Disuse Left Hand Atrophy and Persistent Left Clenched Fist in an Adult with Catatonic Schizophrenia

Abstract

Case description: A 34-year-old male had schizophrenia characterized (in severe episodes) by apathy, negativism and auditory hallucinations. He had low intelligence (IQ = 68), schizoid personality traits and first degree relatives with schizophrenia. At the age of 27, he experienced stereotyped spitting behavior, bizarre facial grimacing and left persistent clenched fist posturing. Neurological evaluation revealed left hand posturing, atrophy and nail injuries of the hand flesh with fungal infection and motor apraxia. Therapy with different antipsychotics, electroconvulsive therapy and lorazepam resulted in partial clinical improvement but failed to improve hand posturing.