Repetitive Transcranial Magnetic Stimulation for Refractory Auditory Hallucinations in Schizophrenia

Inclusion Criteria: * voluntary and capable to consent based on the subject's ability to provide a spontaneous narrative description of the key elements of the study * have a diagnosis of Schizophrenia or Schizoaffective Disorder as confirmed by the Structured Clinical Interview for the DSM-IV (SCID-IV) * between the ages of 18 and 65 * meet criteria for AH of at least moderate severity based on the Positive and Negative Symptom Scale (PANSS) * willing to keep the dose of antipsychotic stable for the duration of the study * meet criteria for medication resistance, defined as daily AH despite 2 adequate 6-week trials of at least 2 antipsychotic medications and including 1 atypical antipsychotic medication. An adequate trial is defined as a daily dose of 1000 chlorpromazine equivalents for typical antipsychotics medications and the following dosages for atypical antipsychotic medications: risperidone 6 mg, olanzapine 15 mg, quetiapine 500 mg, clozapine 300 mg. Exclusion Criteria: * DSM-IV history of alcohol and/or substance abuse in past month, or alcohol and/or substance dependence in the last 6 months * presence of concomitant major, unstable medical or neurologic illness, or a history of seizures * are pregnant * have received rTMS for any reason in the past * have had a dose change of usual psychotropic medications in the 4 weeks preceding study entry.