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A less arduous regimen was the use of continuous warm baths, often given in combination with cold packs.
Historically, physical treatments can be divided into two main classes: * those that were aimed at producing a direct change in a pathophysiological process, usually by some alteration in brain function; » those that were aimed at producing symptomatic improvement through a dramatic psychological impact.
In 1933, about 10 years after the isolation of insulin by Banting and Best, Sakel introduced insulin coma treatment for psychosis (Sakel, 1938).
A suitable dose of insulin was used to produce a coma, which was terminated by either tube feeding or intravenous glucose.
518 Chapter contents History of physical treatments General considerations 519 The pharmacokinetics of psychotropic drugs 519 General advice about prescribing 522 Prescribing for special groups 523 What to do if there is no therapeutic response 524 History of physical treatments Physical treatments have been applied to patients with psychiatric disorders since antiquity, though, in retrospect, the most that could be claimed for the best of these interventions is that they were relatively harmless.
Of course, the same holds for the management of patients with general medical disorders, for which similar treatments, such as bleeding and purging, were often used regardless of diagnosis.
There were always some practitioners who doubted the efficacy of insulin coma treatment.
Their doubts were reinforced by a controlled trial by Ackner and Oldham (1962), who found that, in patients with schizophrenia, insulin coma was no more effective than a similar period of unconsciousness induced by barbiturates.
This study was published about the time when chlorpromazine was introduced, and both factors led to a rapid decline in the use of insulin coma treatment.
It should be noted that the controlled studies did not exclude the efficacy of insulin treatment in some circumstances, and a number of workers continued to maintain that it was effective.
Therefore it is interesting that recent experimental studies have shown that insulin administration causes striking changes in the release of monoamine neurotransmitters in the brain.
Perhaps the main lesson to be learned from insulin coma treatment is that the introduction of a new medical treatment should be preceded by adequate controlled trials to determine whether it is therapeutically more effective or safer than current therapies (see Chapter 6).
This view is erroneous in so far as schizophrenia-like illnesses are actually more common in patients with temporal lobe epilepsy than would be expected by chance (see p. Astute clinical observation, in combination with controlled trials, has shown that ECT is effective 1934 Insulin coma treatment (Sakel) 1936 Frontal leucotomy (Moniz) 1936 Metrazole convulsive therapy (Meduna) 1938 Electroconvulsive therapy (Cerletti and Bini) 1949 Lithium (Cade) 1952 Chlorpromazine (Delay and Deniker) 1954 Benzodiazepines (Sternbach) 1957 Iproniazid (Crane and Kline) 1957 Imipramine (Kuhn) 1966 Valpromide (valproate) in bipolar disorder (Lambert etal.) 1967 Clomipramine in obsessive-compulsive disorder (Fernandez and Lopez-Ibor) 1971 Carbamazepine in bipolar disorder (Takezaki and Hanaoka) 1988 Clozapine in treatment-resistant schizophrenia (Kane in the acute treatment of severe mood disorders.