Talk:Insulin shock therapy

message: Neither novel or the screen adaptation of One Flew Over the Cuckoo’s Nest mentions or uses insulin shock therapy. I'm sorry but the scene to which you are refering is one in which electroshock therapy is used. — Preceding unsigned comment added by Drei00 (talk • contribs) 23:12, 7 December 2007 (UTC)
thread_title: Early comments

message: Having examined the Wikipedia entry for "insulin coma therapy", I saw the request for updates on references. I have edited the version adding necessary references.
The treatment is best identified as "insulin coma therapy" as the aim of each treatment was the induction of coma (defined by absent deep tendon reflexes and pupillary response to light") for periods of 30 to 60 minutes.  The technical term "shock," as in surgical shock, is not applicable.
The additional references are to the detailed history in Chapter 4 of Shorter and Healy; the 1938 book by Manfred Sakel; the texts by Kalinowsky and Hoch (1946) and Sargant and Slater (1946); the articles on insulin coma by Fink: JAMA 1958 reporting the results of the RTC or ICT vs Chlorpromazine; the description of insulin coma as presented in the film about the treatment of the Nobelist John Nash, cited as "A Beautiful Mind"; the theoretical explanation of ICT in the Harvard Review of Psychiatry. (The editor is requested to cite these properly.)
In 1917 the Professor of Psychiatry in Vienna, Julius Wagner-Jauregg reported the successful relief of neurosyphilis by inducing fevers with infections of malaria.  This success became a milestone in thinking when the Nobel Prize in Medicine was awarded in 1927 for this work. Many attempts to treat other mental diseases were tried, but the two techniques that were considered successful  were the induction of coma by insulin (1933) and the induction of seizures by chemicals (1934).  These treatments were considered remarkable, much as the introduction of chlorpromazine and reserpine in the early 1950s was considered remarkable. Until the new drugs were introduced in the 1950s, ICT and ECT were widely used (much like drug treatments are today.)
ICT was replaced by the antipsychotic drugs, not because these are more effective (they are not for hospitalized schizophrenic patients) but because they are less expensive and have lower mortality rates. The risks of ICT were great. The risks of antipsychotic drugs were not known at the time that the RCT for ICT vs CPZ was published in JAMA in 1958. That study, and the cost factor, effectively ended ICT. (Its continuation in some Asian countries was occasioned by the ready availability of insulin but not chlorpromazine.)
Sakel's treatment was based on the same principle which encourages doctors to try any treatment at hand for difficult cases, as widely described as "off-label" uses. Sakel was in charge of an in-patient unit of severely ill schizophrenic patients and had no effective treatment. Insulin had been introduced in 1922 and in 1928 he found it useful in reducing the withdrawal symptoms of opiate dependence. The trial in schizophrenia was a heroic and logical medical experiment.
The induction of seizures by Ladislas Meduna was not fortuitous. He was a neuropathologist; had described a paucity of glia cells in the brain of schizophrenic patients and a marked increase in patients with epilepsy. His hypothesis was to ask, whether inducing seizures would increase gliosis and improve schizophrenia. He was successful in his first experiments which, fortunatelky, were done in catatonic schizophrenics. (See Gazdag et al. J ECT 2009; 25:3-11). (Recent studies in animals report an increase in gliosis with seizures. See citations in Medline to "seizures" and "Glia" -- references by Bolwig in Copenhagen, Henn in Germany.) 
Insulin coma therapy was successful to the extent that seizures were induced (neither insulin nor coma were the effective therapeutic agent) and that patients were selected with catatonic schizophrenia and schizo-affective form of schizophrenia. 
Deborah Doroshow was a senior at Harvard College in the History of Science program. She elected to seek an understanding of the rise and fall of insulin coma as her thesis topic. She interviewed physicians who had experience with insulin  and examined the patient records at Hillside Hospital in New York who had undergone ICT. The negative views ascribed to her are not in the published report.(She is at present a student in medicine at Harvard University and a concurrent student in history at Yale University.) 
The history of insulin coma therapy is a story of a successful treatment for a horrendous disease, schizophrenia.  In the normal march of medicine, it was replaced by another experimental treatment. 
Scidata (talk) 21:19, 30 April 2009 (UTC)
replies: text:  That was an old request for references you saw. Since then the article has been rewritten and plenty of references put in. I have reverted because you hadn't formatted the references correctly. They should be footnotes, not just scattered around the text. I don't think there is anywhere in the article at the moment where a citation is needed, but if you think a mention of any additional books, articles, etc would be useful, why not start a "further reading" section?
Staug73 (talk) 13:59, 1 May 2009 (UTC)
thread_title: Discussion

message: I am not sure that the intro to this article is the best place to get into a discussion of which psychiatric treatments induce coma and I am not even sure what the exact definition of coma is. What is the difference between: unconsciousness, sleep, coma, for example? Nobody is disputing that insulin coma therapy involves a coma - that is the point about it. But ECT? Are patients after the electric shock and before regaining consciousness in a coma? If so the best place to point this out might be the ECT article.Staug73 (talk) 12:27, 17 August 2013 (UTC)
replies: text: I didn't intend to indicate that ECT had been classed as a coma therapy. I'd be interested in the answer to the question about levels of unconsciousness (also 'narcosis') and how these treatment methods were categorised back then, presumably depending whether they (deliberately) caused physiological shock, seizures (convulsive), deep sleep and/or coma. Sighola2 (talk) 16:11, 17 August 2013 (UTC)
thread_title:  Coma 

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