Electroconvulsive therapy (ECT) is a highly effective intervention for treatment-resistant catatonia and severe neuropsychiatric disorders. We present the case of a 67-year-old patient with a long-standing diagnosis of schizophrenia who developed catatonic symptoms in the context of Parkinson disease (PD) and neuroborreliosis. After a medication switch from risperidone to quetiapine the patient rapidly deteriorated, displaying psychotic symptoms, disorganized behavior, and aggression. Multiple pharmacological interventions, including clozapine, high-dose risperidone, and benzodiazepines, were ineffective despite therapeutic plasma levels. The patient required seclusion over 50 times due to persistent agitation. Subsequently, he became increasingly withdrawn, refusing food and fluids, and developed pronounced catatonic features (mutism, echopraxia). After 3 months of unsuccessful pharmacotherapy, bilateral ECT was initiated. Within 6 sessions, the patient showed marked clinical improvement. A total of 18 ECT sessions led to full remission of catatonic and psychotic symptoms, with no further need for coercive measures. The patient was discharged home and continues to receive maintenance ECT. This case highlights the efficacy of ECT in managing complex catatonic states in patients with comorbid neuropsychiatric and neuroinflammatory conditions. It also emphasizes the importance of early ECT consideration when pharmacological approaches fail in multifactorial clinical scenarios.

From an evolutionary perspective, all organisms have two purposes: self-preservation and reproduction, in which immobility responses (IR) are implicated, these are ancestral survival strategies used to avoid serious injury or death. Immobility responses are adaptive reactions present in many species across virtually the entire phylogenetic spectrum, characterized by behavioral arrest and reduced responsiveness, serving evolutionary roles in prey-predator, mating, and offspring-carrying contexts. Several brain structures-including the brainstem, limbic system, striatum, and cortex-modulate IR by integrating fear, motor, and sensory processes; moreover, distinct drugs such as antipsychotics and morphine can induce IR through monoaminergic and endorphinic pathways. Immobility responses have been referred to by various terms, including animal hypnosis, catalepsy, catatonia, cataplexy, death feigning, and dorsal immobility, among others. The most commonly employed laboratory methods for inducing and replicating immobility responses are described herein. Experimental animal models reported in this work (frog, iguana, duck, rabbit, and rat) reproduce IR under controlled conditions, providing valuable insights into motor inhibition, defensive behaviors, and catatonic states.

The film Awakenings (adapted from Oliver Sacks' book with the same title) introduced the audience to a ravaging epidemic that left patients in an unresponsive, sleep-like, and helpless state. Awakenings, now marking its 35th anniversary, had a significant historical impact because it presented a stunning reversal after treatment in a neurologic disease. The feature film received 3 Academy Award nominations: Best Picture, Best Adapted Screenplay, and Best Actor (Robert De Niro). A 1974 British documentary that formed inspiration for the fictional film has never aired on US television. The documentary introduced Oliver Sacks to the public and showed his patients before and after l-dopa treatment. In the fictional film, the patients are a mix of chronically ill psychiatric patients and those in a frozen, immobile catatonic state. However, much to the surprise of the staff, Dr. Sayer (Robin Williams) shows that they can catch objects and respond to their favorite music. The protagonist is the afflicted Leonard, played by Robert De Niro, who initially shows dramatic improvement in his condition but finally regresses. Awakenings was the first film featuring a neurologist as a leading character. The film also cements the image of the neurologist as a sleuthing, relentless optimist with a trick up his sleeve. This article reviews the British documentary and the subsequent fictional film to judge the historical impact of the neurologic representation in film.

Management of catatonia in Huntington disease: A scoping review.

Catatonia is a neuropsychiatric syndrome observed in psychiatric and physical conditions. Linked to neuroinflammation, schizophrenia spectrum disorders remain its principal diagnostic context. Short-term outcomes are favourable with prompt treatment. Long-term prognosis remains poorly understood. This systematic review aimed to evaluate long-term outcomes and mortality rates in individuals with catatonia. We conducted a PRISMA-compliant systematic review (PROSPERO: CRD420251027945) searching PubMed, Web of Science, EMBASE, SCOPUS, PsycINFO, and non-peer-reviewed sources from database inception to July 12, 2025. We included studies of adults diagnosed with catatonia with a minimum 6-month follow-up. Catatonia diagnosis was based on criteria, scales, or clinical judgment. One-year mortality was estimated and compared to general population. Methodological quality was assessed using validated tools (NOS, JBI). Findings were synthesized narratively. Of 6431 records screened, 29 studies met inclusion criteria, encompassing 30,694 patients with catatonia and 11,830 controls. Mean follow-up was 8.1years. Seventeen studies focused on schizophrenia. Quality of studies was heterogeneous; 58% showed moderate concerns and 41% were at high risk of bias. Post-1970s studies reported more episodes, readmissions, and chronicity in catatonic schizophrenia versus other schizophrenia subtypes. Poorer psychiatric outcomes were found when catatonia co-occurred with intellectual disability, depression, or physical illness. Catatonia associated with baseline suicidal ideation (>35% patients) and follow-up autoimmunity. In 75% of post-1970s studies, one-year mortality in catatonia cohorts was lower than adjusted population rates. Catatonia is a marker of poor psychiatric long-term prognosis, without clear link to higher mortality. Early use of effective treatments preventing suicide or psychosis relapses may be considered.

Despite the robust body of evidence supporting the efficacy and safety of electroconvulsive therapy (ECT) in the treatment of severe psychiatric disorders, this procedure remains at the center of social debate, often influenced by historical prejudice. Such misconceptions have contributed to restricted access, which typically occurs either through costly private practice or in large academic centers within the public health system. Among the clinical conditions for which ECT is considered a first‐line treatment, malignant catatonia stands out—a rare and potentially fatal syndrome characterized by psychomotor disturbances and severe autonomic instability. If not treated promptly, its mortality rate may reach up to 50%. This case report describes the successful treatment of malignant catatonia in a patient with schizophrenia, in whom ECT sessions were administered intermittently and without a subsequent maintenance phase during inpatient care at a specialized psychiatric hospital affiliated with the Unified Health System in the state of São Paulo, Brazil. After 10 sessions, there was complete remission of the catatonic state, followed by hospital discharge for outpatient follow‐up. After 16 months, the patient maintained psychiatric stability, medication adherence, and partial independence in daily activities, with no new episodes of psychiatric decompensation. The case underscores the effectiveness of ECT in achieving remission of a rare and potentially life‐threatening disorder.

Background: Electroconvulsive therapy (ECT) is a well-established intervention for severe and treatment-resistant psychiatric disorders, yet its use in adolescents remains limited, particularly in Europe. Data on its safety and effectiveness in this population are scarce. This study aimed to evaluate the clinical outcomes and tolerability of ECT in adolescents diagnosed with schizophrenia and schizoaffective disorder. Methods: We conducted a retrospective observational case series of 22 adolescents (mean age 16.7 ± 1.3 years) treated with ECT between 2017 and 2024 at a university psychiatric department. Diagnoses included paranoid schizophrenia (n = 15), catatonic schizophrenia (n = 2), and schizoaffective disorder (n = 5). Symptom severity was assessed with the Positive and Negative Syndrome Scale (PANSS) before and after the ECT course. Adverse events were evaluated based on daily clinical monitoring and medical records. Results: The overall response rate, defined as ≥50% reduction in total PANSS score, was 82% (schizophrenia: 82%; schizoaffective disorder: 80%). Mean PANSS total score decreased from 158.0 ± 22.6 to 72.1 ± 20.7 (p < 0.0001). Improvements were most pronounced in the general psychopathology and positive symptom domains. No serious adverse events were observed. The most common transient side effects were headache (41%), memory complaints (27%), and somnolence (22%). Conclusions: ECT appears to be an effective and safe treatment option for adolescents with treatment-resistant schizophrenia and schizoaffective disorder. These findings add to the limited European evidence base and support considering ECT earlier in the treatment course of severe adolescent psychosis. Larger, prospective studies with long-term follow-up are warranted to confirm these results.

Mental health is a state of well-being that encompasses physical, psychological, and social aspects, and is not merely the absence of illness or disability. Mental disorders are serious mental health problems that can interfere with an individual's cognitive, affective, and social functioning. As a result, a person experiences difficulties in carrying out daily activities. One of the most common mental disorders is schizophrenia. Schizophrenia is a serious, chronic, and debilitating mental illness characterized by disorganized thinking, delusions, hallucinations, and strange or catatonic behavior. Auditory hallucinations are a stimulus disorder in which patients hear voices, especially human voices. Usually, patients hear people talking about what they are thinking and ordering them to do something. The purpose of this final nursing research paper is to overcome hallucination symptoms by applying occupational therapy (beading). The method used in this final nursing project is a descriptive case study explaining the nursing care provided over 5 days, including assessment, intervention by applying strategies such as scolding, controlling hallucinations, performing scheduled activities, and occupational therapy (bead stringing). From the evaluation results, the patient was able to recognize hallucinations, control hallucinations well, and reduce the frequency of hallucinations. The benefits for health services are to provide additional information on nursing services, improve service quality, and provide comprehensive nursing care for patients with mental disorders who experience auditory hallucinations. For the development of nursing science, it is hoped that this will enhance nurses' ability to provide nursing care and serve as an evaluation tool for nurses in delivering mental health nursing services. Keywords: mental health nursing care, auditory hallucinations, occupational therapy (stringing beads)

We report the case of a 76‑year‑old woman with a 25‑year history of neuropsychiatric symptoms and Moyamoya vasculopathy, first identified in 2016. She presented in March 2025 with severe catatonic excitement and began electroconvulsive therapy (ECT) starting in April, showing marked clinical improvement within 3 sessions. Genetic testing confirmed moyamoya disease (MMD) with a pathogenic RNF213 mutation, associated with increased risk of infarction or hemorrhage. After trials with several anesthetic agents, dexmedetomidine (DEX) combined with remifentanil was selected, enabling stable anesthesia with a consistent electrical dose of 192 mC across 35 sessions over 5 months. The main challenges included hemodynamic stability in MMD, prevention of post‑ictal agitation in advanced age and catatonia, and preservation of seizure quality despite repeated ECT. This case highlights the safe and effective use of ECT with DEX and remifentanil in a patient with genetically confirmed MMD with catatonic symptoms.

BackgroundKlinefelter syndrome (KS) is a disease caused by a 47, XXY sex chromosome abnormality. It has been reported that KS not only causes physical problems but also confers the risk of developing psychiatric disorders, such as schizophrenia, bipolar disorder, and autism spectrum disorder.Case PresentationHere we present a case of an 18‐year‐old male with complete KS who developed an acute psychotic episode after COVID‐19 infection. The patient presented a catatonic state with stupor, rejection of others, and hallucinations that led him to self‐injury. Psychotic symptoms improved in about 2 months with an antipsychotic, aripiprazole.ConclusionTo our knowledge, this is the first report of a KS patient who acutely developed a psychotic disorder after COVID‐19. Vulnerability to psychotic conditions of KS likely manifests as an acute psychotic episode facilitated by the neurotropic effects of COVID‐19.

BackgroundAnti‐NMDA receptor encephalitis is an autoimmune disorder that affects the brain, leading to a combination of neuropsychiatric symptoms, including severe mood changes, agitation, and psychosis, as well as cognitive impairments resembling dementia. It is commonly seen in young individuals and requires early intervention to prevent long‐term neuropsychiatric deficits.MethodCase StudyResultA 20‐year‐old male, born from a non‐consanguineous marriage, presented with a history of multiple episodes of new‐onset focal seizures, which were followed by well‐formed visual hallucinations. Over a period of days, he developed significant behavioral changes, including agitation, anger outbursts, memory disturbances, and a marked decrease in interest in daily activities. His speech output also diminished progressively and eventually led to a mute state. The patient showed increased slowness in activities and a general decline in functional ability. On neurological examination, the patient was found to be in a severe catatonic state, unable to communicate or engage in any purposeful movements. Perioral dyskinesias, characterized by involuntary movements of the mouth, were noted. The remainder of the examination, including cranial nerve function, motor, sensory, cerebellar, and extrapyramidal assessments, was grossly normal. Further investigations included a plain MRI of the brain, which showed a left temporal hyperintensity, suggestive of inflammation, though no other structural abnormalities were identified. EEG was normal, which is not uncommon in early stages of this condition. CSF analysis was normal, with no signs of infection or inflammatory changes. An autoimmune panel was sent, and NMDA receptor antibodies were found to be positive, confirming the diagnosis of anti‐NMDA receptor encephalitis. The patient was started on intravenous immunoglobulin (IVIG) therapy, resulting in a significant improvement in his clinical condition, including resolution of catatonia and gradual restoration of speech and cognitive function.ConclusionEarly recognition of anti‐NMDA receptor encephalitis, characterized by neuropsychiatric and cognitive symptoms, is critical. Timely treatment with immunotherapy like IVIG can significantly improve recovery and prevent irreversible cognitive decline, highlighting the importance of prompt diagnosis in managing this potentially reversible form of encephalitis.

Clinical and etiological characteristics of catatonic disorder due to another medical condition: A retrospective study from a tertiary care center.

This article explores the depiction of catatonic characters in Samuel Beckett’s Waiting for Godot and Endgame by analyzing the flouting of Grice’s conversational maxims. In particular, it considers the unique ways Beckett utilizes language, or the breakdown thereof, as a representational method for psychological states. The study investigates how the characters’ frequent flouting of the maxims of quality, quantity, relation, and manner reveal their psychological inertia and existential stagnation. This violation of communicative norms not only disrupts the flow of dialogue but also serves as a reflection of their deeper inner turmoil and psychological paralysis. By systematically disrupting conversational norms, the characters reflect a deeper state of catatonia, where their dialogues mirror a paralysis of action and thought. These patterns of communication or lack thereof highlight the stagnation that pervades their existence. Through a detailed analysis of key dialogues, the research demonstrates that Beckett uses this linguistic flouting to highlight the characters’ passive existence and immobility within an absurd and meaningless world. The findings suggest that the characters' resistance to conventional communication further emphasizes Beckett's themes of existential despair and absurdity. This study offers a new perspective on how linguistic dysfunction functions as a dramatic tool in Beckett's work, enhancing the portrayal of catatonic states and deepening the thematic exploration of inertia in his plays.

Skraban-Deardorff Syndrome (SDS) is an extremely rare neurodevelopmental disorder caused by a mutation in the WDR26 gene, leading to delayed psychomotor development. Along with this, patients present with different levels of intellectual disability, characteristic dysmorphic features like coarse facies with prominent maxilla and upper lip, and early-onset seizures. They also exhibit neurodevelopmental features such as hypotonia, failure to thrive, and feeding difficulties, minor structural brain anomalies - like enlarged ventricles, white matter volume loss, cerebellar hypoplasia, and microcephaly. Behaviorally, individuals with SDS are elated and socially engaging, with a preference to engage with adults and children rather than pursue solitary activities. In this case report, we present a unique case of SDS in which the patient presented with coprophagic and self-mutilating behavior, progressive catatonia with a change in baseline, and decreased appetite following the loss of a loved one who was also his primary caretaker. The patient exhibited increased sensitivity to psychotropic medications, including aripiprazole, and developed extrapyramidal side effects, further adding to his decompensation from baseline. The patient experienced marked resolution of his coprophagic and catatonic behavior after discontinuation of Aripiprazole, and continuation of Lorazepam daily. This case highlights how patients with neurodevelopmental disorders present differently when faced with changes in their routine and life circumstances, which can lead to unusual behaviors and physiological responses. Additionally, individuals with SDS may require complex care from various specialists. Therefore, a multidisciplinary approach is crucial for diagnosing and improving patient outcomes when presented with rare diseases such as Skraban-Deardorff Syndrome.

Schizophrenia (SZ) is associated with chronic oxidative stress in the patient's body. Previous studies revealed an increased copy number of genes for 47S pre-ribosomal RNA (pre-rRNA) in SZ patients. In this study, levels of oxidative stress and factors involved in the adaptive response to chronic stress (rDNA transcription) were, for the first time, compared in blood cells of patients with catatonic SZ(C) and paranoid SZ(P), chronic forms of schizophrenia, as well as healthy controls (HC). Ribosomal DNA (rDNA) and telomere repeat (TR) were quantified in leukocyte DNA using non-radioactive quantitative hybridization. Fragments of 5' external transcribed spacer (5' ETS) and 18S rRNA were assayed in leukocyte RNA using quantitative reverse transcription PCR (RT-qPCR). Proteins γ-histone H2AX (γH2AX), NADPH-oxidase 4 (NOX4), nuclear factor erythroid 2-related factor 2 (NRF2), BCL2-like protein 4 (BAX), BCL2, and oxidation marker 8-oxo-2'-deoxyguanosine (8-oxodG) were quantified in blood lymphocytes using flow cytometry. SZ(C) cells exhibited higher levels of the oxidative stress markers than SZ(P) and HC cells. The rDNA copy numbers in SZ(C) genomes negatively correlated with the amounts of the oxidative stress markers levels. Thus, genomes of blood cells isolated from catatonic patients harbor more copies of ribosomal genes than those from paranoid schizophrenia patients, correlating with higher levels of rRNA in catatonic patients. The upregulated ribosome biogenesis appears to be required for adaptive response to the elevated levels of oxidative stress in catatonic compared to paranoid patients.

IntroductionThe rapid change a variety of the clinical picture in case of autoimmune encephalitis remain a diagnostic challenge.ObjectivesDiagnostics and therapeutic process as of the atypical psychosis.MethodsA 40-year-old woman, since 2 weeks she expressed catastrophic delusions and dysphoria. Next she revealed tinnitus, psychosensory disturbances, disorganization of thinking and behavior and the first grand mal seizure occurred. In the neurology ward were described psychogenic disorders and she was referred to the psychiatric ward, where catatonic schizophrenia was diagnosed. She was disoriented, with periodic episodes of arousal and freezing, negativism and command automatism. She was hallucinating visually, auditorily, olfactorily, and cenesthetically, expressed delusions of catastrophe, influence, and persecution. Despite modifications of treatment (aripiprazole, haloperidol, olanzapine, quetiapine, clozapine, valproate) she didn’t improve. In the 4th week of hospitalization, an episode of fever of unknown etiology occurred and she was transferred to a higher referral psychiatric ward. Next fluctuating disturbances of consciousness, myoclonus, bilateral palmomental and Babinski’s sign and swallowing disorders were observed. Due to the lack of therapeutic effect tiapride was administer with slight improvement.ResultsLaboratory tests: CRP, VDRL, anti-HIV antibodies - absent, ceruloplasmin, ANA, anti-TPO, anti-TSHR antibodies, tumor markers – normal range.No changes in contrast-enhanced MRI head. In EEG moderate-grade, extensive changes in the fronto-central and frontotemporal leads bilateral.CSF examination – normal range, negative result for 14-3–3 proteinIn a panel for antibodies typical of autoimmune encephalitis - presence of anti-NMDA antibodies. Then autoimmune encephalitis was diagnosed. She was initially treated with immunoglobulins, with slight effects. Subsequently, effective immunosuppressive treatment with mycophenolate mofetil and methylprednisolone was administered. Further, the psychosis resolved, with the normalization of the neurological signs. The patient’s in stable mental and somatic condition was discharged without further psychopharmacology.Image 1:Image 2:ConclusionsIn anti NMDA receptor encephalitis affective symptoms, psychosis, catatonia, consciousness disorders, as well as neurological symptoms occurred. In majority of cases no changes are observed in brain imaging. EEG examination shows non-specific changes in 90% of cases. About 80% of patients recover without functional impairment, but in 7% disease is lethal. Crucial is to determine the etiology of atypical symptoms in order to implement adequate therapy as soon as possible.Disclosure of InterestNone Declared

The classification of psychotic disorders has undergone avariety of changes. Since Karl Ludwig Kahlbaum's (Kahlbaum 1874) first descriptions of catatonic states and Emil Kraepelin's (Kraepelin 1883) nosological classification of psychotic syndromes in the second half of the nineteenth century, the diagnostic criteria for these disorders have been repeatedly modified, significantly impacting clinical practice. Eugen Bleuler (Bleuler 1911) coined the term "schizophrenia", emphasizing the disturbances in thinking, feeling and acting that he had observed. With the introduction of the 11th version of the International Classification of Diseases (ICD-11), several significant changes to the diagnostic criteria were introduced. First-line symptoms according to Schneider lost importance. The subtypes (e.g., paranoid, hebephrenic and catatonic schizophrenia) were also omitted and symptom and progression classifiers have been introduced instead. Finally, catatonia is now defined as an independent diagnostic entity, while in ICD-10 it was still assigned to schizophrenia under the code F20.2. This recognizes catatonia's independent, cross-diagnostic nature. Due to these symptom and progression classifiers, the ICD-11 now takes amore ahybrid categorical and dimensional approach to the diagnosis than the previous version.

Background: Schizophrenia, a severe mental illness, is marked by disturbances in thought, cognitive impairments, negative symptoms, disorganized speech, hallucinations, catatonic behavior, psychotic symptoms, delusions, and behavioral changes. Schizophrenia has been associated with several gene polymorphisms and neurotransmitter imbalances. This study aims to analyze cognitive performance in schizophrenia patients using the Digit Span Test, with a focus on proline dehydrogenase (PRODH) gene polymorphisms. Material and Methods: This cross-sectional, observational analytic study included 99 individuals diagnosed with schizophrenia. Blood samples were collected and analyzed in the Biochemical Laboratory of the Medical Faculty of Andalas University using Polymerase Chain Reaction (PCR) to test for PRODH gene polymorphisms. The Structured Clinical Interview for DSM (SCID-1) was used to diagnose schizophrenia. Data were analyzed using the Chi-Square Test in SPSS 25.0, with statistical significance set at p = 0.05. Results: The cohort consisted of 99 patients who had been diagnosed with schizophrenia, most of whom were male (62.6%) with a median age of 37 years. A majority were unmarried (50.5%). PCR results revealed the following genotype distributions: homozygous dominant (CC) in 22 participants, heterozygous (TC) in 10, and homozygous recessive (TT) in 65. Cognitive function, as assessed by the Digit Span Test, yielded varied results in the forward span (p = 0.334) and higher deficit scores (score &lt; 5) in the CT and TT groups than the CC group in the backward span (p = 0.314). However, these differences were not statistically significant. Conclusion: The PRODH gene polymorphism does not significantly affect cognitive function in patients with schizophrenia. Other factors may be more influential in shaping the cognitive function of individuals with schizophrenia.

&lt;b&gt;Background and Objective:&lt;/b&gt; Schizophrenia is a severe and chronic mental disorder which are characterized by delusions, hallucinations, disorganized speech, catatonic behavior, negative symptoms and cognitive symptoms. Several gene polymorphisms and neurotransmitters have been linked to schizophrenia. This study assessed the correlation between proline level, Kynurenic Acid (KYNA) and glutamate level with cognitive function among schizophrenia patients, contributing to understanding biochemical factors associated with cognitive impairments. &lt;b&gt;Materials and Methods:&lt;/b&gt; The research was a cross-sectional observational analytic study of 99 patients diagnosed with schizophrenia. Schizophrenia was diagnosed by SCID-1 questionnaire and the patient's blood was taken to be analyzed in the Biochemical Laboratory of Medical Faculty Andalas University using Enzyme-Linked Immunosorbent Assay (ELISA) to characterize kynurenic acid level, glutamate level and proline level. Data were analyzed using Spearman Correlation in SPSS 25.0, with significance at p<0.05. &lt;b&gt;Results:&lt;/b&gt; There were 99 schizophrenia patients; most of them were male (62.6%), age median 37 years old and not married (50.5%). The Microproline Level median among participants was 2.64 μg/mL, the median KYNA level was 14.6 nmol/L and the glutamate level was 10.5 μg/mL. Cognitive function was assessed by Rey Auditory Verbal Learning Test (RAVLT), Digit Span Test and Trail Making Test (TMT) with a score median of 4/5/5/5 (Trial 1/2/3/Recall), 6/2 (forward/backward), 68/37 sec (TMT A/B), respectively. Spearman Correlation showed that microproline has a negative correlation with RAVLT Trial 1 (r = -0.221, p = 0.014), Digit Span Backward (r = -0.181, p = 0.036), TMT A (r = 0.204, p = 0.021) and TMT B (r = 0.185, p = 0.034). In contrast, other neurotransmitters do not correlate with any cognitive tests. &lt;b&gt;Conclusion:&lt;/b&gt; Proline may play a role in the pathophysiology of cognitive deficits in schizophrenia, highlighting its potential as a target for therapeutic interventions.

To study the psychopathological structure of resistant schizophrenia with the distinguishing of various clinical variants. The study was conducted at emergency departments of the round-the-clock Psychiatric Clinical Hospital No.1, named after N.A. Alekseev. One hundred twelve patients with a diagnosis of schizophrenia were examined using clinical psychopathological and psychometric methods as standardized scales (PANSS and BFCRS). Three clinical variants have been identified: impaired reasoning and perception with a predominance of delusional disorders, catatonic disorders with a predominance of oneiroid confusion, and impaired behavior and affect with a predominance of aggression. The earliest onset age of 17.1±3.2 years was found in the clinical variant with behavioral impairment (p=0.022). In the clinical variant with impaired reasoning, there were statistically significant differences (p<0.05) in the sum of scores on the PANSS-P subscale - 31.7±3.1; on P1 «Delusions» - 6.5±0.6; P2 «Conceptual disorganization» - 5.9±1.6; P3 «Hallucinations» - 6±0.3; G4 «Tension» - 5.5±0.6; G9 «Unusual thought content» - 5±0.8. The study of resistant schizophrenia with the identification of disorders in various areas of mental activity and the determination of their quantitative indicators is a promising area of research, as it helps to identify risk groups for the development of resistance and develop new strategies for overcoming it.