisa综合征通常被视为抗精神病药物罕见的不良事件。然而，其发生率和诱发因素尚未明确。在此，我们调查了在一项多中心药物安全项目中接受调查的大量精神科患者中发生Pisa综合征的危险因素。
在1990年至1997年间，一个多中心药物安全监测项目（Projekt zur Uberwachung der Arzneimittelsicherheit in der Psychiatrie）监测的45000名精神科患者群体中，17名患者记录了20例Pisa综合征发作情况。所有结果均与该群体提供的流行病学数据相关，并就用药史、当前用药情况、合并用药情况及临床病程进行了系统分析。
在大多数患者中发现了一系列假定的危险因素：既往使用经典抗精神病药物治疗、联合药物治疗、女性、老年以及存在器质性脑疾病。鉴于这些危险因素，Pisa综合征也见于氯氮平、奥氮平和舍吲哚等非典型抗精神病药物。
我们得出结论，Pisa综合征是抗精神病药物治疗中发生的一种非常罕见的不良事件。在出现所报告危险因素组合的患者中，应特别谨慎使用抗精神病药物。
