Insulin shock occurs when there is too little or too much insulin in the human body. It occurs in cases where the patient for a long time did not eat or was engaged in physical activity. The main symptoms of insulin shock are clouding of consciousness, dizziness, fast weak pulse. Sometimes cramps occur.
In psychiatry
In addition, insulin shock began to be used in psychiatry. Specialists artificially induced hypoglycemic coma by administering insulin to humans. The first time such a method of therapy was applied by Sakel in 1933. He was a specialist in the treatment of people with heroin and morphine addiction.
According to the results of the introduction of insulin into the body, patients experienced insulin shock. It should be borne in mind that this method caused a rather high mortality rate. In 5% of cases, the consequences of artificially induced insulin shock were fatal.
During clinical studies, it was found that this technique is ineffective. The effects of insulin shock in psychiatry during clinical trials have shown its inefficiency. This at one time caused a wave of indignation among psychiatrists who actively used such therapy. It is noteworthy that the treatment of schizophrenia with insulin shock was used until the 1960s.
But over time, evidence that the effectiveness of such a method was overrated was actively disseminated. And the therapy worked only in cases when the patient was biased.
IN USSR
Back in 2004, A. I. Nelson noted that insulin shock therapy is still considered one of the most effective in the country. It is noteworthy that the American psychiatrists who visited Soviet hospitals in 1989 noted that the coma caused in this way was used on the territory of the country in relation to people who did not have signs of psychotic or affective disorders. For example, in the case of dissidents, treatment with insulin shock was used forcibly.
But at the moment, the use of this method has been significantly limited. But at the same time, it is necessary to remember that insulin shock is used only in cases where other therapy has been ineffective. But there are regions in which such a method is not used at all.
Indications
The main indication for the use of insulin shock are psychoses, schizophrenia in the first place. In particular, hallucinatory, delusional syndrome is treated in this way. It is believed that such therapy has an antidepressant effect. But, according to official statistics, in some cases, such therapy leads to deterioration, and not to improvement.
How to apply
A special room is allocated for the patient, special staff training is required, continuous monitoring of the patient in a coma. Be sure to follow the diet. Very time-consuming treatment for poor veins.
Side effects
It must be borne in mind that therapy itself has a painful effect. Therefore, the method is not too popular. Insulin shock is combined with profuse sweating, agitation and a strong feeling of hunger, cramps. Patients themselves described this treatment as extremely painful.
In addition, there is a risk that the coma will drag on. Repeated coma may occur. In some cases, insulin shock leads to death. Similar therapy and contraindications are available.
About the effect
Initially, insulin shock was caused only in mentally ill patients who refused meals. Later it was noted that the general condition of patients after such therapy improves. As a result, insulin therapy began to be used in the treatment of mental illness.
At the moment, insulin is used at the first attack of schizophrenia.
The best effect is observed with hallucinatory-paranoid schizophrenia. And the smallest demonstrates insulin therapy in the treatment of a simple form of schizophrenia.
It must be remembered that acute hepatitis, cirrhosis, pancreatitis, urolithiasis are contraindications to the use of insulin.
Such treatment is not recommended for patients suffering from exhaustion, tuberculosis, and brain diseases.
Insulin coma is achieved by intramuscular administration of insulin. Usually find the minimum necessary dose, gradually increasing the number of doses. Start with the introduction of four units of this compound.
The first coma should not last longer than 5-10 minutes. Further, her symptoms stop. Duration of coma can increase up to 40 minutes. The course of treatment is usually approximately 30 com.
Stop the manifestations of coma by introducing a 40% glucose solution. As soon as the patient recovers, he is given tea with sugar and breakfast. If he is unconscious, tea with sugar is injected through a probe. An introduction to coma is carried out every day.
Starting from the second and third phases of insulin therapy, the patient manifests drowsiness, impaired consciousness, and muscle tone decreases. His speech is oiled. Sometimes body patterns change, hallucinations begin. Often there is a grasping reflex, convulsions.
In the fourth phase, the patient becomes completely motionless, he does not react to anything, muscle tone rises, sweat is liberated, and the temperature drops. His face becomes pale, and his pupils become narrow. Sometimes there are respiratory disorders, cardiac activity, all these symptoms are accompanied by amnesia.
Complications
Such an effect on the body cannot but give complications. They are manifested in a fall in cardiac activity, heart failure, pulmonary edema, repeated hypoglycemia. If complications begin, hypoglycemia is interrupted by administering glucose, and then vitamin B1, nicotinic acid is used.
Questions
The mechanism of the effects of insulin on the course of mental illness is still very mysterious. It was possible to find out that the insulin coma affects the deepest brain structures. But at this point in time, science cannot determine exactly how this happens.
It is important to note that once a similar effect was observed in lobotomy. It was believed that she helped "pacify" the patients, but the effect was shrouded in secrets. And only after years the crippling nature of this procedure was clarified, which often led to terrifying and opposite expected consequences.
In the West at the moment, insulin therapy is not even included in educational psychiatric programs. It is simply not recognized as effective. This treatment is considered extremely painful, causes many complications, side effects, and can also cause death.
But proponents of insulin therapy continue to claim that this method works. And in a number of countries, including Russia, it is still practiced for patients with schizophrenia. It is believed that such treatment allows patients to forget for years about their illness. And sometimes even maintenance therapy is not needed. Not every treatment method in psychiatry gives such a result. In this case, insulin therapy is never used without the appropriate expert opinion, as well as the written consent of the patient directly.
Difficulties of psychiatry
Psychiatry is a fairly complex science. While doctors in other areas have accurate diagnostic methods - using instruments that clearly show signs of the disease, psychiatrists are deprived of such opportunities. There is no technique for making a diagnosis, monitoring the patient's condition. Psychiatrists are forced to rely only on the words of the patient.
Similar factors, as well as egregious cases from psychiatric practice, led to the flourishing of the movement that fought with psychiatry. Her representatives questioned the methods used by doctors. The movement unfolded in the 1960s. His supporters were concerned about the blur in the diagnosis of mental disorders. After all, each of them was too subjective. Also, the therapy used often did more harm than good to patients. For example, lobotomy, which was massively carried out in those years, was recognized as criminal in fact. I must say that she really turned out to be crippling.
Dr. Rosenhan conducted an interesting experiment in the 1970s. At his second stage, he reported to the psychiatric clinic that she would reveal the simulators whom he would send. After many simulators were captured, Rosenhan admitted that he did not send simulators. This caused a wave of indignation that rages to this day. It was found that mentally ill people just easily distinguished "their" from mishandled persons.
According to the results of the activities of these activists, the number of patients in psychiatric clinics in the United States decreased by 81%. Many of them were released and freed from treatment.
Method creator
The fate of the creator of insulin therapy was not easy. Most of the civilized countries recognized his method as the main mistake of the psychiatry of the 20th century. Its effectiveness was debunked 30 years after the invention. However, until that moment insulin comas managed to take many lives.
Manfred Zekel, as he was called towards the end of his life, was born in the city of Nadvirna in Ukraine. But it is noteworthy that during his life this area managed to pass into the citizenship of Austria, Poland, the USSR, the Third Reich, Ukraine.
The future doctor himself was born in Austria. And after the First World War, he lived in this country. After receiving a specialized education, he began working in a Berlin psychiatric hospital, focusing primarily on the treatment of drug addicts.
At the same time, a new method of treating diabetes was discovered, which was a breakthrough: the widespread use of insulin for diabetics began.
Zekel decided to follow this example. He began to use insulin to improve the appetite of his patients. As a result, when some patients from an overdose fell into a coma, Zekel noted that such a phenomenon had a positive effect on the mental status of drug addicts. Their breaking was reduced.
With the Nazis coming to power, Zekel returned to Vienna, where he continued to develop insulin-based drugs for the treatment of schizophrenics. He increased the dosage of this substance and called his method of insulin shock therapy. In this case, the lethality of this method was revealed. She could reach 5%.
And only after the war, when the painful method of therapy was used very actively, the article "The Insulin Myth" was released, which refuted the effectiveness of such treatment.
After 4 years, this method was subjected to experiments. For example, in one of them, schizophrenia was treated with insulin in some patients and barbiturates in others. The study found no differences between the groups.
This was the end for insulin shock therapy. In fact, in 1957, Dr. Zekel’s whole life business was destroyed. Private clinics continued to use the method for some time, but already in the 1970s it was safely forgotten in the USA and in European clinics. But in the USSR and the Russian Federation, insulin therapy is still included in the standards for the treatment of schizophrenia, despite the fact that it is considered the “method of last resort”.