The administration of antipsychotics in pregnancy is always a problematic situation. The authors discuss a clinical case of a psychotic woman with delusions about her pregnancy and asking for delivery in pre-term, posing at risk herself and the fetus. In these cases, the therapeutic approach must be agreed in light of a genuine informed consent of the patient and when there are no conditions for the exercise of a legally valid informed consent the problem must be addressed to a legal representative of the patient as we did. It is important that the patient appropriately understands all the difficulties which concern her illness and the situation of being pregnant. The risk of malformations and possible fetal damages must be balanced with the need of patient care. We also discuss the differences in kinetics and metabolism of several classes of neuroleptics during pregnancy. We think that, if possible, the patient should be involved in this therapeutic selection.