The next time Paula has altered mental status she wants her doctor to measure her minute ventilation!

Our hypothesis is that bipolar patients may have permanent peripheral injury interfering with the mechanical ability of the respiratory muscles to ventilate i.e. to move air in and out of their bodies normally, even in states of health.

This is the case for Paula and, it seems for Kraepelin’s manic depressive patient’s patients [although this is something which we must test]. Granted, we do not understand how this could be, given our current scientific knowledge of control of breathing at rest. In a patient, like Paula, with unknown permanent peripheral injury to the neck or chest, the respiratory system may not be able to effectively respond to minor infections [G.I., respiratory], or to exposure to toxins, to head injury, malnutrition, vitamin deficiency, [especially B group,] or iron deficiency [not necessarily to the point of anaemia], to blood loss, surgery, or anything else that can further weaken the respiratory voluntary muscles.

If this hypothesis is correct, then non invasive evaluation of minute volume [see last post] will unmask the hypercapnic respiratory failure that can occur. Hypercapnia [or hypocapnia] can cause altered mental states, delirium, madness, psychosis, or whatever we choose to call “loss of mind”.. If this happens,, then it is possible that treating the hypercapnic respiratory failure will cure the manic, depressed and mixed states of insanity [or extended delirium] and restore normal physical and mental health.

This hypothesis is the extension of Dr E. Kraepelin’s observations, from his testing of all vital signs at rest, in thousands of patients during reversible attacks of depressive insanity and manic insanity, adapted to 21st century evaluations and supportive medical treatments.

The treatments to try, as I understand the literature, is to help the patient to move air in and out of the airway in times of distress, by removing obstructive secretions, opening the airway [bronchodilators], treating secondary and possibly hidden infection and giving non invasive breathing support. This has to be investigated with care, as these patients are nearer to death than they appear. Respiratory failure can cause huge disability and altered mental status for large parts of the patient’s life, before finally killing the patient. Current treatments exacerbate metabolic problems, especially blood sugar, as we are well aware and fully restored physical and mental health may not occur.

If bipolar illness does turn out to be a delirium due to inefficient ventilation, then medications might be developed to strengthen the respiratory system. For example, paxil, an S.S.R.I. has been found in at least one person with very slow breathing [Paula] to strengthen the respiratory muscles over time and to prevent future attacks. It has side effects at the beginning of treatment and can take years to slowly do whatever it does to make the patient stronger and smarter. This is what Paula found, so more research is needed to even know what the Paxil is doing biochemically everywhere in the body, including the brain. Serotonin agonists of various kinds have been found to be key to bone metabolism, liver regeneration, breathing [no one knows how], and basically all system of the body.

Kraepelin observed that seriously manic depressive untreated patients almost ALWAYS recovered their normal mental status spontaneously with time, often decades. Chapter one, Manic Depressive Disorder. Manic depressive insanity patients NEVER became permanently demented, unlike all the other disorders in the asylum. This suggests to me, that these are lengthy attacks of delirium and can be cured with proper medical treatment. [ Attacks often recurred unfortunately, even after years of normal health, wasting even more of these patients lives and perhaps leading to suicide, since the depressive attacks were so unpleasant [perhaps due to the anguish of invisible dyspnea]. – if this hypothesis proves to be correct..

In fact, Paula wants doctors to measure all of their patients minute ventilation, as part of their medical investigations. She especially wants doctors to measure the minute ventilation of psychiatric patients and of demented patients. There may yet be treatments to help that we never imagined. We need to look at the pattern of their vital signs, including minute volume, to try to understand how we might help them and possibly restore their minds. There is no substitute for mind. We need to learn more about muscle, and the skeletal system, and the mechanics of ventilation and its importance for the the health of the brain and for production of mind.

This is what we imagine what might have happened to Paul if all her vital signs had been monitored by her doctors or any other health care professionals or even her family both in periods of wellness [wellness doctor’s appointments] and illness.

Doctors, Paula’s friends and family and Paula herself would have learnt that in perfect health, without taking any medication, her baseline adult respiratory rate was 5 breaths per minute with no visible respiratory distress and some discomfort at rest; even involuntary active exhaling takes work]. This alone presents scientists with a puzzle? How is Paula even alive, never mind thriving and working? This suggests that we have much to learn about the different strategies available to the body.

Had her doctor measured her minute ventilation when Paula became sick, he or she would have discovered that it had declined even further and the doctor would have become very alarmed and would have ordered arterial blood gas tests. One imagines that they would have showed a PCO2 that was too high. The doctor would have immediately understood why Paula looked so unwell, quiet, confused [could not remember her own address] and distressed. [the distress she experienced was dyspnea not depression or anxiety. Dyspnea literally means bad breathing…which is exactly what she had.

I imagine that Paula would have recovered quickly with clearing and opening of her airway and with antibiotics for hidden infection worsening her condition. She might have done well on CPAP or some other non invasive ventilatory support.

Clinical research will help us understand if Paula had ineffective ventilation due to transient neuromuscular weakness, and will also teach us how best to treat her so she feels better and recovers her baseline mental status.

We need to research this carefully.

.TO BE CONTINUED…….[I am still writing this].

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