MANNERISTIC CATATONIA

Manneristic catatonia, one form of Leonhard's systematic schizophrenia s, is illustrated in nine case notes. The essential syndrome of this r are disorder (described by Leonhard in the preneuroleptic era) consist ed in mannerisms and progressive stiffness of psychomotor activity. Ma nnerisms often developed from obsessive and compulsive ideas; whereas distress disappeared, repetitive behaviour developed into a stereotype , Complex movements (e.g. not to shake hands; mutism) became mannerism s. With disease progression stiffness of facial expression and gesture s and an impairment of voluntary motor activity became increasingly pr ominent. There were no signs of (neuroleptic-induced) parkinsonism. Ma nneristic catatonia affects preponderantly men and exhibits an early a ge of onset (median: 23 years). In none of the cases a family history of psychiatric illness was noted. Severe obstetric and birth complicat ions as well as the high prevalence of supratentorial and cerebellar C T/MR abnormalities in this patient group point to deviations of prenat al brain maturation. The median yearly dose of neuroleptics was 83.1 g chlorpromazin equivalents. The characteristic psychopathology was not essentially influenced by modern psychopharmacological treatment neit her in the beginning nor in the long run irrespective of the time of o nset of the disease. Continuous high-dose neuroleptic treatment is not efficacious in this distinct group of systematic schizophrenias. Beha vioural training in a rehabilitation unit is the treatment of choice f rom the early beginning.