Controversies emerged in linking middle cranial fossa-arachnoid cyst to psychosis. Despite the anatomical association between such cyst and psychosocial behaviour, still several features of the cyst itself hamper causation. I report a case of a young female labeled refractory schizophrenia who presented with antipsychotic toxicity overlooking an arachnoid cyst in the middle cranial fossa. Due to the paucity of information in the literature on such association here I discuss further implications from a first medical encounter, from a patient’s perspective and from a disposition perspective as well.