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Irreversible Hypoglycaemic Coma in Islet-Cell Adenoma and in Schizophrenia

Published online by Cambridge University Press:  08 February 2018

D. N. Parfitt
D. N. Parfitt*
Affiliation:
Consultant Psychiatrist St. Ann's Hospital, Canford Cliffs, Dorset
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Extract

As an approach to the problem of schizophrenia it is proposed to compare the effects and after-effects of severe hypoglycaemia due mainly to islet-cell adenoma of the pancreas in otherwise healthy people with the effects and after-effects of severe hypoglycaemia therapeutically induced in schizophrenics.

The difficulties are plain. Personal experience of patients with functioning islet-cell adenoma is limited almost always to a few cases, whereas average experience of insulin coma treatment covers some hundreds of cases; moreover, there is little overlap of experience except in the post-mortem room or in the laboratory for morbid histology. During insulin treatment there is constant supervision by a trained staff, medical and nursing, so that serious developments can be met by immediate intravenous sugar and investigations are continual; with adenomata there is no observation until, perhaps, a general practitioner is called in about alarming symptoms of one kind or another and sometimes months or even years elapse before a patient gets into hospital, where the intensity of observation and even more so of investigation may exceed that available in mental hospitals. Insulin coma treatment has a more or less standard aim, to produce coma of increasing duration up to a maximum of something like an hour which is then repeated thirty times or more; dosage is built up with the greatest care. Adenomata produce conditions varying from the hardly serious to the fatal under the influence of an insulin dosage which is quite unknown.

This comparison is based chiefly on an analysis of 290 serial courses of insulin coma treatment given to schizophrenic patients at Holloway Sanatorium during the four years 1950 to 1953 inclusive, and on the 258 cases of islet-cell adenoma reported by Crain and Thorn (1949) and the 398 cases, all that could be traced up to that date and including the Crain and Thorn cases, analysed by Howard, Moss and Rhoads (1950). Many separate papers have been consulted for more detailed approaches and for extra information, although of course those published before 1950 were included in the reviews already mentioned. Despite the difficulties of this comparison, it can be shown that the similarities between the two groups follow expectation and are very strong indeed, so that the differences which emerge have at least possible significance.

Type
Original Articles
Information
Journal of Mental Science , Volume 101 , Issue 424 , July 1955 , pp. 673 - 682
Copyright
Copyright © Royal College of Psychiatrists, 1955 

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References

Adrian, E. D., Brit. med. J., 1954, i, 287.CrossRefGoogle Scholar
Baker, A. B., Arch. Path., 1938, 26, 765.Google Scholar
Biskupski, J. S., Brit. med. J., 1954, ii, 596.Google Scholar
Black, K. O., Corbett, R. S., Hosford, J. P., and Turner, J. W. A., Ibid., 1954, i, 55.Google Scholar
Blau, A., Reider, N., and Bender, M. B., Ann. intern. Med., 1936, 10, 910.Google Scholar
Bowen, B. D., and Beck, G., Ibid., 1933, 6, 1412.Google Scholar
Crain, E. L., and Thorn, G. W., Medicine, 1949, 28, 427.Google Scholar
Ferraro, A., and Jervis, G. A., Psych. Quart., 1939, 13, 207.Google Scholar
Ferraro, A., J. Neuropath. exp. Neurol., 1942, 1, 188.CrossRefGoogle Scholar
Goodman, J. I., Amer. Pract. Dig. Treat., 1954, 5, 464.Google Scholar
Graham, E. A., and Hartmann, A. F., Surg. Gynec. Obst., 1934, 54, 474.Google Scholar
Greenlees, R. G., White, R. R., and Philips, C., J. Amer. med. Assoc., 1952, 149, 272.Google Scholar
Greenwood, J. Jr., Pennsylv. med. J., 1935, 39, 12.Google Scholar
Hassin, G. B., Arch. Neurol. Psychiat., 1939, 42, 619.Google Scholar
Himwich, H. E., Bowman, K. M., Daly, G., Fazekas, J. R., Wortis, J., and Goldfarb, W., Amer. J. Physiol., 1941, 132, 640.CrossRefGoogle Scholar
Howard, J. M., Moss, N. H., and Rhoads, J. E., Surg. Gynec. Obst., 1950, 90 (Intern. Abst. Surg. Section), 417.Google Scholar
Jelliffe, D. B., and Stuart, K. L., Brit. med. J., 1954, i, 75.Google Scholar
Jetter, W. W., and Sheflen, A. E., J. Neuropath. exp. Neurol., 1952, 11, 317.Google Scholar
Kerwin, A. J., Amer. J. med. Sci., 1942, 203, 363.Google Scholar
Kety, S. S., Woodford, R. B., Harmel, M. H., Freyhan, F. A., Appel, K. E., and Schmidt, C. F., Amer. J. Psychiat., 1948, 104, 765.Google Scholar
Kraulis, W., Ibid., 1948, 105, 373.Google Scholar
Labbé, M., and Boulin, R., Presse méd., 1937, 45, 225.Google Scholar
Layne, J. A., and Baker, A. B., Minnesota Med., 1939, 22, 771.Google Scholar
Lidz, T., Miller, J. M., Padget, P., and Stedem, A. F. A., Arch. Neurol. Psychiat., 1949, 62, 304.Google Scholar
Mackeith, S. A., and Meyer, A., J. Ment. Sci., 1939, 85, 96.Google Scholar
Malamud, N., and Grosh, L. C., Arch. intern. Med., 1938, 61, 579.Google Scholar
Malamud, N., Amer. J. Psychiat., 1948, 105, 373.Google Scholar
Marble, A., The Treatment of Diabetes Mellitus. 9th Ed. By Joslin, E. P., Root, H. F., White, Priscilla and Marble, A., 323.Google Scholar
Moersch, F. P., and Kernohan, J. W., Arch. Neurol. Psychiat., 1938, 39, 242.Google Scholar
Morsier, G., and Moser, J. J., Ann. Méd., 1936, 39, 474.Google Scholar
Murray, E. G. D., Lancet, 1954, i, 221.Google Scholar
Parfitt, D. N., Proc. R. Soc. Med., 1937, 31 (Sect. Psychiat.), 11.Google Scholar
Idem , R.M.P.A. Lecture, 1954.Google Scholar
Revitch, E., Psych. Quart., 1954, 28, 72.Google Scholar
Rivers, T. D., and Rome, H. P., Arch. Neurol. Psychiat., 1944, 51, 550.Google Scholar
Roxburgh, R. C., Lancet, 1954, i, 1057.Google Scholar
Sakel, M., Neue Behandlungsmethode der Schizophrenie, 1935. Vienna.Google Scholar
Sargant, W., and Slater, E., An Introduction to Physical Methods of Treatment in Psychiatry, 2nd Ed. 1948. Edinburgh.Google Scholar
Schaffer, K., and Miskolczy, D., Histopathologic des Neurones, 1938. Leipsig.Google Scholar
Sigwald, J., L'hypoglycémie, 1932. Paris.Google Scholar
Smith, A. N., and Cochran, J. B., Lancet, 1952, i, 289.Google Scholar
Tom, Mary I., and Richardson, J. C., J. Neuropath. exp. Neurol., 1951, 10, 57.Google Scholar
Wickes, I. G., Brit. med. J., 1954, 2, 1029.Google Scholar
Wilder, R. M., Clinical Diabetes Mellitus and Hyperinsulinism, 1940. Philadelphia.Google Scholar
Wolff, H. G., Physiol. Rev., 1936, 16, 545.Google Scholar
Wortes, J., and Lambert, R. H., Amer. J. Psychiat., 1939, 96, 335.Google Scholar
Yannet, N., Arch. Neurol. Psychiat., 1939, 42, 395.CrossRefGoogle Scholar
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