Background <p>Artistic creativity is often observed in individuals with schizoaffective disorder, bipolar type, while medication adherence can be compromised by perceived cognitive side effects. Schizoaffective disorder, characterized by both psychotic and mood symptoms, presents unique challenges in balancing symptom control with the preservation of creative potential. This case report explores the interplay between hallucinations, creative drive, and medication adherence in a patient with schizoaffective disorder, bipolar type.</p> Case presentation <p>A 39-year-old male poet, diagnosed with schizoaffective disorder, bipolar type, was admitted to a psychiatric hospital following medication nonadherence and a manic episode. He reported that his hallucinatory experiences were integral to his creative process and that antipsychotic medications blunted his creativity and emotional depth. Despite recognizing the need for treatment, he frequently discontinued medication to maintain his artistic drive. This resulted in recurrent manic episodes and hospitalizations. A Structured Clinical Interview for DSM-5 (SCID-5) confirmed the diagnosis and differential diagnosis were systematically excluded. The patient expressed a desire for a treatment approach that would allow him to maintain his creative abilities.</p> Conclusion <p>This case highlights the challenge of balancing symptom control with creative expression in schizoaffective disorder. Individualized treatment, potentially combining therapy and tailored medication, is crucial to address both psychiatric symptoms and artistic needs. Further research should focus on optimizing treatment to preserve creative potential<b>.</b></p>