Rev Bras Psiquiatr. 2007;29(3):291-7 291 Cartas aos EditoresA 59 year-old female patient, who had her illness onset at age 26, presented to treatment with persistent and severe auditory hallucinations and persecutory delusions. Over 33 years she was continuously treated with several typical and atypical antipsychotics at full therapeutic dosages and for sufficient time, having had slight improvement of overall status, maintaining severe hallucinations and delusions and related social and professional disability and impairment. After 11 unilateral electroconvulsive therapy sessions her Brief Psychiatric Rating Scale (BPRS) scores dropped from 33 to 22, and her Mini-Mental State Examination (MMSE) dropped from 28 to 19. However, the treatment was interrupted due to cognitive side effects. She was maintained on clozapine 800 mg/day, amisulpride 600 mg/day and lamotrigine 400 mg/day for one year, with limited effect over social activities and persecutory delusions, maintaining severe auditory hallucinations (AHS = 30).In early 2005 she received twenty 20-minute sessions of 1-Hz LTPC rTMS, at 90% motor threshold with a clinically relevant 50% AHS reduction. The largest effects were in auditory hallucinations frequency and intensity. Patient, relatives and Care Provider reported global improvement in social and family interaction and self-care.One year after the first treatment, the patient reported recurrence of the auditory hallucinations and received the same treatment protocol with significant symptom improvement, having AHS scores dropped from 24 to 17 and BPRS scores from 43 to 15, without cognitive deficits (MMSE = 28). Patient and relatives reported marked improvement in spontaneity, social skills, and family relations. These findings not only replicate previous studies, but also suggest that patient's outcomes goes beyond symptom relief, including reduction of negative symptoms and improvement in quality of life. We also suggest that large-duration protocols may be better, and that effects may last about 6-8 months, being the treatment repetition capable to induce similar effects, without the development of tolerance. These findings require replication in larger samples using sham-controlled double-blind procedures, and with the assessment of additional outcomes, such as quality of life and affect regulation.Dear Editor, Treatment-resistant auditory hallucinations (TRAH) occur in 20% of treated schizophrenia patients and contribute to disability and morbidity. Repeated transcranial magnetic stimulation (rTMS) is a recent strategy for TRAH which has been tested in around 20 randomized controlled trials, and found controversial results. Hoffmann et al. reported data from 50 schizophrenia/schizoaffective disorder patients showing superiority of rTMS over sham stimulation in auditory hallucinations with a 9-day, 1-Hz stimulation in the left temporo-parietal cortex (LTPC), using the Auditory Hallucination Hoffmann Scale (AHS) and the Clinical Global Impression Scale (CGI) as assessment instruments. 1 Similar studi...