2. Insulin Coma Therapy was introduced by Manfred Sakel and was used between
the 1940’s and 50’s to treat schizophrenia. ICT was a psychiatric treatment in
which patients received large doses of insulin in order to produce daily comas
over several weeks.
What is Insulin Coma Therapy?
3. ● ICT was a labor-intensive treatment that required a trained staff and a
special unit.
● Patients, who were diagnosed with schizophrenia, were selected on the
basis of having a good prognosis and the physical strength to handle the
treatments effects.
● There were no standard guidelines for ICT treatment.
● Typically, patients received gradually increased doses of insulin to 100-
150 units for six days a week for two months.
● After receiving ICT, nurses spent time giving patients special treatment
such as walks, picking flowers, or playing games.
● Doses of 450 units were used occasionally, and courses of up to two years
have been documented.
Procedure
4. Although few psychiatrists (including Sakel) reported a success rate of 80%,
the general consensus was 50% in patients who had been ill for less than a
year with no influence on relapse.
Sakel believed that the therapy worked by, “causing an intensification of the
tonus of the parasympathetic end of the autonomic nervous system, by
blockading the nerve cell, and by strengthening the anabolic force which
induces the restoration of the normal function of the nerve cell and the
recovery of the patient.”
Another theory was that patients were somehow “jolted” out of their mental
illness.
Effects
5. Symptoms and Side Effects
Patience experienced various
symptoms of hypoglycemia:
● flushing
● pallor
● sweating
● salivating
● drowsiness
● restlessness
Hypoglycemia that resulted made
patients liable to further convulsions
and “after-shocks”.
Coma- if the dose was high enough-
would follow.
Each coma required termination by
IV glucose.
Seizures sometimes occurred before
or during the coma.
In addition, patients frequently
emerged from treatment “grossly
obese”
The most severe risk factors included
death and brain damage resulting
from irreversible or prolonged coma.
6. Many psychiatrists believed that the seizures resulting from ICT were actually
therapeutic (that schizophrenia and epilepsy rarely occurred in the same
patient) and gave patients electroconvulsive therapy or cardiazol/metrazol
convulsive therapy during the coma, or on the day of the week that patients
did not have insulin therapy.
Studies at the time claimed that many of the cases of brain damage were
actually therapeutic improvement because patients showed “loss of tension
and hostility”.
Faults of the Medical Professionals
7. ● 1953 British psychiatrist Harold Bourne published “The Insulin Myth” in
the Lancet, in which he argued that insulin coma therapy had no sound
basis, and that if treatment worked it was because patients were chosen
for their good prognosis and given special treatment.
● 1957, when ICT was already declining, the Lancet published the results
of a randomized, controlled trial where patients received ICT or identical
treatment but with unconsciousness produced by barbiturates. Which
concluded that with no difference in the results, insulin was not the
specific therapeutic agent.
● 1958 Bourne published a paper on increasing disillusionment in the
psychiatric literature about ICT for schizophrenia.
Decline of ICT
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