Abstract
BackgroundThe 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.Case presentationWe 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.ConclusionsWhile 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.
Highlights
The clenched fist syndrome/psycho-flexed hand, first described in the early 1980s, has not yet entered the major psychiatric textbooks
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
The nosological status of clenched fist syndrome (CFS) is unclear
Summary
We believe that the clenching of our patient’s fists is best explained as a conversion disorder, CFS. There is still insufficient clinical data on CFS. Further research should strive to gain more knowledge on etiology, pathogenesis, clinical manifestations, and treatment. Should it be labelled a syndrome, a disorder, a reaction, a conversion reaction, a phenomenon, or an entity? All these designations have been used in articles about the CFS/psycho-flexed hand. That is an indication of the unresolved nosological status. The medical community will hopefully design studies that can broaden our understanding. We urge the psychiatric community to disseminate the current knowledge, report on further observations, and collaborate with colleagues from other medical specialties that encounter this or similar disorders
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