Among the tardive dyskinesia syndromes, dystonia can be the most diffi
cult to treat. It may be severe to the point of being disabling, yet t
he patients may require antipsychotic medications for an even more dis
abling psychosis. Clozapine, an atypical neuroleptic drug that lacks e
xtrapyramidal effects, may be the drug of choice for such patients. Th
is report describes three patients with significant dystonia, previous
ly disabled by their psychoses, who have been successfully managed wit
h clozapine plus other agents for >3 years.