OBJECTIVES: I. Determine the effect of repetitive transcranial magnetic stimulation on treatment refractory auditory hallucinations of patients with schizophrenia.

PROTOCOL OUTLINE: This is a randomized, double blind study. Patients are randomized to one of four treatment arms. Arm I: Patients receive 9 days of active transcranial magnetic stimulation (rTMS) which consists of 8 minutes of rTMS on day 1, 12 minutes duration on day 2, and 16 minutes duration on days 3-9. The total duration of stimulation is 132 minutes. Arm II: Patients receive 9 days of sham rTMS. Patients are then offered active rTMS for the same length of time. Arm III: Patients receive 5 days of active rTMS which consists of 8 minutes of rTMS on day 1, 12 minutes duration on day 2, and 16 minutes on days 3-5. The total duration of stimulation is 68 minutes. Arm IV: Patients receive 5 days of sham rTMS. Patients are then offered active rTMS for the same length of time. Patients are followed weekly for 3 months.

Ages Eligible for Study:  18 Years   -   60 Years,  Genders Eligible for Study:  Both

Criteria

PROTOCOL ENTRY CRITERIA:

--Disease Characteristics--

• Diagnosis of schizophrenia or schizoaffective disorder based on DSM-IV version of SCID
• Auditory hallucinations occurring at least 5 times per day resistant to adequate medication trials of at least 2 alternative antipsychotic medications, including at least 1 atypical agent Adequate medication trial defined as at least 6 weeks at a dose of 1000 CPZ equivalents for standard neuroleptics and published recommendations of therapeutic dosing for atypical neuroleptics
• Righthanded
• No history of seizure that is not drug induced or secondary to alcohol withdrawal
• No first degree relative with epilepsy

--Prior/Concurrent Therapy--

• At least 2 weeks on stable antipsychotic medication No concurrent clozapine or bupropion No cochlear implants or surgically implanted metal implants in the head

--Patient Characteristics--

• Cardiovascular: No history of cardiac arrhythmia No cardiac pacemaker
• Other: No active drug or alcohol abuse within past 6 weeks No serious medical illness that would increase risk to patient in case of seizure No shrapnel in the head Not pregnant Negative pregnancy test