title: Trimethoprim as adjuvant treatment in schizophrenia: a double-blind, randomized, placebo-controlled clinical trial.
abstract: Various infectious agents, such as Toxoplasma gondii, have been hypothesized to be potentially relevant etiological factors in the onset of some cases of schizophrenia. We conducted a randomized, double-blind, placebo-controlled treatment trial in an attempt to explore the hypothesis that the symptoms of schizophrenia may be related to infection of the central nervous system with toxoplasma gondii. Systematically selected patients with ongoing and at least moderately severe schizophrenia from Butajira, in rural Ethiopia, were randomly allocated to trimethoprim or placebo, which were added on to participants' regular antipsychotic treatments. Trial treatments were given for 6 months. The Positive and Negative Syndrome Scale (PANSS) was used to assess outcome. Ninety-one patients were included in the study, with 80 cases (87.9%) positive for T. gondii immunoglobulin G antibody. Seventy-nine subjects (87.0%) completed the trial. The mean age of subjects was 35.3 (SD = 8.0) years, with a mean duration of illness of 13.2 (SD = 6.7) years. Both treatment groups showed significant reduction in the overall PANSS score with no significant between-group difference. In this sample of patients with chronic schizophrenia, trimethoprim used as adjuvant treatment is not superior to placebo. However, it is not possible to draw firm conclusion regarding the etiological role of toxoplasmosis on schizophrenia based on this study because the timing and the postulated mechanisms through which toxoplasmosis produces schizophrenia are variable.
authors.affiliation: Department of Psychiatry, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia. shibreteshome@yahoo.com
authors.forename: Teshome
authors.initials: T
authors.lastname: Shibre
authors.forename: Atalay
authors.initials: A
authors.lastname: Alem
authors.forename: Abdulreshid
authors.initials: A
authors.lastname: Abdulahi
authors.forename: Mesfin
authors.initials: M
authors.lastname: Araya
authors.forename: Teferra
authors.initials: T
authors.lastname: Beyero
authors.forename: Girmay
authors.initials: G
authors.lastname: Medhin
authors.forename: Negusse
authors.initials: N
authors.lastname: Deyassa
authors.forename: Alemayehu
authors.initials: A
authors.lastname: Negash
authors.forename: Alemayehu
authors.initials: A
authors.lastname: Nigatu
authors.forename: Derege
authors.initials: D
authors.lastname: Kebede
authors.forename: Abebaw
authors.initials: A
authors.lastname: Fekadu
mesh_terms: D000328:Adult; D000818:Animals; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D002908:Chronic Disease; D003906:Developing Countries; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005002:Ethiopia; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012424:Rural Population; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D012565:Schizophrenic Psychology; D014122:Toxoplasma / Q000187:drug effects / Q000276:immunology; D016781:Toxoplasmosis, Cerebral / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D014295:Trimethoprim / Q000008:administration & dosage*
chemical_list: D014150:Antipsychotic Agents; D007074:Immunoglobulin G; D014295:Trimethoprim