Event-related potential (ERP) studies have demonstrated impaired auditory sensory processing in patients with schizophrenia, as reflected in abnormal mismatch negativity (MMN). We sought to extend this finding by evaluating MMN in 13 treatment-refractory patients with schizophrenia, and 14 age- and gender-matched healthy controls. Subjects responded to infrequent visual stimulation while ignoring binaurally presented auditory tones. The amplitude and topographical pattern of the MMN were analyzed. The control group presented the expected reduction in the amplitude of the MMN from frontal to central and parietal locations. In comparison, the MMN amplitude was not reduced in the treatment-refractory patients, and was largest at the central-posterior electrode location. In addition, patients displayed larger negativities at left frontal, and left- and right-temporal electrode locations than the control subjects. These findings are consistent with pre-attentive abnormalities in treatment-refractory patients with schizophrenia.