HUMAN PSYCHOPHARMACOLOGY, VOL. 9,307 (1 994)

LETTER TO EDITORS

Letter Sirs, A Survey of Insulin Coma Experience Among Former Soviet Psychiatrists in Israel

Insulin coma therapy was a widely accepted treat- ment in schizophrenia in many countries. A series of controlled studies after the introduction of neuroleptics suggested that it is less effective than chlorprornazine and more time-consuming and dangerous (Fink etal., 1958; Blumberg et al., 1960). In most countries insulin coma therapy is no longer practiced.

The lack of efficacy of neuroleptics in a subgroup of schizophrenic patients is recognized and has reached increasing attention. Clozapine’s success has stimulated hopes for neuroleptic resistant patients. Lozovsky et al. (1985) reported effects of chronic insulin on rat brain DA receptors, and raised the possibility that insulin coma might have a rational biological basis. Many clinicians describe anecdotal evidence to the effect that remissions of schizophrenia achieved with insulin coma therapy were of higher quality and more lasting than seen today with neuroleptics.

Recently, a large scale immigration of Soviet psychiatrists to Israel has occurred. Insulin coma therapy remained popular in the Soviet Union. We surveyed former Soviet psychiatrists in Israel on their experience in recent years with insulin coma.

METHODS One hundred and eleven questionnaires were sent out to every psychiatric hospital in Israel, after tele- phone contact to obtain addresses of new immi- grant psychiatrists (1 7 hospitals). Sixty seven questionnaires were returned. The questionnaires were sent in both Hebrew and Russian. Sixty-four respondents reported personal experience with ICT, in 32 different hospitals in the former Soviet Union. The mean number of patients tested with ICT was 219 per psychiatrist (median 100) with a mean of 10.4 patients treated with ICT per year of psychiatry experience.

Table 1 summarizes the questionnaire responses.

DISCUSSION The above results suggest that ICT remained a widespread treatment among Soviet psychiatrists

Table 1. ~~

(1) Diagnostic indications for ICT Schizophrenia Other

(2) Clinical indications for ICT Neuroleptic non response Neuroleptic side-effects Previous positive experience

(3) Period of schizophrenic illness appropriate for ICT

First episode Recurrent episode Chronic illness

(4) Improvement with ICT Partial Significant Complete remission

(5) Length of remission Less than one month Month to year More than vear

97% 3%

36% 3%

68%

98% 51% 15.3%

29% 63% 8%

12% 28% 60%

and did not die a natural death by competition with neuroleptics and ECT. This is not scientific evidence for the effectiveness of ICT, but is pre- sumptive evidence that further scientific study is needed.

PAVEL LOKSHIN, KATRINA PROLOV AND R. H. BELMAKER

Ministry of Health Mental Health Centre, Faculty of Health Sciences

Ben Gurion University of the Negev, Beersheva, Israel

REFERENCES Blumberg, A. G., Laderman, P. and Fink, M. (1960).

Efficacy of divided and single dose schedules in insulin coma therapy. American Journal of Psychiatry, 116, 839-840.

Fink, M., Shaw, R., Gross, G. E. and Coleman, F. (1958). Comparative study of chlorpromazine and insulin coma therapy of psychosis. Journal of the American Medical Association, 166, 1846-1850.

Lozovsky, D. B., Kopin, I. J. and Saller, C. F. (1985). Modulation of dopamine receptor supersensitivity by chronic insulin: implication in schizophrenia. Brain Research, 343, 190.

0 1994 by John Wiley & Sons, Ltd.