BACKGROUND: Therapy resistant, severe residual schizophrenia poses major challenges for the psychiatric pharmacological treatment. METHOD: We report about a 44-year old schizophrenic male who has been detained in a closed forensic ward for 10 years, following a conviction in one manslaughter case. Despite various pharmacological treatment efforts severe residual schizophrenia remained. RESULT: Adding Amisulpride to the ongoing treatment with Olanzapine achieved a noticeable improvement of symptoms, resulting in the possibility of relaxing imprisonment conditions. CONCLUSION: A combination of Amisulpride and Olanzapine seems to be effective in treating severe residual schizophrenia.