A Case of Catatonic Schizophrenia Associated With Proximal Interphalangeal Joint Flexion Contracture in Non-Dominant Hand

Lee, Sang Soo; Moon, Seok Woo; Nam, Beom Woo; Seo, Jeong Seok

Abstract

OBJECTIVES
Psychogenic contractures in the hand are a rare topic in the medical literature and psychoflexed hand is rarely mentioned even in orthopedic textbooks. By reporting a case with classic catatonic features of the catatonic type of schizophrenia associated with proximal interphalangeal joint flexion contracture in non-dominant hand, the existence of this rare and almost unknown entity is emphasized and the diagnostic and therapeutic importance facing the clinicians dealing with psychological related symptomatology is suggested. CASE: A 54-year-old, single, right-handed woman who lived alone presented to emergency department in catatonic stupor state, severe dehydration due to refusal of oral intake for about 15 days. She had received a diagnosis of schizophrenia, catatonic type at age 33 and had been hospitalized with catatonic motor and behavioral symptoms for a long time. She was hospitalized in medical intensive care unit and abnormal results of laboratory studies at admission including hypernatremia due to severe dehydration, prerenal azotemia, and hemoconcentration was corrected. Catatonia was confirmed by CRS Catatonia Rating Scale (CRS). Her catatonic and other psychotic symptoms began to resolve with treatment, but the patient was found to have had the psychogenic hand deformity characteristics of proximal interphalangeal joint flexion contractures of left 2nd, 3rd, 4th, 5th finger which started about 20 years ago. She allowed us to try to have a appropriate diagnostic evaluation but as she had experienced a full resolution of catatonic and other psychotic symptoms, she began to resist all the orthopedic treatments. She was discharged by caregiver's request because of economic problems.
CONCLUSION
This case highlights the importance of having specific and systemized medical workups for catatonia of schizophrenia in order to prevent the sequelae of severe psychopatholgy such as flextion contractures and other potential complications.