A Co-Morbid Condition

accompanying the mood disorder is most likely to be a progression of the original metabolic encephalopathy, often made worse by the side effects that the psychiatric medications.

This is the result of the original category error that the doctor may have made.

The only way to avoid this category error is to standardize and revise the physical medical examination to include evaluation of minute ventilation in order to investigate the state of the motor functions of the body involved with breathing. All doctor’s appointments should start with at least getting the respiratory rate, especially if the patient does not know what is wrong with them or complains of abnormal mood. Hypercapnia will result in gradations of extremely unpleasant mood and also occasionally intoxicated-like euphoric, irritable of combative mood. All mood disorders should involve screening for metabolic encephalopathy no matter what what personal issues the patient has gone through, in order to eliminate the very real possibility of hypercapnia or other possibilities. remember that the causes are quite broad and the symptoms and signs mostly non specific.

Table 38-1Classification of the Major Metabolic Encephalopathies

Due to lack of glucose, oxygen or metabolic cofactors
  Hypoglycemia
  Ischemia
  Hypoxia
  Hypercapnia
  Vitamin deficiencies
Due to peripheral organ dysfunction
  Hepatic encephalopathy
  Uremic and dialysis encephalopathies

From: Chapter 38, Metabolic EncephalopathiesBasic Neurochemistry: Molecular, Cellular and Medical Aspects. 6th edition.Siegel GJ, Agranoff BW, Albers RW, et al., editors.Philadelphia: Lippincott-Raven; 1999.Copyright © 1999, American Society for Neurochemistry.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

to be continued…..

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