Science involves integrating new knowledge

Over one hundred years ago, Dr Emile Kraepelin found abnormal breathing rates in unmedicated patients with manic depressive insanity [bipolar illness]. He came to the conclusion that bipolar illness was a consequence of metabolic dysfunction. This is especially clear in bipolar depressive attacks, where Kraepelin found breathing that was slow. This is a reference to respiratory failure. Slow breathing, a sensation of anguish [dyspnea] and lethargy seem obviously linked to the poor mood and cognitive deficits of bipolar depressive attacks. .

The lung does not seem to be the problem. We do not think that these patients have COPD.

We are starting to think that the skeletal respiratory muscle pump system is responsible.

Paula and have just figured out two things. Two observations which may explain why she got so sick all those years ago.

This new data may change medical practice and medical treatments, by changing what we understand to be important in the field of respiratory physiology to changing our models of serious “mental” illness.

1] Paula’s minute ventilation is 1.95 litres in health ………..not the 5-6 litres mentioned in textbooks. Minute ventilation is derived from respiratory rate at rest per minute and respiratory volume [using portable spirometry]. This has never been described in the scientific literature. [We worked this out with the help of a respiratory physiologist lung doctor who is my friend].

How can this be? Does Paula need less air than others?   Has her metabolism made adjustments due to her difficult birth?

This suggests that by ignoring breathing rate and minute ventilation we have made incorrect assumptions about biological issues.

2] Paula’s breathing rate does not increase from the biological stress of infection, inflammation or other usual stimulants of breathing rate at rest. Her breathing should rise when she becomes ill.  It stays the same and it is already slow in health. When ill, her blood pressure and heart rate rises, just not her respiratory rate. This is not right. This puts her at risk of developing hypercapnia. Hypercapnia can result in mental confusion and air hunger, it is ver unpleasant and distressing. We think that Paula probably has damage to the skeletal respiratory muscle pump system affecting her ability to fight rising acids in the body especially from respiratory illness. 

These are areas requiring more research. 

Damage to the pharynx, nerves fibres of the neck and torso are not unusual from birth to adulthood. These areas of the body have no protection from injury.  Less flexibility to control acids in the body is the result. And unseen and unfelt pump failure, I think, will definitely contribute to reversible PCO2 balance and pH abnormalities resulting in delirium [all motor subtypes]. Non progressive mild delirium in people like Paula., mistaken for depression due to locomotor factors conserving energy.

Science is always a work in progress .” in a new tab) This is a good thing. This is how new models are constructed. This is how new treatments are developed. This is how current treaments change for the better.

The range of breathing rates at rest is very wide, from 3 breaths per minute to 30 breaths per minute in healthy adults. Breathing depth increases but cannot increase enough to provide as much air as the person who breaths a more normal 12 to 20 breaths per minute. So how can we explain this? We need to look into this further, especially in neurological and neuropsychiatric patients. Breathing seems to be more complex than we thought, especially the motor component of ventilation- moving air in and out of the body and lungs.

This new data may change medical practice and medical treatments, from rethinking mechanical ventilation [in smaller thinner people or in bigger thicker people, people who differ from the average man or average woman] to changes in the very model of serious bipolar depression and mania and potential changes and [hopefully] major improvements in the treatments of serious “mental” illnesses.

This reflects the hard work done by scientists like Dr Emile Kraepelin.

This explains how doctors were mystified nd puzzled over Paula’s very existence and continued existence. Doctors assumed that Paula should be dead or will drop dead any second…….this is what Paula and I faced from physiologists and from doctors of all kinds.

They refused to change their scientific model to fit data that Paula and I had to collect over the twenty years that they refused to help us.

This new data is a celebration of the scientific model of ever growing collection of data and knowledge .

Dr Emile should be celebrated for his collection of scientific data regarding the importance of physiological vital signs in patients who have become seriously ill in ways that we are just beginning to understand in the way he did in the early 1900’s !

Perhaps scientists could do a prospective study to follow healthy unmedicated adults in order to find out if people with abnormal minute ventilation at rest develop neurological or neuropsychiatric syndromes the older they get. We should start to get data from the time they are young adults.

How many Paula’s are there?


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