Insulinocomatous therapy began to be used as early as 1933. It is based on the introduction of the patient into the hypoglycemic coma by introducing him a large dose of insulin. Until today, the exact mechanism of action of this method of treating schizophrenia and psychosis has not been fully studied, but it is so effective that insulinocomatous therapy is used in almost all countries of the world. However, the method requires an individual approach to each patient and a careful calculation of the dose of the drug. Any mistake in the preparation and conduct of this procedure can harm the patient.
Insulinocomatous therapy - indications
Even before 1960, similar therapy was used everywhere. She was part of the treatment of an increasing depressive state, neurosis, schizophrenia.
At present, this treatment technique is being replaced by a wide range of psychotropic drugs developed by the pharmacological industry.
Now, such treatment is used in the fight against schizophrenia of the initial stage. Also, insulinocomatosis therapy in psychiatry is used if the patient’s body is not sensitive to modern drugs and his schizophrenia was not previously treated with insulin.
There are positive reviews about insulinocomatous therapy in catatonic and catatonic-oneiric states in the depressive-paranoid and hallucinatory-paranoid picture with a polymorphic malysystematized delirium. Especially the method is effective in combination with chlorpromazine or haloperidol. When stopping the state of withdrawal from drug addicts, insulinocomatosis therapy is shown first of all, because it was from this that its use of psychiatry began.
When the method is not effective
Insulinocomatous therapy for schizophrenia is still used, but there are diseases in which this method is ineffective:
- paranoia and paraphrenic state, accompanied by delirium;
- a condition close to neurosis due to depersonalization disorder;
- giberfrennoe state with adynamic and apathetic disorder.
You need to understand that this method of treatment is selected purely individually and there are no established canons in this matter. It all depends on the condition of the patient and the doctor’s commitment to certain methods of therapy. After all, as already noted, the mechanism of action of insulinocomatous therapy is still unknown.
In which cases the treatment is not applied
The following diseases are absolute contraindications:
- An acute infectious disease, such as tuberculosis.
- Cirrhosis of the liver, as well as all types of hepatitis.
- Inflammation of the kidneys, the formation of stones.
- Diseases of the endocrine system associated with inflammation of the adrenal gland, thyroid gland and pituitary gland.
- It is categorically impossible to treat insulin in diabetes.
- Pathology of the pancreas and digestive organs.
- Diseases of the heart and circulatory system.
- The presence in a person of malignant tumors of any location.
- Respiratory diseases.
- Hormone treatment is prohibited during pregnancy.
- Do not use therapy for patients under 18 years of age.
Preparation for treatment
Insulinocomatous therapy is the immersion of a patient in an artificial coma with subsequent withdrawal from it. In this regard, all physical indicators of the patient must be satisfactory.
To prepare the patient for the procedure, he is placed in a hospital, where he undergoes a full examination. A person donates blood for sugar analysis and identification of possible pathogens of infection. Internal organs such as the liver, kidneys, pancreas, are checked by ultrasound.
Particular attention is paid to sugar levels, it is checked in a variety of situations - on an empty stomach, after exercise, after eating, etc.
Insulinocomatous therapy (methodology) was developed by psychiatrists for mentally ill people, in connection with this, all preparatory procedures and treatment are carried out on the territory of a neuropsychiatric dispensary.
The preparatory phase includes the introduction of insulin into the blood in small doses with a gradual increase in the amount (sometimes up to 7-8 units).
Typically, preparation takes from 1 to 2 weeks, after which the patient is immersed in a coma. In this case, the dose of insulin in each individual patient is different, set it, observing the reaction of the body. That is why the patient is under the constant supervision of medical personnel.
1st phase of therapy
Conventionally, all insulinocomatous therapy can be divided into 4 phases. They differ in the dosage of the administered insulin and the reaction to it.
In the 1st phase, after 2 hours the patient has an increase in sweating and salivation, arrhythmia, a decrease in blood pressure, a feeling of acute hunger and thirst. All this manifests itself against the background of general malaise and headache, numbness of the lips, tongue and face.
2nd phase of therapy
The second phase, which begins 3 hours after the administration of the drug, is manifested by the inhibition of the patient, a weak reaction to optical and acoustic stimuli, and questions addressed to the patient. Muscle relaxation comes, the person tends to sleep. The temperature decreases, hand trembling is observed.
3rd phase of therapy
This phase occurs 4 hours after administration of insulin. The patient is in deep prostration, does not understand what is happening to him, does not answer questions, loses the ability to consciously speak and move limbs. This condition is called predcomatose. There are signs of delirium, as the patient pronounces incoherent phrases and single words.
By the middle of the phase, muscle tone rises so much that the patient can unconsciously tug on the limbs, muscles of the face and even the nose, this phenomenon is called a proboscis symptom.
Blood pressure rises, perspiration intensifies, pupils dilate, heart palpitations increase. During the 3rd phase, the patient can become aggressive, delirium intensifies, hallucinations appear.
4th phase of therapy
The 4th phase of therapy is already a coma. It comes after 4 hours from the start of treatment. The patient’s consciousness at this stage is completely lost. It does not respond to light and other external stimuli. Respiratory and swallowing reflexes persist. The facial muscles are completely relaxed, there is an abundant course of saliva.
The muscles are completely relaxed, but it also happens that the spasm that arose in the 3rd phase persists during the 4th.
Coma promotes the spread of tension to all muscles, the body stretches, the head tilts back, tremors may occur. In this case, a person’s breathing becomes frequent and shallow.
Treatment regimen
In total, the patient must undergo from 15 to 40 procedures for the course of treatment. The first coma should last no more than 5 minutes, the second longer for 2-3 minutes. In this mode, the duration of the coma is brought up to 40 minutes. If the patient stops breathing or a heartbeat, then the procedure is immediately completed.
Depending on the progress in the patient's condition, the number of coma dives and the method of withdrawing from the course are selected. That is, you can do this by gradually reducing the time spent in a coma or simply abruptly stopping them.
What complications arise during treatment
The most dangerous complication of coma is an increase in the time spent in it. With any deviations in the patient’s condition from the norm, he is eliminated from it by glucose injection. But even with the management of drugs necessary for interrupting a coma, it can last from 2 to 5 days.
Another complication is the development of cardiac pathologies (up to a complete cardiac arrest), breathing problems, etc. The patient during a coma can choke with his saliva or he has a spasm of the respiratory tract.
To stop all these conditions, a set of special measures is used:
- Glucose or a special syrup is injected through a gastric tube.
- A series of injections of vitamins B 6 , B 2 , B 1 , C is carried out. They help glucose to be absorbed faster in the cells of the body.
- Be sure to put a dropper with sodium chloride.
- To restore heart rhythm, 1 ml of adrenaline is administered.
- The work of the heart muscle is supported by caffeine and cordiamine.
- In order not to develop pneumonia, the patient receives penicillin.
- To prevent bedsores, the skin is treated with special solutions. This measure begins after 2 days of coma.
After the patient regains consciousness, his psyche may be excited, this condition is stopped by antipsychotics.
To prevent seizures, the patient receives 0.1 g of phenobarbital daily.
In order to prevent epileptic seizures, the patient is treated with Seduxen, Clonazepam, or Magnesium Sulfate. The dosage is selected by the doctor based on the patient's condition and its general indicators.
Conclusion
In most Western medical circles, insulinocomatosis therapy is considered ineffective because of the high risk of harming the patient more than helping. This is caused by complex calculations of the dosage of insulin and other drugs, which can lead to frequent errors by medical personnel. Only Soviet doctors were able to carry out such complex calculations, which led to the use of the method on the territory of the USSR until the mid-80s. Then it was supplanted by the presence of new psychotropic drugs, they became easier to use.