What is the Basic Pathophysiology of Bipolar illness?

No one has looked for the pathophysiology of bipolar attacks; except for researchers such as Dr Emile Kraepelin. Dr Kraepelin obtained measurements of his patients respiratory rates, blood pressure, heart rate, body temperature and cognitive function, seeking knowledge about the patient’s physiology and possible pathophysiology during the different states of bipolar illness, depressive insanity, manic insanity and mixed states.


  1. the disordered physiological processes associated with disease or injury.

No one in the twenty first century does this anymore, for reasons that are unclear to myself and to Paula.

This most likely has to do with the error of categorizing these illnesses as “mental” illness instead of physical illness involving “altered mental status” due to pathophysiology we are not even looking for.

Even though, many sufferers of bipolar depression may actually be suffering from attacks of ventilatory failure and could be “rescued” by supportive medical assistance in moving air in and out of the body during periods where this is made more difficult for them due to physical illness, physical weakness and physical upper airway obstruction.

And many, like Paula, may have impaired ventilatory reflexes to rising endogenous respiratory acids produced by our own cells and their ongoing metabolism.

No one knows if respiratory rates [said to be on average between 12-20 breathes per minute] change during adulthood, due to non progressive injury to the system moving air in and out of the body, or due to hormonal changes affecting voluntary muscle and/or chemical reflexes, or to changes in physical size, affecting the difficulty of moving air in and out; [obesity, anorexia, muscle wasting] or due to some other reason we have not yet thought of.

No one has tested ventilatory rate and depth over adult lifespan, with or without evidence of disease. This is especially important in chronic conditions involving altered mental status as seen in bipolar attacks. The locomotor features of manic depressive insanity are clearly, in my view, the same as the altered mental status and altered locomotor features seen in delirium; we have not looked at physiology and pathophysiology in manic depressive insanity, in my view, because they happen to adolescents and young adults and we are generally biased toward the young.

The parents of these patients often have lots of medical information to share with psychiatrists who refuse to collect paediatric medical history’s because of an error in professional thinking. Due to “old fashioned ” ideas regarding the presence of psychological problems [often regarding said parents], the psychiatrists will refuse to listen to the parents because they “know better”. The right of c”confidentiality” will ensure that the psychiatrist will listen only to the patient, who-if depressed or manic- will have no idea what is wrong with them. If the psychiatrist told their vital signs [including respiratory rate, for a start] they might find signs of pathophysiology leading to a better appreciation of insidious ventilatory failure requiring resuscitative strategies to rescue the mental status [and mood] of these uniquely vulnerable young people.

It breaks my heart that no doctor and no researcher is looking into this possibility despite Kraepelin’s studies into abnormal patterns of vital signs in the different presentations of this debilitating illness.

You wish to know why sleep is disrupted in bipolar depressed states? Maybe because of the unbearable mostly hard to see and describe dyspnea which might underlie the distressed mood in depression. Sleep in virtually impossible in mania, because breathing becomes irregular and heart rate drops with inaction.

Why not look at basic vital signs to see if physiology is abnormal in bipolar attacks or not?

Are psychiatrists afraid to try basic first aid techniques that any layman can practice?

Do they not remember that mood and mental changes can be a sign of abnormal pathophysiology?

Do they not know that measuring basic vital signs, especially ventilatory rate and depth, may explain all we wish to know about how changes to basic physiology can affect the brain and the mind?

What about intracranial pressure and pushing on different parts of brain tissue disrupting their cells? Ventilatory dysfunction and intracranial pressure are closely related. Ventilatory dysfunction may be different in bipolar depression [eg depressed] versus mania [irregular] explaining the distress of depressed mood and the euphoria and irritability of manic mood.

Isn’t anyone interested in doing a study to see if this hypothesis can be replicated or not? [in unmedicated patients- because medication will change vital signs, maybe this is why they work or don’t work].. More knowledge is better medicine. So why don’t researchers become more knowledgeable ?

We are failing patients with bipolar attacks, yet we cling to “old fashioned” ideas and refuse to look at bipolar illness as altered mental status [chronic delirium with all locomotor subtypes] requiring a long search for possible medical causes.

And no one has really looked into the possibility of ventilatory failure due to non progressive injury to the ventilatory system ranging from the brain stem, through the throat, neck and torso and the abdominal ,involving voluntary muscles, ganglions, nerve fibres, etc…]

Why not?

Do we really wish to help these patients?


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