And the clues to what kind of physical condition we are dealing with is likely to be clarified by the careful serial measurement of the physical vital signs of resting respiratory rate, blood pressure, heart rate and heart examination and body temperature. Normal patterns of vital signs are vital for staying alive and for function of the organs including function of the brain.
This was Dr Emile Kraepelin’s big discovery. Vital signs are vital for normal brain function and mood and locomotor activity. Mental disturbance should lead to an immediate search for the physical condition affecting the brain starting with measurements of at rest vital signs. Respiratory rate is especially important to check because an abnormal resting breathing rate will suggest a respiratory acid base disturbance which can occur even with completely healthy lungs. And all acid base disturbances of the blood will affect the brain and will cause some amount of mental confusion.
No one since Kraepelin has looked at mental illness in this way and it is especially helpful in the case of bipolar depression [or any depression affecting cognition] and in the case of bipolar mania. This model [of mental illness as physical illness] will probably be most useful in figuring out the causes of delirium or dementia [hopefully reversible with better treatments based on improved understanding of the physical problem]. Maintaining a constant blood pH is critical to a person’s well-being.
I cannot emphasize this enough. Despite its fundamental importance, the full breadth of acid base biology has been given short shrift in psychiatry, despite the enormous advances we have made in the field of modern emergency medicine and critical care.
Kraepelin suggested that metabolic imbalance was responsible for the syndrome of manic depressive insanity and he knew this because he found respiratory rate to be abnormal in these patients. [and abnormalities in the rest of the vital signs followed suit.
We have the tools to look into this in the mental illness field. But we are using the wrong mental model and so we are coming to the wrong conclusions and we find ourselves not being able to resuscitate these people back to their normal baseline function and personality.
We need to start trying to replicate Dr Kraepelin’s findings. We need to start measuring the same vital signs he did in unmedicated patients in order to to see if we find the same patterns of abnormal vital signs.
Paula and I replicated Kraepelin’s findings because we knew what he had discovered and what he had reported.
Manic depressive insanity and perhaps major depression is a physical condition. it is a physical condition we have not examined seriously because we have been using the model of “Mental” illness and this has led us astray. This mental model is still leading us astray.
Mental illness is physical illness. We need to change our approach. We need to understand acid base imbalances. We need to separate lung problems and lung disease from the motor act of moving air in and out of the body. Moving air in and out of the body is a mechanical motor act requiring coordination of many body parts.
Why aren’t doctors listening?
Don’t they want to resuscitate their patients mental function? Although it means abandoning their incorrect and simplistic incorrect model of Mental” illness?
Paula is glad she listened to Kraepelin, understood her physical problems and with my help, began to understand which medication helped bring back her baseline mental status and personality, but it was too slow a process and we had to do it all by ourselves.
I’m sure there is a better way, once the physical problem becomes clear.
We need to measure vital signs of respiratory rate, blood pressure, heart rate and body temperature and we need to think about what we find and their relevance to PCO2 [read my past blogs] and pH of the blood and remember that these physical signs are VITAL to the function of the mind and of the mood, personality and to the speed and amount of locomotor activity.
We think that this is great hypothesis to explore in the 21st century, much better than the incorrect sloppy model doctors are currently using.
will edit the parts below later……….
Emotions and thoughts are a product of biological function. Biological function can cause loss of mind function, not the other way around. Biological function can affect emotional lability and abnormal prolonged emotions [if distress and/or euphoria are even emotions-they are products of intoxications/poisonings-some taken voluntarily like cocaine or alcohol, and others due to broken feedback mechanisms affecting the blood, and other poisonings happening from exposure [known or unknown]. to be continued…..
People with altered mental status and mood cannot tell us what is wrong, because they have fallen too ill. The model of Mental Illness is the wrong model. The model for all extended periods of behaviour change and possible disturbance to mental status should start with a simple screening test of memory that a ten year old could perform. With Paula, we discovered that all we had to do was ask her her personal address every day. Every day she was sick she did not know it. This was different than before she looked and acted strange and lethargic and stopped eating and became suddenly incompetent at her job and semi incompetent at the daily tasks of life. So the first step if a person slides from their usual baseline performance is to test basic memory [for one’s address for example] and for cognition [ here is a newspaper [grade 9 reading level usually]- can you read it? do you understand what you were reading ? is this usual for you ?
Or one could start with measuring breathing rate at rest , and if abnormal-too slow, too fast, measure tidal volume . This would be easy in a biological clinic for changes in mental status. to be continued