When long lasting mood disorders accompany mind failure then it is especially important to look for suddenly worsening motor function, since impaired motor function from any cause can impair ability to breath despite NOT having COPD ( chronic obstructive pulmonary disorder.
Paula did not have COPD when she experienced her attack of mind failure. She had some kind of motor weakness accompanying her hidden hypoventilation.
Sudden and sustained motor weakness affecting the motor part of breathing can happen to anyone, at any age, due to injury, blood loss, vitamin deficiency due to blood loss ( which could be unsuspected), accidental malnutrition ( due to illness related loss of appetite), the list is endless. …..see the post on metabolic encephalopathy.
It is not that hard to screen someone for mind failure or even respiratory failure. the key is to recognize that naming the problem as a possibility, when speaking with the patient, will help the patient to identify it.
When Paula experienced mind failure 20 years back, if anyone had asked if she was experiencing mind failure she would have said YES!! And then she might have forgotten due to her mind failure, but the person who asked would not forget and would be able to investigate further. If asked whether or not she had difficulty breathing, Paula would most likely have said YES, even though she did not know it before she was asked, she did not know it because she did not recognize the sensation and needed help to identify it. Paula would then forget her difficulty breathing, but the doctor would not and would investigate further.
Getting Paula’s respiratory rate at rest would have diagnosed her ventilator problem as hypoventilation.
It is likely that Paula’s near death experience at her birth cause motor injury to the parts of the brain or body which moves air in and out of the body.
Her vital signs tell her medical history without the need for words or even the patients knowledge of past motor injury.
It is clear from her physical exam, as long as respiratory rate at rest is included.
Why isn’t counting respiration’s with a stop watch at rest an important part of all diagnosis, especially in mood or mind failure?
Doesn’t matter, it must become standard procedure in all branches of medicine including neurology and psychiatry.
Hello new patient. You have a mood disorder?? let me take your vital signs, to see if there is a medical problem that you are not aware of.
That is what a good doctor is there for, to check for other diagnosis based on medical signs ne the vital signs would seem a logical place to start!!!!!
Of Sound Mind 