Combined treatment of manic-depressive psychoses

May 01, 2018 19:00 | Symptoms And Treatment
Any psychiatrist knows, and everyday clinical experience confirms that not every manic-depressive disease requires the same treatment method. It has long been sought to find out which type of therapy is most suitable for one form or another of the disease, but so far these efforts have not yielded yet reliable results. It is known that vital forms of depression are best suited for treatment with tofranil and that postpartum depression reacts relatively poorly to convulsive therapy. However, this does not mean that on the basis of the patient's condition or the course of the disease, the psychopathological picture, the age and constitution of the patient, the number of phases and the like of mental and physical data, the physician can now come to the conclusion that this is the case and not another method of treatment. It should be as accurate as possible clinical-therapeutic observation, follow-up and clinico-statistical surveys of homogeneous clinical material, more accurately establish a range of indications for each form. Only in very few cases of depression can we now accurately chart the way of somatic therapy on the basis of accumulated experience, in most cases it is necessary to make a decision without a clear understanding of why this patient is assigned this particular, and not another remedy. This state of things naturally induces the use of combined treatment, which, in the absence of thoughtfulness and a sense of proportion, can degenerate into an indiscriminate and stupid application of a multitude, a variety of means and techniques.

The temptation to use a number of theoretical possibilities simultaneously is supported by the fact that only a few patients have a clear, psychopathologically clean clinical picture. Whether it is possible to use combined therapy in manic-depressive psychoses and whether it promises to be more effective here than any single method, it is still not clear. It should only be emphasized that one can never "combine" in cases when it is a question of testing some medical method.

Regarding the first question, we already know that various methods of convulsive therapy can be combined with inhalation, and pharmacotherapeutic. It is possible to combine convulsive therapy with medium doses of phenothiazine preparations, tofranil, relaxants, evipan anesthesia. In this case the dosage of evipan should be relatively a namesake. It is also possible to perform simultaneous inhalation and pharmacological therapy. Reserpine can be used along with convulsive therapy in combination with orfenadrine. Known caution is recommended, however, and in this case. After taking pure reserpine, convulsive or inhaled treatment is possible no earlier than 48-96 hours.

It is much more difficult to answer the second question - the degree of expediency of combined treatment. In our opinion, the time necessary for the onset of remission is not reduced here. But it is true-and this is very important-that convulsive treatment with simultaneous daily inhalation therapy reduces the number of convulsive-therapeutic procedures needed for remission. The same applies to the combination of convulsive therapy with pharmacological therapy. In addition to reducing the required number of shocks, this combination therapy is also gentle. If, on the basis of the first impressions, they do not dare to carry out only pharmacotherapy alone, one can start using electroconvulsive therapy starting with it. This leads to the fact that patients suffering from various manifestations of their psychosis, rather, begin to feel relieved and do not suffer so painfully the fact of being in the hospital.

The question of which therapeutic combination to choose, it is necessary to solve individually. Some data for this solution is provided by the study of the psychopathological picture, but other factors must also be taken into account: the patient's age, general somatic state, blood circulation, blood pressure, cerebral blood supply, metabolism, allergic reactions, etc.,for example, his insuperable fear of shock.

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