Kraepelin seems to have made some important and accurate observations.
Bipolar attacks; response to [internal] bleeding and [hidden till measured with a stop watch] bradypnea.
It seems to me, from reading Kraepelin, that a basic physical examination is all that is needed to diagnose serious and disabling bipolar depression.
- Looking at the patient’s general physical state
[ie. Kraepelin tells us these patients looked unwell; thin, malnourished, pale, cold, constipated, dehydrated, tired, changes of sleep patterns, etc…]
- Measuring the patient’s basic physical signs
[Kraepelin documented different patterns of altered mental status, abnormal breathing rates, heart signs, pulse, blood pressure, and body temperature in depressed and manic phases of this syndrome. ]
This will tell the the doctor if the patient is physically sick.
Breathing rates may be abnormally low during attacks of depressive insanity.
Blood pressure, heart rate and level of distress may be unusually high.
It is possible that “retarded” breathing” makes physical and mental functioning more difficult – especially after suffering blood loss or infection.
Is it possible that greatly increased muscle activity and temperature [Mania] is needed by these patients, to increase breathing during metabolic challenges. Is it possible that abnormal breathing is linked to abnormal mental status ? Is it possible that recovery can be accelerated by modern supportive medical treatments ?
1] Can we replicate Kraepelin’s findings ?
2] if “retarded” breathing turns out to be important, then what can we do for these patients ?
Promoting recovery to pre-injury level is important from a patient care as well as a societal perspective. [in Kraepelin’s day patient’s recovered completely but it took decades to happen by itself.]
Bipolar patients seem to be “wired” differently. Breathing rate stays low and the ANS must adjust everything a little differently. Raising breathing rate seems to require heat of muscle activity [arms, legs, etc..].