Insulin therapy for mental disorders
Mental Disorders / / August 12, 2017
Insulin is assigned mainly to patients with schizophrenia.Pre made a thorough examination of the somatic status of patients.Contraindications: tuberculosis, cardiovascular and renal disease, liver disease, and endocrine diseases, pregnancy.Insulin therapy is not performed well during menstruation.
treatment is carried out in a specially dedicated to this Chamber and performed by a doctor and nurse.
insulin injections are made in the morning, on an empty stomach.The first introduction is limited to 4 units of insulin.Then add 4-8 units daily.On Saturdays and Sundays, no treatment.After
insulin patients developed hypoglycemia, the depth of which depends on the dose administered insulin.In the initial stages of treatment after administration of small doses of insulin in patients developing a sense of weakness, lethargy;hyperemic skin, but sometimes pale, sweating appears.The pulse may be first delayed and then accelerated.Patients feel a sense of hunger and thirst.With increasing doses of this symptoma
At these early stages of the treatment of patients kept in hypoglycemic state for about 3 hours. "Docked" hypoglycemia by giving the patient a glass of warm sweet tea (100-200 grams of sugar) and a breakfast rich in carbohydrates.The level of sugar in the blood is reduced, and patients come to its normal state.
In the second stage, with an increase in dosage of insulin, the degree of consciousness deepens off: state stun goes into stupor.In this state, in contact with patients can not start.The tendon reflexes are lost, there are pathological reflexes, patients do not respond to painful stimuli.Sometimes this is preceded by the stage of the motor drive: the sick tossing in bed, shouting some incoherent words or phrases.Pale skin, the body of the patients covered in cold sweat.20 minutes after the onset of hypoglycemia soporous state eliminate intravenous infusion of 20 ml of 40% glucose solution, which quickly brings the patients from this state.Consciousness is reduced, and patients given a glass of warm sweet tea or sugar syrup (150-200 grams of sugar) and breakfast.
In the third stage of treatment with the continued increase in the daily dose of insulin in patients with evolving state of transition between stupor and coma: no contact, tendon and skin, as well as pathological reflexes are not called, there remains only a weak reaction of pupils to light.In this condition the patients maintained for 20 to 30 minutes, then cropped hypoglycemia as well as the derivation of soporous state.
course of treatment usually consists of 20-30 sessions in which achieved soporous-comatose state.
It should be noted that the dose of insulin, causing stupor and coma, are strictly individual (an average of 40 to 120 units), so careful monitoring of the dynamics of the hypoglycemic state is necessary from the initial stages of treatment.
After reaching the required number of comatose states reduce daily insulin dose at 10-14 units to total abolition.
Seizures resembling epileptic seizures, require conventional measures used in such cases: the patient's protection from possible trauma, bit his tongue, swallowing large amounts of saliva, which can penetrate into the respiratory tract.The patient did not hold, so as not to contribute to fractures and dislocations;head turned to one side, rubber pad is inserted between the teeth.Immediately after the cessation of the state of hypoglycemic seizure cropped.The occurrence of seizures during hypoglycemia is not a contraindication to continuation of treatment.
protracted coma is a condition in which the ball can not be removed from the usual method of hypoglycemia.In these cases intravenously administered caffeine solution (10% -1,0-2,0), glucose (40% -20.0).If there is no effect, subcutaneously administered epinephrine solution (1: 1000-1,0).It is necessary to warn of repeated intravenous infusions of glucose solution, as they can seamlessly translate someone in hyperglycemic hypoglycemic.
Repeated (of delayed) coma may develop within a few hours of relief insulin coma.In these cases, the patients again shows signs of a hypoglycemic condition.Their cropped in the same way as conventional hypoglycemic coma.