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ABSTRACT Background: Chronic schizophrenia with persistent residual symptoms poses significant therapeutic challenges, particularly in patients with long-standing illness and repeated relapses due to medication non-adherence. Individualized homoeopathic prescribing has been explored as an adjunctive approach in chronic psychiatric conditions. Case: A 57-year-old woman with a 20-year history of schizophrenia presented with persistent social withdrawal, guilt feelings, irritability, subjective cognitive complaints, and a fixed erotomaniac delusion. The illness was precipitated by significant psychosocial stressors, including financial loss and bereavement. The patient had a history of multiple hospitalizations, long-term institutional care, repeated modified electroconvulsive therapy (mECT), and ongoing antipsychotic treatment. The PANSS score of 45 at baseline. Intervention: An individualized homoeopathic remedy, Ignatia Amara 200C, was prescribed based on totality of symptoms, including ailments from grief, self-reproach, sensitivity, aversion to company, desire for sweets and music, and chronic constipation. The patient continued conventional psychiatric medications concurrently. Outcome: Over a three-month follow-up period, improvement was observed in mood, affective reactivity, and guilt intensity. Subjective forgetfulness improved, and overall functioning showed stabilization. However, the fixed erotomaniac delusion persisted. The PANSS total score at last follow-up was 33. Conclusion: This case highlights the complexity of chronic schizophrenia with residual features and suggests that individualized homoeopathic treatment may serve as a complementary approach in long-term integrative management. Controlled studies are required to further evaluate therapeutic effects.