Trimethoprim as adjuvant treatment in schizophrenia: a double-blind, randomized,
placebo-controlled clinical trial.
Author(s): Shibre T, Alem A, Abdulahi A, Araya M, Beyero T, Medhin G, Deyassa N, Negash A,
Nigatu A, Kebede D, Fekadu A.
Affiliation(s): Department of Psychiatry, Faculty of Medicine, Addis Ababa University, Addis
Ababa, Ethiopia. shibreteshome@yahoo.com
Publication date & source: 2010, Schizophr Bull. , 36(4):846-51
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.
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