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Introduction: Schizophrenia affects about 1% of the population, starting before the age of 25 and persisting throughout life. The disease is characterized by the presence of positive symptoms such as delusions, hallucinations, thought disorganization, negative symptoms such as affective flattening, withdrawal, isolation, as well as cognitive symptoms, such as changes in attention and memory. Objective: To report a case of severe schizophrenia that presented a high degree of functional impairment and life cycle disruption. Methods: These informations was obtained through the collection of clinical data from the patient's medical record, information from family members and, the clinical evaluation. Results: The patient's mother reported the onset of symptoms at the age of 16, when her son would get very irritable for any reason. After killing his stepfather, the patient was caught in the act and taken to the Juvenile Detention Center. The patient tried to hang himself with his own hands several times, and was then admitted to a psychiatric clinic. He was treated with clozapine, starting with 25 mg and reaching a dose of 700 mg per day, without side effects of neutropenia, seizures, and sialorrhea. During his evolution, while still hospitalized, he showed good progress, with a reduction in delusions and hallucinations, demonstrating insight into his illness and self-criticism, returning to functionality. After being discharged from the hospital, he returned to social life with the family. Discussion: Schizophrenia can evolve severely, leading to the breakdown of the patient's life cycle, serious dysfunctions, and irreversible damage in biological, psychological, and social aspects. Poor adherence to treatment, the side effects of medications, refractoriness to drugs and therapies, as well as the use of illicit drugs, can be elements that, individually or in combination, worsen the prognosis of the disease. The use of clozapine is an important resource that can be used in cases refractory to other medications, bringing results. Conclusion: Even in the face of the patient's severe condition, there was a good response to treatment with clozapine.
