A 40-year-old woman with the diagnosis of schizoaffective disorder had been treated with different typical and atypical antipsychotic drugs since the age of 26. Three months after self-discontinuing her medication, she experienced an exacerbation of her psychotic symptoms, so ziprasidone and valproic acid treatment were started. Six months after initiation of the treatment, tardive dystonia was developed involving the neck region. Discontinuation of ziprasidone produced no benefit; thus clozapine, 75 mg/day, was initiated both for psychotic symptoms and dystonia. Due to lack of improvement in the dystonia and because she suffered from side effects, the dosage of clozapine was decreased to 25 mg/day and botulinum toxin type A treatment was administered. She had partial improvement and repeated injections were planned. Although atypical antipsychotic drugs cause fewer extrapyramidal side effects than typical antipsychotics, we must be cautious when prescribing these drugs because of their disabling side effects.
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