NO, HER FEEDBACK MECHANISM TO CONTROL PCO2 AND BLOOD pH are BROKEN and this can cause enormous hidden problems physiologically. [not so hidden though, if you check the Paula’s vital signs. Then her problem is obvious!! Paula’s minute ventilation is inadequate and has difficulty with some respiratory challenges despite her normal healthy lungs.
Paula’s feedback mechanisms seem to be stuck on too low and/or occasionally on too high. [or not- we have never measure minute ventilation in mania only in depression].
It is the change in local PaCO2 as well as the change in pH that causes a change in minute ventilation. Or another way to understand this statement is to say that “the change in minute ventilation [respiratory rate times tidal volume] is due to a change in local PaCO2 of the blood as well as the change of pH of the blood. Under normal physiologic conditions, an increase in PCO2 causes a decrease in pH, which will increase minute ventilation and therefore increase alveolar ventilation to attempt to reach homeostasis. The higher the minute ventilation, the more exchange and loss of PCO2 will occur inversely. The opposite is also true; a decrease in PCO2 will increase pH, which will decrease minute ventilation and decrease alveolar ventilation; this is an example of the necessary evaluations of blood gas in the setting of acid-base disorders. https://www.ncbi.nlm.nih.gov/books/NBK551648/ Partial Pressure of Carbon Dioxide StatPearls Messina Z, Patrick H.
Paula’s vital signs suggest that for her, physiologic conditions are NOT normal. And correction for PCO2 is not normal.
Paula’s adult baseline minute ventilation rest is completely abnormal [too little air] during health and does not change during upper respiratory obstruction. She has hypoventilation during both conditions. No one knows how she is even alive, much less capable of complete recovery with time, lots of time, decades of lost time. Additional adverse breathing conditions [poor quality air for example] can cause a motor switch to hyperventilation with excitement and intoxication [euphoria] or irritability or combativeness. The pattern of all vital signs are different during hypoventilation and hyperventilation, and abnormal in both, affecting mood, circulation [vasoconstriction/vasodilation], behaviour and cognition.
The stereotypic mood and behavior patterns seen in unmedicated manic depressive insanity seem to be cause by the inability to adequately control respiratory gases and pH in the blood due to damage to the ventilatory system resulting in fixed abnormal breathing rates and patterns.
If hypercapnia is the result [need serial arterial blood gas results to know for sure], the intracranial pressure may be raised and may be causing the stereotypic motor and cognitive and behavioural and mood changes.
Of Sound Mind 