{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T11:01:29Z","timestamp":1784890889427,"version":"3.55.0"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"\n Background<\/jats:title>\n Treatment-resistant schizophrenia (TRS) affects up to one-third of individuals with schizophrenia and remains a major clinical challenge despite optimized pharmacotherapy. Repetitive transcranial magnetic stimulation (rTMS) has been proposed as a neuro-modulatory intervention for refractory symptoms, yet evidence specific to TRS remains limited and inconsistent.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To evaluate the efficacy and safety of rTMS for reducing global symptom severity, negative symptoms, and auditory hallucinations in adults with treatment-resistant schizophrenia, and to examine the influence of stimulation parameters on treatment outcomes.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A systematic review and meta-analysis was conducted following PRISMA guidelines and registered with PROSPERO (CRD420251143558). Eight electronic databases were searched up to 10\n th<\/jats:sup>\n September 2025. Randomized controlled trials including adults with TRS and comparing rTMS with sham stimulation were eligible. Standardized mean differences (Hedges\u2019 g) were pooled using REML-based random-effects models. Heterogeneity and subgroup effects were examined, and publication bias was explored through visual inspection of funnel plots.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Across included trials, rTMS was not associated with statistically significant improvements in overall symptom severity measured by PANSS (SMD 0.14, 95% CI \u22120.26 to 0.54), negative symptoms (SMD 0.37, 95% CI \u22120.12 to 0.86), or auditory hallucinations measured by AHRS (SMD \u22120.03, 95% CI \u22120.26 to 0.20), based on post-treatment outcome scores. Substantial heterogeneity was observed for PANSS and negative symptoms, while heterogeneity for AHRS was low. Subgroup findings were exploratory and should be interpreted cautiously.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Current evidence does not support a consistent therapeutic benefit of rTMS over sham stimulation for symptom reduction in treatment-resistant schizophrenia. While some subgroup analyses suggested variability in effect estimates across stimulation protocols, these findings were exploratory and should be interpreted with caution. Further large-scale, well-designed trials are needed to clarify the role of rTMS in this population.<\/jats:p>\n <\/jats:sec>\n \n Systematic review registration<\/jats:title>\n \n https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420251143558<\/jats:ext-link>\n , identifier CRD420251143558.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpsyt.2026.1783758","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T10:10:28Z","timestamp":1784887828000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and safety of rTMS for global symptom severity, negative symptoms, and auditory hallucinations in treatment-resistant schizophrenia: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Mohammed A.","family":"Alhassan","sequence":"first","affiliation":[{"name":"Division of Psychiatry, Department of Medical Specialties, College of Medicine, Majmaah 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