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USE OF CONVULSIVE THERAPY WITH INSULIN
Although convulsive therapy is no method of treatment of
the schizophrenic psychosis itself, it can often play an adjuvant
part, and be particularly useful for dealing with individual
symptoms. Depression in schizophrenia, as in basically
different disorders, is often much improved by a few electrical
fits; and their use before the treatment proper is begun may
allow the patient to be more easily treated, and may, if neces-
sary, permit the physician to get a clearer perception of how
much schizophrenic disturbance there is actually present.
Depression in schizophrenia is a secondary symptom,
possibly partly psychogenic in origin, possibly partly a result
of the metabolic changes that are having a total effect on the
patientÂ’s health; but the intensity of the affective change
may obscure the realisation of the more fundamental and
ominous symptoms. The hypothymia, lassitude and anergia,
which are more directly related to the schizophrenic process
may also clear up under the influence of a few convulsions,
which are more likely to be required for that purpose after the
termination of insulin treatment than before it has begun.
Catatonic stupor usually yields to convulsive therapy, but
sometimes passes into a catatonic excitement.
Convulsions should then be used if there is doubt of the
diagnosis, or if the catatonic state interferes with the practical
details of insulin therapy, e.g. in the intake of an adequate
diet, Qr if the condition fails to respond fairly rapidly to
insulin and a depressive component is suspected. The insulin
treatment will itself be nearly always required to establish
ground gained by convulsive therapy, and to prevent the
possibility of rapid relapse. Insulin will also remedy sympl~ms
of thought disorder untouched by convulsions. There is
some evidence that a few convulsions may be of benefit
during the course of insulin treatment, for instance when the
patient has started to improve, but has failed to maintain
improvement. Where the two treatments are combined they
should be given separately and not on the same day. The
role of convulsive therapy in schizophrenia is therefore a
supplementary but important one; the improvements claimed
in the past from convulsions alone have mostly been symp-
tomatic ones without significance for the course of the
disease, or have proved temporary. Some of the few apparent
cures may well have occurred in what were fundamentally
depressive illnesses, with a schizoid colouring derived from the
structure of the personality. The highest recovery rate in
any large and varied group of cases .initiaiiy diagnosed as
schizophrenia will be achieved when insulin and convulsion
therapy are skilfully combined in differing proportions in
each case, based on the actual symptomatology shown.
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