How do you assess altered mood, arousal, cognition, personality and locomotor activity [lethargy/excitement]? Well Paula and I will tell you and you will be astonished at how simple the answer is. Simple, yet upsetting. Upsetting because there really is something physically wrong with these patients and nobody knows it. They do not know it.
How do you assess altered mood, arousal, cognition, personality and locomotor activity [lethargy/excitement]? You assess the ability of the patient to BREATHE. Ya, I understand that no one wishes to do this. It is complicated, I know. Especially the neurological, motor part called Ventilation. Ventilation or respiratory rate and tidal volume and minute ventilation [RR times Tidal Volume], this system is run under the watchful eye of the brain stem and hypothalamus in order to keep the products of cell metabolism in just the right ratio for chemical homeostasis of the blood, which circulates throughout the body…..including the brain. to be continued….
Reeves “DISORDERS OF THE NERVOUS SYSTEM” A Primer, RESPIRATIONS
Excessive sighing and yawning, Cheyne-Stokes respirations, hyperventilation, hypoventilation, and apnea are nonspecific presentations of bilateral brain stem involvement whether it be structural or metabolic. “Altered Mental Status” DISORDERS OF THE NERVOUS SYSTEM A Primer, Alexander G. Reeves, M.D. Rand S. Swenson, M.D., Ph.D. https://www.dartmouth.edu/~dons/part_2/chapter_cases.html
How could doctors not check respiration and respiratory rate? How could family general doctors not check respiration and respiratory rate? How could neurologists [of all people] not check respiration and respiratory rate? And finally, how could psychiatrists [the doctors that supposedly evaluate and supposedly treat manic depressive insanity and other serious syndromes with neurological features] not check respiration and respiratory rate? How could they not look for nonspecific presentations of bilateral brain stem involvement whether it be structural or metabolic by carefully assessing breathing rate , tidal volume, and minute ventilation , and if these are abnormal then obtaining an arterial blood gas test?
Especially if a person experiences a sudden and extended change to their mood, mental ability, and locomotor activity?
How can you NOT think of endocrine and metabolic acid base difficulty?
Knowing what Paula and I now know, we are, beyond dismayed, that doctors ignore BASIC vital signs like respiratory rate, tidal volume, minute ventilation and arterial blood gases. Don’t doctors know that vital signs tell them what they need to know about a person’s basis physiological function? This is why they are called vital signs. Because they are important [vital] to staying alive and at one’s maximum physical and mental ability.
Patients cannot tell their doctors that they have an attack of respiratory acidosis or hypercapnia encephalopathy, the doctor must and should know the differential diagnosis for altered mental status and mood.
Hypercapnic respiratory encephalopathy is a CLINICAL syndrome!!!!!!
Let say it once more ……hypercapnic respiratory encephalopathy is a CLINICAL syndrome!!!!!!
How many of your seriously mentally ill incapacitated patients have been worked up for the possibility of hypercapnic respiratory failure because of broken ventilatory systems that need medical support to help combat rising PaCO2??????
Have you worked them up for respiratory acidosis type 2 yet?
What is your excuse now? [remember HCO3 and pulse oximetry may be normal]
Don’t you wish to help your patient recover their baseline mental status and mood?
Doctors??? Are you even listening????
Have you even counted anyone’s minute ventilation … [Minute Ventilation is RR at rest , multiplied by tidal Volume]?
Look at past blogposts to learn about Paula’s respiratory rate at rest and Paula’s tidal volume and Paula’s minute ventilation. It will present you with a cool scientific puzzle to solve. Kraepelin was fascinated with the scientific puzzle he uncovered. You should try and replicate his findings. Paula and I can help you if you do not know how to begin.