To the Editor: “Mrs. B,” who had significant depression symptoms and psychotic symptoms with significant exacerbations of self-care in the past 7 months, was diagnosed with schizoaffective disorder, depressed subtype, because of persistent psychotic symptoms even after response of her depression with mirtazapine 60 mg/day. She still had significant psychotic symptoms even after several kinds of antipsychotics, such as risperidone 8 mg/day, olanzapine 30 mg/day, and aripiprazole 30 mg/day during her 1-month hospitalization (Brief Psychiatric Rating Scale−18 items [BPRS−18] scores: 56, especially in items of uncooperativeness [6 points], hallucinatory behaviors [7 points], hostility [6 points] and suspiciousness [6 points]). Because of apparent treatment-resistance, the antipsychotic was switched to clozapine 200 mg/day gradually, with excessive salivation side effects. The responses of her psychotic symptoms still remained limited after using clozapine (BPRS−18 scores: 53). Her self-care, social, and occupational functioning also did not improve (Social and Occupational Function Assessment Scale [SOFA] score: 20].