PİSA SENDROMU; BİR OLGU SUNUMU

Öz

Pisa sendromu PS , ilk kez 1972 yılında Ekbom ve arkadaşları tarafından bildirilen, gövdede gelişen nadir bir geç distoni türüdür. PS gelişmesi sıklıkla uzamış antipsikotik tedavisiyle ilişkilidir, ancak diğer ilaçları kullanan hastalarda kolinesteraz inhibitörleri, antiemetikler gibi , ilaç kullanmayan bireylerde idyopatik PS ve nörodejeneratif bozukluklarda da bildirilmiştir. Bu yazında, risperidon kullanımına bağlı olarak PS gelişen şizofreni tanılı bir olgu tartışılacaktır. PS özellikle D2 reseptörlerine etkin antipsikotiklerin uzun süreli ve yüksek dozda kullanımında görülmektedir. PS gelişirse kullanılan antipsikotik tedavisi kesilmeli, ekstrapiramidal sistem yan etki profili düşük antipsikotiklere geçilmelidir. PS’e sebep olabilecek diğer tıbbı durumlar dışlanmalıdır. Baklofen ve klozapin tedavi seçenekleri arasında düşünülmelidir

Anahtar Kelimeler

• tardiv distoni,risperidon,baklofen,klozapin

PISA SYNDROME; A CASE REPORT

Abstract

Pisa syndrome PS is rare type of tardive truncal dystonia which were first reported by Ekbom et al in 1972. The development of PS is most commonly associated with prolonged treatment with antipsychotics; however, it has also been reported, although less frequently, in patients who are receiving other medications such as cholinesterase inhibitors and antiemetics , in those not receiving medication idiopathic PS and in those with neurodegenerative disorders. In this article, a case of a shizophrenia in which PS induced by the use of risperidone will be discussed. PS is seen particularly in long-term and high doses of administration of D2 reseptor sensitive antipsychotics. If PS is diagnosed antipsychotic treatment must be discontinued and switching to other antipsyhotics which have low potential of extrapyramidal side effect profile is a better choice. The other medical conditions which can cause PS should be excluded. Options of baclofen and clozapine treatment should also be considered

Keywords

• Tardive dystonia,risperidone,baclofen,clozapine

References

1. )Suzuki T, Matsuzaka H. Drug-Induced Pisa Syndrome ( Pleurothotonus ). CNS Drugs 2002; 16(3): 4.
2. )Ekbom LK, Lindholm H. New dystonic syndrome associated with butyrophenone therapy. Z Neurol ; 202: 94-3. )Kurtz G, Kapfhammer HP, PeukerB. Pisa syndrome in clozapine therapy. Nervenarzt 1993; 64(11): 742-6.
3. )Arora M, Praharaj SK, Sarkar S. Clozapine effective in olanzapine-induced Pisa syndrome. Ann. Pharmacother 2006; 40(12):2273-5.
4. )Duggal HS, Sivamony S, Umapathy S. Pisa Syndrome and Atypical Antipsychotics (1). Am J Psychiat 2004; 161(2): 373.
5. )Padberg F, Stübner S, Buch K, Hegerl U, Hampel H. Pisa syndrome during treatment with sertindole. Br. J. Psychiatry 1998; 173:351-2.
6. )Walder A, Greil W, Baumann P. Drug-induced Pisa syndrome under quetiapine. Progress in Neuro- Psychopharmacology and Biological Psychiatry 2009; (7):1286-7.
7. ) Miodownik C, Lerner V, Witztum E. Pisa syndrome and laryngeal dystonia induced by novel antipsychotics. Isr. J. Psychiatry Relat. 2011; (3):195-0.
8. ) Teng PR, Lai TJ. Paliperidone-related Pisa syndrome. J. Clin. Psychopharmacol 2013; 33(1):129

9. ) Kwak YT, Han IW, Baik J, Koo MS. Relation between cholinesterase inhibitor and Pisa syndrome. Lancet 2000; 355:2222.
10. ) Suzuki T, Kurita H, Hori T, Sasaki M, Baba A, Shiraishi H, et al. The Pisa syndrome (pleurothotonus) during antidepressant therapy. Biol. Psychiatry 1997; (2):234-6.
11. ) Guerrero AM, Llamas S, Murcia FJ, Ruíz J. Acute Pisa syndrome after administration of a single dose of mirtazapine. Clin. Neuropharmacol 2013; 36(4):133-4.
12. ) Fichtner CG, Pechter BM, Jobe TH. Pisa syndrome mistaken for conversion in an adolescent. Br. J. Psychiatry 1992; 161(6):849-52.
13. ) Gambarin M, Antonini A, Moretto G, Bovi P, Romito S, Fiaschi A, et al. Pisa syndrome without neuroleptic exposure in a patient with Parkinson’s disease: case report. Mov. Disord 2006; 21(2):270-3.
14. ) Patel S, Tariot PN, Hamill RW. Pisa Syndrome Without Neuroleptic Exposure in a Patient With Dementia of the Alzheimer Type. J. Geriatr. Psychiatry Neurol 1991; 4(1):48-51.
15. ) Marchione P, Spallone A, Valente M, C. Giannone, F. De Angelis, and G. Meco, et al. Reversible Pisa syndrome associated to subdural haematoma: case- report. BMC Neurol 2014; 14:149.
16. ) Stübner S, Padberg F, Grohmann R, Hampel H, Hollweg M, Hippius H, et al. Pisa syndrome (pleurothotonus): report of a multicenter drug safety surveillance project. J. Clin. Psychiatry 2000; (8):569-74.
17. ) Güzey C, Scordo MG, Spina E, Landsem VM, Spigset O. Antipsychotic-induced extrapyramidal symptoms in patients with schizophrenia: associations with dopamine and serotonin receptor and transporter polymorphisms. Eur. J. Clin. Pharmacol 2007; (3):233-41.
18. ) Meram CS, Özgüven HD. Antipsikotik İlaçların Yan Etkileri. In: Saygur H, Alptekin K, Atbaşoğlu C, Herken H, editors. Şizofreni ve Diğer Psikotik Bozukluklar. 1st ed. Ankara:Türkiye Psikiyatri Derneği; 2007: p. 395–
19. ) Rummel-Kluge C, Komossa K, Schwarz S, Hunger H, Schmid F, Lobos CA, et al. Head-to-head comparisons of metabolic side effects of second generation antipsychotics in the treatment of schizophrenia: A systematic review and meta-analysis. Schizophr. Res 2010; 123:255-33.