An Extension Protocol for Patients Who Previously Completed the TMS Pilot Study

For non responders and partial responders: Inclusion Criteria: * Completion of the study #8116 (NCT05319080) * The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnosis of schizophrenia or schizoaffective disorder * A reduction of AHRS less than 50% of the initial score * Capacity and willingness to provide informed consent * If female and not infertile, must agree to use one of the following forms of contraception for the duration of study participation: systemic hormonal treatment, an intrauterine device (IUD) which was implanted at least 2 months prior to screening, or "double-barrier" contraception. Women of child bearing potential must have a negative pregnancy test at screening * Right handed * Normal hearing * Taking an antipsychotic medication at a stable dose for at least 4 weeks. All oral and depot antipsychotics are allowable. Exclusion Criteria: * Substance use disorder (excluding nicotine) within last 90 days, or positive toxicology screen for any substance of abuse * Pregnancy * Severe adverse events of TMS * History of seizure, epilepsy and neurologic conditions with structural cerebral damage, including stroke, multiple sclerosis, traumatic brain injury, Alzheimer's and other neurodegenerative diseases, meningoencephalitis or intracerebral abscess, parenchymal or leptomeningeal cancers, dementia, developmental disability, cerebrovascular disease, increased intracranial pressure, or central nervous system (CNS) tumors, brain surgery, head injury with loss of consciousness \>1 hour or clear cognitive sequelae, intracranial metal implants, known structural brain lesion * Subjects with devices that may be affected by TMS (pacemaker, cardioverter defibrillator, medication pump, intracardiac line, cochlear implant, implanted brain stimulator/neurostimulator) * Subjects with suicidal ideation with intent or plan (indicated by affirmative answers to items 4 or 5 of the Suicidal Ideation section of the baseline C-SSRS) in the 6 months prior to screening or subjects who represent a significant risk of suicide in the opinion of the investigator * Frequent and persistent migraines * Clinically significant skin disease * Presence of unstable medical disorders, including those that are previously undiagnosed, untreated, inadequately treated, or active to an extent which might make participation hazardous. For example, hypertension, previous stroke, brain lesions, or heart disease * History of prior clinically significant, adverse response to neurostimulation * Current treatment with ototoxic medications (amino-glycosides, cisplatin) For complete responders: Inclusion Criteria: * Completion of the study #8116 (NCT05319080) * The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnosis of schizophrenia or schizoaffective disorder * A reduction by at least 50% of the initial AHRS score * Taking an antipsychotic medication at a stable dose for at least 4 weeks. All oral and depot antipsychotics are allowable. Exclusion Criteria: * Substance use disorder (excluding nicotine) within last 90 days, or positive toxicology screen for any substance of abuse * Subjects with suicidal ideation with intent or plan (indicated by affirmative answers to items 4 or 5 of the Suicidal Ideation section of the baseline C-SSRS) in the 6 months prior to screening or subjects who represent a significant risk of suicide in the opinion of the investigator * Presence or positive history of unstable significant medical or neurological illness