Please select the eligibility criteria that correspond to the clinical trial below.
Title: A Randomized Double-Blind Sham-Controlled Trial of Transcranial Magnetic Stimulation for Refractory Auditory Hallucinations in Schizophrenia
Brief Summary: Studies using repetitive transcranial magnetic stimulation (rTMS) as a treatment for refractory auditory hallucinations (AH) in schizophrenia have shown promise. The majority of studies have examined the effect of low frequency left-sided stimulation (LFL) (i.e., 1 Hz) to the temporal parietal cortex (TPC). Priming stimulation (6 Hz) prior to LFL stimulation (hereby simply referred to as priming) has been shown to enhance the neurophysiological effects of LFL rTMS alone and, as such, may lead to greater attenuation of AH. Therefore, this study evaluated the efficacy of priming rTMS and LFL rTMS, compared to sham, applied to the TPC in patients with schizophrenia experiencing refractory auditory hallucinations (AH).


Options:
A: Inclusion Criteria:

* Patients will fulfill DSM-IV-TR diagnostic criteria for schizophrenia
* Patients reporting auditory hallucinations on average at least 5 times per day based on prospective assessment using a diary or handheld counter.
* Patients are maintained on their psychotropic medication at steady dosages for at least 4 weeks before study entry and for the duration of the trial.

Exclusion Criteria:

* Cardiac pacemaker implant, or a history of epilepsy, neurosurgery, or brain trauma patients suffering from chronic medical conditions of any sort
* History of current hypertension
* History of seizure or heat convulsion
* History of epilepsy or seizure in first degree relatives
* History of head injury
* History of any metal in the head (outside the mouth)
* Known history of any metallic particles in the eye
* Implanted cardiac pacemaker or any intra-cardiac lines
* Implanted neuro-stimulators
* Surgical clips or any medical pumps
* History of frequent or severe headaches
* History of migraine
* History of hearing loss
* Known history of cochlear implants
* History of drug abuse or alcoholism
* Pregnancy or not using a reliable method of birth control (non-pregnancy will be proved by beta-HCG test)
* Systemic and metabolic disorders
* Inadequate communication skills or under custodial care.
B: 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.
C: Inclusion Criteria:

* Male or female in-patients and out-patients, 18 - 60 years of age
* Diagnostic criteria for schizophrenia according to ICD-10/DSM IV
* PANSS negative sum score \> 20 points, 1 of items N1 - N7 (range 1 to 7) ≥ 4 (at least moderate)
* Improvement in PANSS negative sum score less than 10 % in the last 2 weeks prior to study entry, stable antipsychotic medication
* Informed Consent

Exclusion Criteria:

* Clinically relevant psychiatric comorbidity, verbal IQ \< 85
* History of epileptic seizures, organic brain disease
* Instable medical comorbidity or condition
* Previous treatment by rTMS
* Factors not compatible with the use of TMS, e.g. cardiac pace makers or other metallic implants, pregnancy
D: Inclusion Criteria:

* Schizophrenia according to Diagnostic and Statistical Manual - DSM-IV
* Auditory verbal hallucinations for at least 6 weeks (despite antipsychotic drugs)
* Medication Resistance according to Kane et al., 1988
* Age between 18 and 50 years old
* Informed consent

Exclusion Criteria:

* Concomitant major and unstable medical or neurologic illness
* Pregnant

Answer: B