Objective To investigate the efficacy of repeated transcranial magnetic stimulation （rTMS） combined with risperidone under theta burst stimulationin（ TBS） mode in the treatment of first-episode schizophrenia， and to observe the changes of serum prolactin（ PRL） levels. Methods From January 2019 to December 2019， a total of 100 patients with first-episode schizophrenia in Jingmen NO.2 People's Hospital were randomly divided into study group and control group， with 50 patients in each group. Before treatment， Positive And Negative Syndrome Scale（ PANSS） scale was used to evaluate the patients， and plasma PRL was detected. The patients in both groups were treated with risperidone oral liquid. The study group was treated with rTMS under TBS mode for four weeks， and at the end of 2 weeks and 4 weeks after treatment， psychological assessment was carried out and plasma PRL was detected. Patients were followed up for 4 weeks after rTMS treatment， and plasma PRL was redetected. Rusults （1） There was no statistically significant difference on the total score and factor score of PANSS scale between the two groups before treatment， but there was statistically significant difference in time effect between the two groups after treatment（ all P＜0.05）. In the comparison of effects between groups， there were statistically significant differences in negative symptoms（ F=4.419；P ＜ 0.05）， but there was no statistically significant difference in the other factors and the total score of PANSS（ all P ＞ 0.05）. In the comparison of interactive effects， there were statistically significant differences in the total score of PANSS and the scores of all factors（ all P＜0.05）.（ 2） There was no statistically significant difference in serum PRL between the two groups before treatment， but there were statistically significant differences in time effect， intergroup effect， and interaction effect between the two groups after treatment（ Ftime=558.270， Fgroup=70.257，Finteraction=51.863， all P ＜ 0.05）. After treatment， there were statistically significant differences in serum PRL between the two groups at different time points（ t1=43.296，t2=78.881，t3=92.162；P ＜ 0.05）. Conclusions rTMS therapy under TBS mode can improve the negative symptoms of first-episode schizophrenia， delay the increase of plasma PRL caused by risperidone， and have slight adverse reactions. However， the long-term efficacy is difficult to maintain.