ASSOCIATED with the Massachusetts Department of Mental Health is an ' agency designated to investigate certain deaths occurring in psychiatric hospitals. In the last 11 years eight deaths incident to insulin coma or subcoma therapy have been reviewed: four in state hospitals, two in private institutions, one in a veterans hospital, and one following treatment in a patient's home.
Numerous fatal insulin reactions have been reported.1 Most of the clinical papers have been concerned with the events of the final coma. Little attention has been paid to factors, other than overt organic diseases, which give warning of an untoward reaction. Certain clinical features and aberrant physiological responses occurring prior to the fatal reaction, and of possible value in prognosticating it, are presented in this report.
Case 1.
—A white man aged 47, with a diagnosis of schizophrenia, paranoid type, was treated with insulin coma. On the 63d treatment, 28th coma,