Brief sleep treatment with chlorpromazine

Abstract

A technique utilizing brief periods of sound narcosis (24–48 hours of sleep treatment) induced by chlorpromazine is described. It proved to be an effective and efficient therapeutic-diagnostic-management tool for severely behaviorally-disturbed and uncontrolled patients in an open, crisis-oriented milieu ward in Vietnam where no other facilities for managing such patients existed. The patient's behavioral state (assaultive, agitated, excited, disruptive manifestations) rather than a nosological diagnostic category constituted the indication for a trial of brief sleep treatment. The success of the treatment could usually be predicted from the promptness with which the patient succumbed to the soporific effects of chlorpromazine upon its initial administration and from the “soundness” of his sleep. Thus it became particularly helpful in differentially diagnosing acute or transient psychotic stress states from the more entrenched, persistent ones. The degree to which this therapeutic tool may have aborted more lasting psychotic reactions was not assessed through the use of control patients, nor was the possible efficacy of drugs other than the antipsychotic, chlorpromazine, determined. No hypothesis for the possible specific therapeutic effects of chlorpromazine-induced sleep is advanced, though some appear in the world literature. 8,9,16,29 Because the usual complications of sleep treatment have been minimized by the particular form in which it was used here and because of the potential implications of this relatively simple and safe technique for the crisis management of severely disturbed psychiatric patients in the civilian community (secondary prevention), especially for settings which have limited psychiatric treatment resources, a description of this technique and a discussion of its results have been presented.