The aim of this paper is to present a case of paliperidone-induced Pisa syndrome and provide treatment experience.

The case report is combined with a review of the literature.

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.

We propose olanzapine as a possible replacement choice for patients with paliperidone-related Pisa syndrome.