Vital Signs are the Roadmap

To understand the reasons for mental disturbance , it is vital to get a picture of the respiratory rate and depth, the blood pressure, the heart rate and function and the temperature of the body. This is what Dr. Emile Kraepelin did and this is what I did with Paula and Jerry and others. And this is what they do in the biological clinics for the investigation of mental disturbance in the 22nd century.

It makes sense. The sustained vital signs at rest will tell you a lot about what your brain is dealing with beyond what you can be aware of. The vital signs at rest speak for the brain as much as your mood, your mental status or your behavior. And especially when your behavior makes no sense, it is key to understand if the vital signs make no sense as well; and the vital signs make no sense in manic depressive attacks.

Much of what we know about abnormal patterns of vital signs comes from critically ill patients being monitored by invasive tools to help understand what is going on inside.

We do not usually carefully look at the vital signs of behaving moving patients, because we assume that their biological functions are intact and uninjured and this may not be the case.

The biological clinic of the future checks all possible sources of stress, including checking for mechanical failure of major parts of the body which might affect internal pressures of the head. To look for possible causes for altered mental status with cognitive impairment, like depressive episodes or manic episodes or mixed.

Conditions which are harmful to the brain include amount of pressure and air and water and blood need to be managed in order that pressures in the skull and head can be OK. This requires intact lungs, normal control of breathing [for acid base regulation of the blood], intact kidneys and motor activity. When motor activity is sluggish or speedy , slow to react to a stimulus or too fast, this tells us that something is wrong and the circulation of blood needs to be considered. And the first step is the vital signs and the internal pressures underlying the circulatory system. Because water and air are incompressible and the blood vessels will try to accommodate fluctuation of internal pressures of internal body cavities and normal fluid shifts and we can infer a lot by looking at the motor parts to see how they are working.

Abnormal motor function, motor stiffness, motor bouncyness, puffiness, most of the things we note in depressive and manic states involve the state and function of the skeletal muscle.

Muscle TONE is defined as the tension in a muscle at rest. It is the muscle’s response to an outside force, such as a stretch or change in direction. Appropriate muscle tone enables our bodies to quickly respond to a stretch.

  • Muscle tone is the maintenance of partial contraction of a muscle, important for generating reflexes, maintaining posture and balance, and controlling proper function of other organ systems.
  • Tone is controlled by the sensory muscle spindle, which measures muscle stretch.
  • Tone is not limited to skeletal muscles, but is also a property of cardiac and smooth muscles.

Muscle tone is what helps our posture. Posture is altered in depressive states [slumped posture] and the reasons for this may relate to changes in muscle tone, especially if these motor l changes are sustained….

Fluid pressure is key to understanding muscle tone and reflex speed, in our opinion.

Skeletal muscles are hierarchical structures with important functional components spread across molecular, cellular, and tissue levels of organization. Studying interactions across these levels is crucial, as multiscale mechanics can yield emergent properties not exhibited by isolated tissue components. Here, through physical modeling of muscle morphology and experiments on bullfrog muscle, we show that fluid pressure within muscle acts as an important but largely unacknowledged intermediary between contractile proteins operating at molecular scales and extracellular matrix elements present throughout the tissue. We show that forces transmitted through pressurized fluid to the extracellular matrix significantly influence the mechanics of both actively contracting and passively deformed muscle, a finding with implications for our understanding of both normal and pathological muscle physiology. Internal fluid pressure influences muscle contractile force David A. Sleboda and Thomas J. RobertsPNAS January 21, 2020 117 (3) 1772-1778; first published December 26, 2019;

Fluid fills intracellular, extracellular, and capillary spaces within muscle. During normal physiological activity, intramuscular fluid pressures develop as muscle exerts a portion of its developed force internally. These pressures, typically ranging between 10 and 250 mmHg, are rarely considered in mechanical models of muscle but have the potential to affect performance by influencing force and work produced during contraction.

Like most biological structures, muscles are primarily made up of water. Water is present in intracellular, interstitial, and capillary fluid spaces within muscle, and due to its near incompressibility, has the potential to transmit or oppose forces generated within the tissue.

In bipolar depression and bipolar mania we see differences in muscle tone and in muscle reflex speed. Sluggish versus speedy responses to stimuli, stiff versus relaxed states of the muscle at rest, etc…. this is what we see and yet do not understand what we see. We are seeing the significance in understanding physical pressure in the body..To be continued….gathering my thoughts..easier to show than to tell….to b continued…

Observation and measurement. This is key to understanding what the brain is reacting to.

In bipolar illness, it seems that respiratory rate and depth is abnormal and affects the volume and content of blood in the body and, in particular, in the head. An increase in blood volume will present difficulties in the head because the brain is encased in bone.

Hypercapnia due to respiratory depression and hypoventilation will result in cerebral vasodilation. If feedback mechanisms are broken, then intracranial pressure could increase enough to affect the brain and affect the function of mind.

Paula’s case is an example of a broken feedback mechanism resulting in reactions that seem to decrease intracranial pressure and maintain sufficient blood flow to the brain.

Like doctors trying to contain intracranial pressure an Intensive Care Unit, the brain’s own reflex reactions to an increase in pressure in the head will involve decreasing water in the blood and increasing systemic blood pressure to keep the brain from herniation.

This is what we find in stages of bipolar depression.

Respiratory depression and upper respiratory obstruction most likely results in hypercapnia, cerebral vasodilation and an increase in blood volume resulting in intracranial hypertension. The increased pressure on the brain results in dysfunction of the mind, unpleasant mood and decreased locomotor activity [to avoid major shifts in blood].

The major stimulus is avoiding possible herniation of the brain, no matter what the costs. This is what depressive episodes are about, if they display these vital sign measurements.

Avoidance of herniation can result in hormonal and locomotor reactions for long periods of time.

If intracranial pressure declines over time, the brain and the function of mind can return to normal.

The need for ………to be continued………


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