Palliative psychiatry in ultra-treatment resistant schizophrenia with refractory somatic hallucinations: A case report

• Ultra-treatment-resistant schizophrenia with persistent somatic hallucinations. • Clozapine and Electroconvulsive therapy failed; pharmacologic strategies had limited benefit. • Palliative psychiatry reframed care to prioritize distress reduction, dignity. • Creative therapies and peer counseling enhanced engagement and well-being. • Functional and psychosocial interventions improved the quality of life despite symptoms. We report the case of a middle-aged male with ultra-treatment-resistant schizophrenia and severe multimodal hallucinations, including rare and difficult-to-manage somatic hallucinations. Conventional treatment strategies, including multiple antipsychotic regimens, clozapine, and electroconvulsive therapy, provided limited benefit. Care was reframed within a palliative psychiatric framework that prioritized symptom relief, dignity, and quality of life via integration of creative therapies, peer counselling, alongside supportive pharmacotherapy. Despite the persistence of psychotic symptoms, the framework contributed to meaningful improvement in the patient’s well-being and functionality by reducing distress, avoiding polypharmacy with adverse effects, enhancing engagement with treatment, and within the community. This case contributes to the limited clinical literature by demonstrating the structured application of palliative psychiatry in UTRS, highlighting its potential to enhance quality of life even when all evidence-based treatments have been exhausted. This framework offers palliative psychiatry as a humane and practical framework for clinicians to consider in cases of ultra-treatment-resistant schizophrenia when complete symptom remission is unattainable.