Candida lusitaniae Peritonitis Associated With Nonsurgical Pneumoperitoneum: A Case Report Exploring a Causal Relationship or Coincidence.

Schizophrenia is a chronic and disabling mental disorder characterised by positive symptoms, such as hallucinations and delusions, negative symptoms, including affective blunting and reduced motivation, and significant cognitive and functional impairments (). Despite advances in antipsychotic pharmacotherapy, a substantial proportion of individuals fail to achieve adequate symptom control (, ). It is estimated that approximately 20–30% of patients develop treatment-resistant schizophrenia (TRS), typically defined by lack of response to at least two adequate antipsychotic trials (–). TRS is associated with persistent symptom burden, impaired quality of life, increased rates of hospitalisation, elevated suicide risk, and substantial healthcare costs (). Clozapine remains the most effective pharmacological treatment for TRS and is recommended as the gold-standard intervention (). However, its clinical utility is limited by incomplete response in a significant proportion of patients, poor tolerability, and the need for intensive monitoring due to potentially serious adverse effects (, ). As a result, many individuals with TRS continue to experience refractory positive and negative symptoms despite optimal pharmacological management (). This therapeutic gap has driven increasing interest in adjunctive non-pharmacological approaches aimed at modulating the neurobiological mechanisms underlying symptom persistence. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation technique that delivers focal magnetic pulses to targeted cortical regions, inducing changes in neuronal excitability and connectivity (). rTMS has demonstrated efficacy and safety in several psychiatric conditions, most notably major depressive disorder, and is supported by evidence-based clinical recommendations for therapeutic use in this population (). In schizophrenia, rTMS has been investigated for its potential to reduce auditory hallucinations, typically via low-frequency stimulation of the temporoparietal cortex (often left-sided), and to ameliorate negative symptoms through high-frequency stimulation of the dorsolateral prefrontal cortex (commonly left-sided). However, stimulation parameters vary considerably across studies, including differences in frequency (1–20 Hz), intensity (100–120% motor threshold), coil type (e.g., H-coil), treatment duration, and cortical targets (). Proposed mechanisms underlying the efficacy of rTMS in schizophrenia include modulation of dysfunctional cortical-subcortical circuits, regulation of aberrant dopaminergic activity, and enhancement of neuroplasticity ().