Pisa Syndrome Associated with Aripiprazole and Lithium

Pisa Syndrome Associated with Aripiprazole and Lithium

Objective: In this case report, we intended to present a case of a patient who experienced two episodes of Pisa syndrome (PS). Case Report: A 52-year-old male patient was admitted to our hospital inpatient service showing an acute manic episode. In addition to his routine monthly administration of long-acting aripiprazole injection, oral aripiprazole at a dosage of 15 mg daily was introduced during initial week of treatment. After one week, the patient developed the first occurrence of PS. These symptoms subsided after stopping oral aripiprazole. But the syndrome occurred seven days later, subsequent to an increase in the lithium carbonate. The patient’s dystonia was improved after lithium carbonate was discontinued. Conclusion: The occurrence of PS in this patient is a dopaminergic-cholinergic imbalance within the basal ganglia, which may be associated with aripiprazole or lithium. Furthermore, lithium carbonate may disrupt gamma-aminobutyric acid neurotransmission in projection neurons within basal ganglia, potentially leading to movement disorders.