Multi-target TMS for Schizophrenia Negative Symptoms

This randomized controlled trial (RCT) is the first to evaluate the efficacy and safety of a multi-target TMS protocol targeting the right orbitofrontal cortex (R-OFC), left dorsolateral prefrontal cortex (L-DLPFC), and left inferior parietal lobule (L-IPL) for negative symptoms of schizophrenia.

Inclusion Criteria: 1. Outpatients or inpatients at the Department of Psychiatry, Shanghai Mental Health Center; 2. Meet the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria for first-episode schizophrenia (diagnosed using the Structured Clinical Interview for DSM-5, SCID-5); disease duration less than 5 years at enrollment; 3. Male or female aged 16-45 years; 4. Education duration ≥ 9 years; 5. Stable medication regimen for at least 6 weeks prior to baseline visit and throughout the study period; psychiatric symptoms generally stable within 1 month prior to baseline visit; 6. Participants and their guardians can understand and sign written informed consent; 7. Total score on the PANSS Negative Symptom subscale (PANSS-N) \> 15, and at least one item score ≥ 3. Exclusion Criteria: 1. Current or lifetime psychiatric disorders as determined by SCID-5 assessment; 2. Severe or unstable physical illnesses, including: neurological disorders (delirium, dementia, stroke, epilepsy, migraine, etc.), congestive heart failure, angina pectoris, myocardial infarction, arrhythmia, hypertension, hyperglycemia, malignant tumors, and immunocompromised conditions; 3. Alcohol abuse within 30 days prior to the study or alcohol/drug dependence within 6 months prior to the study; participation in any clinical trial within 30 days prior to baseline; 4. Pregnant or breastfeeding women; 5. Intellectual disability (IQ \< 70); 6. No history of modified electroconvulsive therapy (mECT) within the past 6 months.