Nissen Trygve, Wynn Rolf
Division of Mental Health and Addictions, University Hospital of North Norway, N-9291, Tromsø, Norway.
Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, N-9037, Tromsø, Norway.
J Med Case Rep. 2018 Jun 18;12(1):168. doi: 10.1186/s13256-018-1729-5.
The clenched fist syndrome/psycho-flexed hand, first described in the early 1980s, has not yet entered the major psychiatric textbooks. Curiously, the phenomenon has been illuminated mainly in journals and textbooks on hand surgery. There is a need to examine, describe, and understand this syndrome from a psychiatric perspective.
We present a case we encountered in an intensive care unit. A 60-year-old white man with schizophrenia, cerebrovascular disease, diabetes mellitus type 2, and peripheral neuropathy, developed rather acutely bilateral clenched fists in the aftermath of a traumatic dislocated hip fracture that was operated on. He later died due to complications from the surgical procedure.
While this was a complex case with some clinical uncertainty regarding the cause of our patient's symptoms, we conclude that psychological processes were central to the development of his clenched fists. The phenomenon of clenched fists and our case are discussed with reference to the accumulated literature on psychogenic hand disorders and the International Statistical Classification of Diseases and Related Health Problems, 10th version. The nosological status appears to be obscure. This case presentation is a first step in increasing the understanding of this syndrome from a psychiatric perspective.
握拳综合征/精神性屈曲手，于20世纪80年代初首次被描述，尚未被纳入主要的精神病学教科书。奇怪的是，这一现象主要在手外科的期刊和教科书中有所阐述。有必要从精神病学角度审视、描述并理解这一综合征。
我们呈现一例在重症监护病房遇到的病例。一名60岁的白人男性，患有精神分裂症、脑血管疾病、2型糖尿病和周围神经病变，在接受外伤性髋关节脱位骨折手术后，急性出现双侧握拳症状。他后来因手术并发症死亡。
虽然这是一个复杂的病例，对于患者症状的病因存在一些临床不确定性，但我们得出结论，心理过程是其握拳症状发展的核心。结合关于心因性手部疾病的累积文献以及《国际疾病分类及相关健康问题统计分类》第10版，对握拳现象及我们的病例进行了讨论。其疾病分类学地位似乎尚不明确。本病例报告是从精神病学角度增进对该综合征理解的第一步。
