Lost your mind? It may be physiological.

This was the case with Paula. She lost her mind overnight when she was around 43 years old. She felt awful and could not explain it. She lost a good portion of autobiographical memory, including how to do her job and what her address was.

Why? In retrospect, the answer was simple. She could not breathe. Her lungs were fine, she does not have Chronic Obstructive Pulmonary Disorder [COPD}. The reason she felt so bad was most likely due to a physical sensation called dyspnea. Dyspnea means having the sense that breathing is difficult, and it can also refer to shortness of breathe. It is almost impossible to describe. Paula did have shortness of breathe when she tried to speak. Her voice was weak and she could only say 2-3 words at a time before feeling breathless. She did not recognize any of these sensations as they are very strange and very abnormal. She had never experienced anything like it. Sometimes patients cannot explain what is wrong. Paula could not explain what was wrong. Suddenly she could not function. She was experiencing psychomotor retardation, a motor syndrome associated with depression.

Her breathing rate during this attack [which lasted over a year] was 2.5 breathes per minute. Her blood pressure was very high. Her heart rate was fast with intermittent palpitations. Her body temperature was lower than normal and her hands and feet and lips were cool and pale.

There you have it. All the clues to what was wrong and why she had an acute change to her mental, mood and locomotor status is obvious.

But no one measured her vital signs. No one counted her resting respiratory rate. No one knew the she might have suffering a mild [there is no such thing] respiratory failure.

Why didn’t she die or faint or have a cardiac event? Most likely because this was an acute on chronic syndrome. Chronic syndromes can occur with few if any signs of abnormal physiology. The body simply adapts with its myriad of evolutionarily conserved solutions. We have since measured her respiratory rate when well. She seems not to be able to raise her respiratory rate at rest and instead uses involuntary strategies to expel air actively and increase her tidal volume and obtain adequate minute ventilation. She can do this despite a usual resting respiratory rate in health, of 3-5 breaths per minute. We have had all this officially tested by a lung doctor, even though her lungs are fine. Only the motor skeletal function necessary to exchange air properly is broken.

This is unusual but not unheard of [at least in the last century when they studied respiratory rate in adult healthy populations. Modern doctors will most likely freak out and have never heard of this because they typically do not measure respiratory rates anymore except in the intensive care ward and that is because machines do the work for them.

…to be continued.

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