Improving Neurocognitive Deficits and Function in Schizophrenia With Transcranial Magnetic Stimulation

High-frequency, repetitive transcranial magnetic stimulation (rTMS) to the dorsolateral
prefrontal cortex (DLPFC), the dysfunctional brain region most implicated in cognitive
deficits in schizophrenia, has recently been shown to improve cognition in non-Veteran
samples with schizophrenia. The investigators' goal is to confirm the efficacy of this
treatment modality to remediate cognitive deficits and improve functionality in Veterans with
schizophrenia, as well as to gain a better understanding of the neural mechanisms responsible
for cognitive deficits and their remediation. The investigators propose conducting a
small-scale study to generate pilot data supporting the feasibility of conducting rTMS with
Veterans and the effectiveness of rTMS in this population. In addition, the investigators
will conduct neurophysiologic experiments to test whether certain neural maker of abnormal
brain function improves with rTMS.

Inclusion Criteria:

- SCID confirmed diagnosis of Schizophrenia or Schizoaffective Disorder

- Stable medication regimen (no change in dose or agents within the 2 weeks prior to
study entry and throughout the duration of the study)

- Stable social environment and housing to enable regular attendance at clinic visits

- Ability to undergo cognitive testing, EEG scans and rTMS

- IQ > 80 (WASI full scale score)

- In general good medical health

- Is in treatment with a psychiatrist and/or primary care physician within the VHA
system

Exclusion Criteria:

- Pregnant or lactating female

- History of prior adverse reaction to TMS

- On medications known to significantly lower seizure threshold, e.g.:

- clozapine

- chlorpromazine

- clomipramine

- History of seizures or conditions known to substantially increase risk for seizures

- Implants or medical devices incompatible with TMS

- Acute or unstable chronic illness that would affect participation or compliance with
study procedures, e.g.:

- unstable angina

- Substance abuse/dependence (not including caffeine or nicotine) within one-month
period prior to study entry or during study participation

- Unstable psychiatric symptoms that precludes consistent participation in the study,
e.g.:

- active current suicidal intent or plan

- severe psychosis

- History of loss of consciousness greater than 15 minutes due to head injury.

- Participation in another concurrent clinical trial

- Patients with prior exposure to rTMS

- Have a mass lesion, cerebral infarct or other active central nervous system disease,
or history of traumatic brain injury