It certainly explains why Paula’s behavior was so bizarre. Everywhere….at work, at home, with colleagues, with friends, with loved ones…..Luckily she could only barely talk so no one even understood how bizarre she was, so unlike her usual self…because she was amnesic without knowing just how amnesic she was. And yet she was not too amnesic in that she knew who she was, where she lived and worked and recognized the people she knew.
It explains her sudden incompetence at work. It explained how everything she cooked turned bad. It explained how embarrassed she was at failing at everything she used to know how to do. It explained her shock at not knowing how to do “normal ” things, things that had been effortless the day before; having conversations, relaxing, being able to sleep, and eat and play with her children.
Paula knew she was “strange” because she had no idea how to “be”.or “act” or “converse” like her usual self. It was like this part of her was somehow erased. I guess that this condition is called retrograde amnesia. She woke up in a fright one day after having had a number of mild illnesses in a row [stomach flu, a cold, a mild virus with fever] and had partial retrograde amnesia from that point on, without knowing that she had retrograde amnesia.
Her mind was blank. She had many thoughts, and they mostly consisted of wondering why her mind was blank and why she felt so terrible [anguish, we now think-due to dyspnea she did not realize was distress due to inadequate breathing].
She did many things that were mistaken for depression; she slouched when standing and while sitting, she collapsed her upper body forward while holding her head with both arms ; these postures unconsciously helped her to breathe more easily. she cried when she failed at a task that used to be second nature [does crying help breathing too?] and her voice changed and sounded soft and uncertain, she had to push air out with effort to get any words out and she only succeeded in speaking 2-3 words at a time.
Paula had no idea why she was suddenly “strange”, visibly so. She was embarrassed. She also felt guilty, appropriately so, since she could not perform as usual and she simply appeared incompetent [she was] and neglectful and even lazy. She was usually hardworking, confident and knowledgeable and a fun person.
Paula did not know that she was experiencing a memory disorder. Paula also did not know she was experiencing cognitive impairment.
That is the problem with brain dysfunction, without a fully functioning brain, you cannot analyze or identify the problem.
No one imagined that she had a sudden onset of a memory disorder; an attack of retrograde amnesia starting the day she woke up in a panic, knowing something was terribly wrong with her.
Why would anyone imagine such a thing? Memory loss, and especially autobiographical memory loss is a private internal thing, especially if you cannot speak much because you are short of breath and you don’t know it.
In retrospect, a sudden brain dysfunction coming on with a sense of anguish and panic, suggests an acute attack of “something”. Maybe a stroke? Can a stroke cause retrograde amnesia? et me look this up;
What is retrograde amnesia? from * https://www.healthline.com/health/retrograde-amnesia
“Amnesia is a type of memory loss that affects your ability to make, store, and retrieve memories. Retrograde amnesia affects memories that were formed before the onset of amnesia. Someone who develops retrograde amnesia after a traumatic brain injury may be unable to remember what happened in the years, or even decades, prior to that injury.
Retrograde amnesia is caused by damage to the memory-storage areas of the brain, in various brain regions. This type of damage can result from a traumatic injury, a serious illness, a seizure or stroke, or a degenerative brain disease. Depending on the cause, retrograde amnesia can be temporary, permanent, or progressive (getting worse over time).
With retrograde amnesia, memory loss usually involves facts rather than skills. For example, someone might forget whether or not they own a car, what type it is, and when they bought it — but they will still know how to drive.“
How many other patients diagnosed with serious mental illness and mood disorders are actually patients who have suffered brain injury, a serious illness [think – Long COVID], a seizure or stroke.
If they suffered this injury, silently, during the night, then they will wake up incapacitated and not know why.
I think that patients who end up in the emergency room or in a psychiatrists office after and sudden attack of incapacitating “mental illness” need an evaluation of their memory for the recent past. Simply asking them about the state of their memory would seem to be a good start.
Paula could not explain what was happening to her but she had enough insight remaining to be able to answer straightforward questions [we think]. At the very least she would have answered “I don’t know” if she was really mentally confused and that should lead to a more professional investigation of her retrograde memory.
Without a memory for yesterday, the patient will be lost and not know what to do or how to behave. That is what happened to Paula.
Paula did not know it yet, but her memory disorder gradually disappeared; but it took 10 years to restore her memory and her cognition completely.
I think that most doctors know nothing about memory disorders .
I think that most doctors know nothing about chronic respiratory acidosis.
Since we now know that Paula most likely had an acute on chronic respiratory acidosis, we can hypothesize that supportive medical care for this complex but treatable medical problem might have restored her mental status much more quickly and it is possible that home ventilation during exacerbations of her [hidden and unknown] COPD might prevent future episodes from happening.
This is a hypothesis which needs checking out.
An arterial blood gas is required to detect hypercapnic respiratory failure; in which either respiratory rate becomes abnormal [too slow or too high] or tidal volume is impaired. Getting minute ventilation [not invasive] for confused possibly amnesic psychiatric or confused and possibly amnesic medical patients will tell you their respiratory rate and their tidal volume and will suggest who needs an ABG test [invasive].
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To be continued….