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.
Azotemia ; Behavioral Symptoms ; Catatonia ; Contracture ; Dehydration ; Disulfiram ; Emergencies ; Female ; Fingers ; Hand ; Hand Deformities ; Humans ; Hypernatremia ; Intensive Care Units ; Joints ; Middle Aged ; Orthopedics ; Schizophrenia ; Schizophrenia, Catatonic ; Stupor

OBJECTIVETo evaluate the clinical therapeutic effect of electroacupuncture for treatment of catatonic schizophrenia.

METHODSEighty cases were randomly divided into an observation group and a control group, 40 cases in each group. The observation group was treated with electroacupuncture, Baihui (GV 20) and Taiyang (EXHN 5) were selected, once daily; the control group was treated with modified electric convulsive therapy (MECT), the treatment was given once every 2 days or 3 days, 14 to 21 days constituted one course in the two groups.

RESULTSThe markedly effective rate and total effective rate were 72.5% and 92.5% in the observation group, 77.5% and 97.5% in the control group, respectively, there was no significant difference between the two groups (both P>0.05).

CONCLUSIONThe therapeutic effect of electroacupuncture is similar to that of MECT.

Acupuncture Points ; Adolescent ; Adult ; Combined Modality Therapy ; Electroacupuncture ; Electroconvulsive Therapy ; Female ; Humans ; Male ; Middle Aged ; Schizophrenia, Catatonic ; therapy ; Treatment Outcome ; Young Adult

We report the first two cases of manic and hypomanic episodes respectively induced by risperidone treatment done to schizophrenics in Korea. One case was a 22-year-old woman with catatonic schizophrenia. Since 3 years ago, she had shown psychotic symptoms, but with was poor treatment compliance. She had mainly negative symptoms such as social withdrawal, decreased flood intake, mutism, and symptoms had been worsened since last 4-5 months. Prior to closed ward admission, she was prescribed 2mg/d of risperidone far a week at OPD. Two days after taking medicine totally 6-8mg, she revealed manic features. After hospitalization, risperidone was discontinued and then, lithium 900mg/d and high dosage of conventional antipsychotics(chlorpromazine 1200mg/d or haloperidol 20mg/d) were prescribed. About on the l0th day of hospitalization, there was limited improvement of her manic symptoms. The other case was a 29-year-old man with a 3-year history of paranoid schizophrenia. He was never exposed to antipsychotics before. His main symptoms were delusions of being poisoned and of persecution. His positive and also negative symptoms were alleviated by 38 days of risperidone 2mg/d trial. However, one week after dosage increment to 3mg/d, hypomanic symptoms appeared. Risperidone medication was discontinued and was replaced by chlorpromazine 300mg/d. The hypomanic episode was resolved over 5 days. In both of the two cases, manic episodes occurred by monotherapy of risperidone without mood stabilizer, and there were no history of substance abuse and other psychiatric disorders, family history of psychiatric disorders, and comorbid physical illnesses. It is hypothesized that the potent blockade effect on serotonin(5-HT2) receptor of risperidone causes antidepressant effect, as well as therapeutic effect for negative and affective symptoms in schizophrenia. Risperidone would induce manic or hypomanic features in schizophrenic patients. And there are few case reports of risperidone-induced mania or exacerbation of preexisting manic symptoms by risperidone treatment in mood disorder and schizoaffective disorder. Risperidone is being used more widely, even for obsessive-compulsive disorder and other psychiatric disorders. It is necessary for clinicians to recognize manic switch, one of psychiatric side effects by risperidon trial. It is recommended that the combination of mood stabilizer with risperidone or usage of the minimum effective dose of risperidone may bewefal especially in the patients with mood disorders or schizoaffective disorders. Clozapine which has mood-stabilizing properties is also beneficial in risk groups of risperidone-induced mania.
Adult ; Affective Symptoms ; Antipsychotic Agents ; Bipolar Disorder* ; Chlorpromazine ; Clozapine ; Compliance ; Delusions ; Female ; Haloperidol ; Hospitalization ; Humans ; Korea ; Lithium ; Mood Disorders ; Mutism ; Obsessive-Compulsive Disorder ; Psychotic Disorders ; Risperidone ; Schizophrenia ; Schizophrenia, Catatonic ; Schizophrenia, Paranoid ; Substance-Related Disorders ; Young Adult