Depression with psychomotor retardation should be studied in an intensive care unit

because altered mood, locomotor activity and mental status is a medical emergency. Brain cell atrophy and brain inflammation is bad, very bad and needs to be investigated in an intensive care unit, – at least till we understand what it is and how to treat it. If acute bipolar attacks are not investigated properly, with all the knowledge and tools that an I.C.U. can offer, the result can be increased risk of death and increased risk of morbidity or impairment and a lower quality of life. This is exactly what often happens to seriously depressed or manic young adults left to linger in psychiatric wards or in group homes or at home.

For those doctors responsible for patients with bipolar illness, yet not familiar with physiology, pathophysiology and the methods of intensive care medicine, here is an excellent book to download : Acute Care Testing Handbook 2020 by Corina Seeger and Chris Higgins; from Radiometer. – available to download for free from https://www.radiometeramerica.com [for the U.S and Canada].

Radiometer ” pioneered the blood gas market in 1954 and continue to develop their extensive knowledge and experience in acute care diagnostics. They develop cutting edge tests and technology to answer the question of what comes next in health care. Across professional backgrounds, job positions and locations, they work to address today’s challenges and tomorrow’s opportunities. 

Paula and I think that what comes next in health care is the application of acute care diagnostics to bipolar attacks, including major depression. The Acute Care Testing handbook explains what could be done to investigate the brain atrophy and inflammation underlying altered mood, memory, cognition and locomotor activity seen in bipolar attacks.

Rapid access to blood tests is the mainstay in the diagnosis and treatment of acute disease.  [except for so called psychiatric disease] Oxygenation status and acid base balance are determined by arterial blood gas analysis and constitute a central part of MODERN evidence- based treatment algorithms in critical care. 

Furthermore, critical care testing allows for assessment of many other factors, for example, renal function [creatine] and electrolytes, inflammation [C-reactive protein] and cardiac biomarkers.

This handbook is a concise, well organized guide covering the spectrum of parameters provided by state of the art devices. Each parameters physiological role and pathophysiology is explained, and reference intervals are provided, as well as the most likely causes of abnormalities. 

Oxygen Status

    Life  depends on the continuous delivery of oxygen, present in inspired air to tissue cells. This is achieved by the synergistic action of the respiratory and cardiovascular systems in a process that is marked by 3 sequential events:

  • Uptake of oxygen to blood from alveolar air in lungs
  • Transport / delivery of oxygen in blood from lungs to tissues
  • Release of oxygen from blood to tissues

The interactions in the pulmonary and the systemic circulation are rather COMPLEX, and under ALTERED PATHOPHYSIOLOGIC CONDITIONS it may be difficult to predict the consequences of impaired oxygen uptake, impaired oxygen transport or impaired oxygen release. It is therefore imperative to evaluate all three to get the necessary information for adequate patient management.  Oxygen partial pressure [pO2] can be used to evaluate oxygen uptake. Oxygen content [ctO2] can be used to evaluate oxygen transport. p50 can be used to evaluate the ability of oxygen release.

Altered pathophysiologic conditions can involve pH, PCO2, and HCO3 abnormalities as well as conditions affecting the blood itself.

There are many issues to explore when looking at brain inflammation and brain atrophy and many involve the function of the entire body, not only the brain.

We haven’t yet begun to seriously address what is happening inside the body and brain of the patient with depressive or manic attacks because we haven’t realized how serious these conditions really are and how much they ruin people’s lives and livelihoods.

Having a functioning brain is pretty central to having a functioning life.

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