NARCOTHERAPY OF SCHIZOPHRENIA BY INTRAVENOUS ALCOHOL DRIP METHOD

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP82-00039R000100230005-1
• Release Decision: RIPPUB
• Original Classification: R
• Document Page Count: 14
• Document Creation Date: December 22, 2016
• Document Release Date: May 10, 2012
• Sequence Number: 5
• Publication Date: February 29, 1952
• Content Type: REPORT

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NARCOTHLR[1PY OF SCHIZOPHRENIA BY INTRAVENOUS ALCOHOL DRIP METHOD
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author: 0, V. Kerbikov
Nerropatologiya i Psikhiatriya, No 6, 1950, pp Zj.3-G.9
STAT
STAT
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NARCOTHLRAPY OF SCHIZOPHRENIA BY INT VENOUS _ALCOHOL DRIP
PRELIMINARY COMMUNICATION
(Presented 13 June 1950 at the scientific session of the Scientific
Resear. ch Institute of Psychiatry imeni Asatian~ of the M7_nistry of
Health)Georgian SSR in Tbilisi.)
i
Professor 0. V. Kerbikov and Ye, S. Zorina (Yaroslavl')
(Aecep bed by the Editors 27 July 1950)
While it is an ordi_naryr occurrence f'or theory to lag behind
practice in all fields of :Life, the reverse condition has come to
exist in tree fielc._ relating to narcotherapy of psychoses' where
psychiatric practice lags behind 'the theoretical developments of
I. P. Pavlov and his pupils,
K
After having tried a number of remedies (somifen, & ioetan,
veronal, luminal, etc.), psychiatrists have come to depend on one
agent, sodium aanytal, which leaves patients in a sate of partial
(not unbroken) sleep.
This type of treatment, however, is far from the stage where
it may be considered satisfactory. It is substantially less effec-Live than:i_ns..lln shock treatments This explains the fact that
treatment by prolonged sleep is used less than treatment with in-
sulin for most cases,
Is there any justi?'icati-on for hoping that narcotic sleep
would be more effective if it were to be induced by other prepa-
rations? Of course there is.
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A number of investigations, especially the investigations of
V. S. Galkin, have shown that the reactions of the organism during
narcotic sleep tend to vary depending on the character of the nar-
co tic,
The problem in the search for new methods of producing pro-
longed sleep, we think, may be defined as follows. It is necessary
to find a sleep-inducing agent in which therapeutic action would not
only result from the sleep it induces but also from the properties
of the agent itself, Our investigations for such agents have led
us to adopt ethyl alcohol.
To explain our choice lets us first of all consider the ex-
change of opinion that took place at one of "Pavlovas Wednesdays't
(L;. April) to l93), V. P. Golovina said during the course of a
discussion on the action of narcotics; "Do you remember patient
S. who had been completely blocked up? When we gave her some al-
cohol she began to talk without ceasing,'' To which 1, P. Pavlov
replied; ''That is to say we destroyed her block, and so for a
whole month she acted without any brakes.'
Thus attempts were made in Pavlov's laboratory to use
alcohol as an agent for influencing the psychotic condition of
schizophrenics,
A number of considerations and. facts have caused us to
regard alcohol as an agent capable of exerting a therapeutic
influence on the schizophrenic process,
1. Psychiatric practice established long ago that the
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expression of schizophrenia and the expression of alcoholism rarely
coincide. The strange changes produced by alcohol and schizophrenia
in the psyche have been written about by S. G. Zhislin among Soviet
writers and by E. Bleuler among foreign writers,
on the basis of variational statistical analysis of data
consisting of ii,186 cases, we found a negative correlation between
the syndromes of alcohol psychoses and the schizophrenias (syndromo-
logical antagonism).
2. There is no doubt that the basic disturbances occurring
in schizophrenia relate to the activity of the brain's cortex.
There is reason to think that alcohol, being a 1tcortical" narcotics
would be more effective than sodium amytal and other barbiturates
belonging to the category of "core" narcotic
3, Alcohol is a normal component of the blood (up to 0.02
percent according to Krakov), N. V. Lazerev places it among
endogenous narcotics. one can here think of its powerful physio~
logical action, Its role as a fuel is known, the burning of alcohol
in the organism results in the "savi.ng't of other substances, fad`;
b-ns in particular.
1i. Certain features are peculiar to the pharmacodynamics
of alcohol. It is distinguished by widely varying effects (the
smallest dose of ethyl alcohol capable of creating functional
paralysis is 25 times the minimum dose necessary for urethan,
times greater than for ether, and L. times greater than for chloro-
form), by prolonged duration of its effect, by its persistent
lingering within the organism (rate of combustion i..s 10 milliliters
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t
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per hour according to one source, 16 milliliters per hour for
whatever quantity is present according to another source).
narcotics increase rather than decreases; ~t stimulates the
q
utilization of glucose by the different tissues (Vo I.
Prostyakova).
t i,.
T, , 4i i flg rd' i'bn of alcohol in contrast with other
ne-, , Gi (:,
our search for agents capable of producing prolonged narcosis.
We thus had adequate reasons for settling on alcohol in
However, a problem of purely meth.od.ological character
arose --- to find. a means for repeated, daily introduction of
ethyl alcohol into the organism in considerable doses with a
dual purpose: (1) to cause patients to fall daily into a nar-
cotic sleep and. (2) to be able to assure the organismts receiving
a subsequent dose of alcohol before the alcohol already hd thin
the system has completely been burned up, or, in any case, be-
fore its effect, has worn off.
essary to stop further therapy. Moreover, it was necessary to
would inevitably produce thrornbophlebitis and would make it nec-
introducing it internally, inasmuch as two or three such doses
We could not employ the usual method used. by surgeons for
p.
onset of hemolysis.
prevent the denaturation ofb in the blood with possible
Our attempts begun in April l9L~8 were successful. We
found a liquid with a composition that met the requirements men-
tioned above and one in which the percentage of alcohol could be
altered to suit the condition of the patient. We introduced this
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liquid intravenously by the drip method,
In March 199 we were given two cots in the hospital ward
for therapy with this liquid.
Altogether we applied the a lcohol~containing liquid by the
drip method X88 times,
Four hundred twenty-six injections were made as course
treatments of psychoses, 6 for diagnostic purposes, and 70 for
improvi.ng the somatic condition of patients.
Injections for improving the somatic condition were given
to 1l severe chronic cases who were suffering from emaciation due
to prolonged refusals of food or from comparable ailments. As a
rule the injection aroused the appetite; the patients improved
physically. Parallel with this, the psychic condition in the
majority of cases tended to straighten out to some extent
(internal improvement of illness). Three of them were discharged
from the hospital into the care of relatives,
Those injections that had been. made for diagnostic pur-
poses, as a rule, helped to establish the genesis for different
conditions of stupor; they are now being used as a method of
differential diagnosis for cases involving forensic psychiatric
expert opinion.
On the average each course of treatment for a patient
requires 11 injections. Remission took place for 13 patients,
while the therapy gave no results in lO cases. The last figure
in a sense is indicative of hurry on our part to terminate therapy
5
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The activity (as confirmed by self-observation) is
characterized by the combination of hypomania with a rr1anifesta~
tion of deafening and a narrowing of awareness. In this phase
the patient undergoes a feeling of general release, tries to
move around, talk, and. to orate. They dwell on experiences
that have an emotional cast to them. Patients more frequently
than not become euphoric, occasionally depressed. They dis~
close involved experiences. Special features of personality
hitherto unknown because of inhibitions or inaccessibility
are disclosed in this phase, creating an opportunity for de-
terminirlg the relationship of patients to their surroundings,
the character of their thinking, and the types of their reactions.
It becomes possible to achieve a rapport with patients (an im-
portant moment for psychotherapy). This phase is often for-
gotten by patients.
The narcotic phase is characterized by dii'ferences in
depth varying from a state approximating surgical narcosis to
a more superficial condition resembling physiological sleep.
We did not attempt to deepen the narcosis. The duration and
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for the groups that had been showing no results.
Patients who had remissions remained in the fixed group
for an average time of 3~ days (from the first injection to dis-charge ).
The narcotherapy as we conducted it involved two phases;
the first consisted of a state of activity, the second, a state
of narcotic sleep.
 We make daily injections for L-~ days, discontinue for
2-3 days, and then repeat -- two to four rounds altogether. The
2L-hour cycle for patients at this time is divided as follows:
a state of hypomaniacal excitement with a change in consciousness
lasting 2-5 hours; a state of narcotic sleep and drowsiness last-ing I4-8 hours; regular nightly sleep (which does not suffer)
las.Lng 9-10 hours; and a condition which is normal for the
patient lasting ~.-6 hours. During the period of therapy there
is increased appetite (one female patient was affected by bulimia)
and patients gain in weight. Several female patients who had not
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depth of the phases depend upon the concentration and rate of
introducing the narcotic mixtures The average effectiveness for
each infusion is 3 to 32 hours (Figures 2 and 3).
Upon awakening, the patients are slightly d
hypomania usually being expressed to a lesser degree and for a
shorter period of time.
During the period of the injection there is noted a
hyperemia of the skin surface, particularly of the face, which
varies with the amount of the narcotic mixture absorbed by the
organism. This is accompanied by increased sweat secretion
The pulse rate fluctuates 5-iO beats above and below the usual
rate. At the same time it is stronger and softer as in insulin
hypoglycemia. Respiration is free and deep. The blood pressure
at first decreases by 10-12 milligrams, but 2-3 hours after the
injection it returns to its original level. Increased diuresis
is observed. The eye reflexes, the tendon reflexes, and sensi-
tivity vary, depending upon the depth of the narcosis.
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menstruated for 3-~. months did so, which may be explained probably
by its being a component of stimulating therapy at the expense of
}"' on ofn in the blood. Some of the patients
the den~t~.rat' ~.
insi nifican't decrease in the number of
were observed to have an g
Tobin and leucocytes, these levelled out
erythrocytes, hemo g ,
interval. The urine underwent no change.
after the 2 3 day
asarlt indirect manifestations we noted only
Alpo ng unple ,
vomiting on the part of several patients (which began with the
and disappeared after the concentration of
first few injections
and irritation (redness, slight fever)
the solution was dilvted) ,
which disappeared 3- days following the ter-
along the veins,
mrtina.tion of the =ectionsm Anon-pathological hardening of the
~-nJ
h in ections is observable for about a third
veins than receive t e j
of the patients It has also proved to be temporary. Not once
did we find ourselves obliged to use heart stimulants or lobelin
'ons because of the development of any general
or to stop the injecti
manifestations of cofapsee
procedure is carried out by a nurse, although,
the entire
of course, a doctor is present in the ward.
The outward behaor of patients changes after the first
few injections. Among recently affected schizophrenics it is
first of all in the release of inhibitions and change
expressed
the direction of hypomani.a, in a change in attitude
in mood in
toward hallucinations, in the di.sintegratioll of delirium spells
the time had conditioned the affective strain of the
h1 Ch up to
patients . Incil)ient hysterical symptoms and an intensification
of sexual fantasies are observed. A disappearance of auditory
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hallucinations takes place for some during the course of the first
phase Effects of this kind are less evident during the period of
released inhibition in cases of prolonged illness.
Forty patients received complete treatments; 35 suffering
from. schizophrenia, 3 from reactive depression, and 2 from cir-
cular psychosis. Eleven patients received injections to improve
an aggravated somatic condition, and 13 patients, principally
suffering from stupor, to determine the diagnosis.
It is difficult to speak positively of the effectiveness
of the therapy in the face of such a small body of material. We
have a considerable amour: of experience with respect to women
because Ye. S. Zorina has bee:ri using this therapy in the women's
ward since l92.9.
For 2Zt. patients two had type A remissions, six type B,
five type C, and four type D, while seven disclosed either a
change of syndrome or no change whatever.
Similar figures were obtained at the Yaroslavl' hospital
while using insulin shock therapy.
The male ward showed considerably poorer results. Of 12
schizophrenic cases, one had type A remission, one type B, one
type C, and three type D, while the state of six patients showed
no change.
It would be premature for us on the basis of this data,
to make the obvious conclusion that men are less amenable to
cure by this method because they have used alcohol more heavily.
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All three patients suffering from reactive stupor re-.
covered; one circular patient (maniacal condition) was discharged
as cured; and the second (in a depression phase) showed no im-
proverrler1t, `I`he correlation between the effectiveness of therapy
and the length of illness has not yet been established. Of 17
patients who had been ill for one year, 7 had type A, B, and C
remissions; of 11 patients who had been ill for more than three
years, five had remissions. The greatest duration of catamnesis
was one year for a type A remission.
We are not going to construct any theories concerning the
mechanism of interference by our method with respect to the
pathologically_changed higher nervous functions, Instead we
shall cite certain findings of Pavlov and his pupils,
Pavlov' once said; "During the thirty years we have been
working with conditioned reflexes, we have continually received
the impression that the inhibition process is more labile than
the stimulation process, that is, that it is much more easily
disrupted and weakened from different actions than is the stimu-.
lation process," (Pavlovts Wednesdays, tom II, page 27L).
Just as did Pavlov, so did psychiatrists working with him
explain the majority of the manifestations of schizophrenia by the
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in the past. The fact is that this therapy was conducted in the
ments ward only during February, that is, only during the period
when we were taring to establish our method, The average number
of injections was seven, that is, the majority had undergone a
single five-day course of treatment,
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pathology (irradiation, inertness, paradoxical and ultraparadoxical
phases) of the inhibition process,
It is known that the first fact that was established in
studying the action of alcohol (I. V. Zavadskiy, M. P. Nikiforovskiy,
A.. A. Lindberg, F. K. Fedorov, M. K. Petrova.) was that it first of
all paralyzes the inhibition process and only then does the para-
lyzing process spread to stimulation,
It has been established through the last researches of V.
K. Fedorov that the paralyzing action o a narcotic affects first
of all the more delicate, new, and least securely established
nervous processes in the large hemispheres.
These experiments have disclosed that new, delicate, and
fragile processes may take place as pathological connections,
which are broken by alcohol, Alcohol can help reestablish con-
ditioned reflex actions,
The following statement of I. P. Pavlov is most important
for us; t1Where you have a hypnotic condition, the inhibition
process is the most important functional activity, whereas the
paralyzing force of narcotics tends to weaken this process.
When you have a reverse condition, that is, when the stimulating
process predominates and the action of the inhibition process is
entirely absent, then the paralyzing agent affects the positive
process.' (Pavlovis~es, tom III, pages 233-23L).
Consequently alcohol acts upon that which is predominant
for a given pathological functioning of the cortex.
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This statement of I. P. Pavlov serves to explain the posi-.
tive action of the therapy we are studying in the healing of
different psychotic conditions a
In evaluating schizophrenic symptoms as the manifesta-
tion of a chronic hypnotic, that is, inhibitive, state, Pavlov
wrote; Thus, this state, on the one hand, is pathological --
pathological inasmuch as it deprives the patient of the possi-
bility of normal activity; on the other hand its actual mechanism.
makes it physiological -- physiological inasmuch as it protects
the cortical cells from threatening disintegration caused by work
they cannot hand,, (An Experimental Excursion of a Physiologist
into the Field of Psychiatry),
When using these statements of Ie P. Pavlov in psychiatric
therapeutic practice, there is generally applied the second part
of the sentence just quoted, that is, the idea of the protective
role of inhibition,
Nevertheless, it is necessary to make use of the first part
of Pavlov+s utterance for certain cases of schizophrenia, where
chronic inhibition is referred to as being pathological.
It would be proper to mention that the self-healing of a
catatonic stupor which had. continued for twenty years was explained
by Pavlov by bhe fact that the onset of old age had removed the
inhibition.
There seemingly are schizophrenics who should be treated not
so much by intensifying the inhibition as by removing it.
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Alcohol in this sense has certain undoubted advantages,
inasmuch as it clearly is able to bring on two phases of activity
-- inhibitive and release of inhibition.
In our practice we do not by any means hasten and deepen
the second phase for all cases; quite frequently we try to pro-
tons the first phase, easily achieved by using the drip method
of administering the preparation.
We naturally do not have as yet any hard and fast criteria
on the basis of which it would be possible to say in what cases the
first phase should be prolonged or should be used exclusively, and
in what cases it should be curtailed as much as possible or even
eliminated (whi..ch. is possible by a preliminary administering of
pentcthal, a narcotic with a single-phase action) . Here we are
completely in the field of clinical experience, similar to the
way in which the question of determining on the basis of clinical
practice whether hypoglycemic or shock doses should be used in
insulin. therapy.
Many workers (Narbutovich and Golovina, Perelman, Ivanov-
Smolenski.y, Gi].yarovskiy, Razymovskaya-Molukalo, Svyadosh, etc}
have used alcohol in the form of sporadic injections of small
doses so as to temporarily release the inhibition factors of
patients who are in a stupor. We have used it as an agent in
course sleep therapy and, as far as can be determined by pre-
l:~.2 inary observations, with satisfactory results,
{Note; Article includes four photographs]
END
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