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People with schizophrenia and related psychoses may be more likely to be ‘treatment‐resistant’ when dually diagnosed with intellectual disabilities. This case study highlights many of the difficulties which can occur in their assessment and management. Clozapine is currently the best available intervention for treatment‐resistant schizophrenia, and its use has increased in people with intellectual disabilities. However, it is not always effective, and a wide range of adjunctive strategies have been suggestive and tried. The evidence base for the specific use of these additional strategies in people with intellectual disabilities needs to be increased.