A 34 year old man was referred to our unit for psychiatric evaluation. His psychomotor development was normal until the age of 12, when he started showing progressive loss of cognitive skills and finalized motor activity. Symptoms rapidly worsened and by the age of 20 his language and motor skills were severly compromised. Starting at age 17 he had been treated with both 1st and 2nd generation antipsychotics which did not lead to any changes in symptoms. Family history was negative for psychotic or neurological disorders. The mother had alcohol abuse disorder and the younger sister was diagnosed with generalized anxiety disorder.

At the time of our evaluation patient was receiving 10 mg of Olanzapine. He was vigilant and passively cooperative to examination; he displayed physical immobility, waxy flexibilitas, stereotyped behaviour, camptocormia, echolalia, blunted affect and automatic and repetitive behaviour. Thought content was difficult to evaluate but he denied hallucinations or delusional thoughts.

BP was normal, as well as brain MRI and PET. Screening for Wilson's disease, metabolic diseases and fragile X Syndrome were negatve. DAT scan was also performed and showed no abnormalities. Medication withdrawal didn’t lead to any changes in his status.

The patient's symtoms fulfill the criteria for drug resistant Catatonic Schizophrenia. However the early onset of symptoms, the rapid deterioration of cognitive abilities, the early and extensive motor imparment and the complete resistance to drug treatment make this an interesting case for discussion about differential diagnosis.