Why are Skeletal Motor Patterns affected in syndromes such as Bipolar Illness and Delirium?

Energy may be the reason why skeletal motor patterns are affected in syndromes such as bipolar illness and delirium. Both syndromes have clear psychomotor patterns; in delirium the motor subtypes are called hypo motor [quiet] subtype,, hyper motor [vocal] subtype and mixed subtypes. In psychiatry, these motor patterns are called psychomotor retardation and psychomotor excitement [ or mania ] and mixed states because…. just because……[I think that these terms refer to the same motor abnormality]. Psychiatrists are hoping against hope that long attacks of psychomotor retardation and dysphoric mood isn’t hypo motor delirium and that attacks of psychomotor excitement with euphoric mood isn’t hyper motor delirium [mania existing in both so called psychiatric and organic mania, a pattern of hyper motor excitement]. Checking for unseen ventilatory failure along with the mood and mental status changes [retrograde amnesia and cognitive impairment] would help identify the organic syndrome from a psychiatric one. Psychiatrists do not know this, having forgotten that this is what Kraepelin found [ventilatory failure] in thousands of patients in the depressive and manic phases of the syndrome.Paula and I have been discussing what Kraepelin found in 1926 ever since we took his advice and measured Paula’s respiratory rate while she was dysphoric with psychomotor retardation and altered mental status and found that her respiratory rate was depressed at baseline at rest [no drugs, no yoga]. This finding helped us to help her doctors restore her baseline mental status and her baseline psychomotor energy status because hypercapnia [which we assumed to be the result of her ventilatory failure] is reversible until it is not [depends on the dose]. We describe how we did this in other blogposts. We describe all of this in other blogposts as we were discovering it.

Energy, depends partly on adequate gas exchange and adequate gas exchange depends largely on the physical state of the ventilatory skeletal muscles that must move air in and out of the lungs. And less energy [for any reason] means less motor activity and perhaps slowed motor activity, as well. Gas exchange is thus an essential process in energy metabolism, and gas exchange is an essential prerequisite to life and to motor activity. Gas exchange is dependent not only on the health of the lungs but also on the the strength and functionality of the skeletal muscles of the neck and chest and the even the abdomen. Sometimes the legs and arms also help the respiratory skeletal muscles when necessary.

Weakened local neck and torso skeletal muscle can be damaged by illness and by injury and will result in temporary and/or permanent effects on energy due to effects on the decline of gas exchange in cells. For altered mood and mental status and behavior resulting from levels of ventilatory failure, the muscles of the body engaged in breathing should be evaluated. An easy way to do this is to count respiratory rate per minute. Abnormal respiratory rates rates [too slow, too fast with apneas] when at rest and awake suggest underlying problems which must be investigated. And abnormal baseline respiratory rates can definitely alter function of the brain and of the mind, especially since carbon dioxide levels in cells affect oxygen status and also are strong cerebral vasodilators which, is a good thing until it begins to change normal levels of intracranial pressure, pressing on brain tissue and causing changes to behavior and mood due to mechanical effects on tissue and cells.

The lungs are key to gas exchange and energy, and so are the skeletal muscles.

It can be very difficult to detect muscle weakness in adults unless a person becomes deformed as a result. Local hypotonic muscle [floppy weak muscle] is not always obvious to the eye, but can be detected by its abnormal function. Deep muscle tissue and superficial muscle tissue can be affected. Failure of respiratory rate to rise during a respiratory challenge at rest suggests muscle failure requiring mechanical support to help push air in and out and help to clear the airways.

Measuring baseline respiratory rate at rest will show us the ventilatory system muscles at work and abnormal baseline rates are very concerning because they point to problems with skeletal muscle.

Skeletal muscle must generate enough physical force to generate negative pressure in the thorax:

The thorax is the part of an animal’s body between its head and its midsection. In vertebrates (fishes, amphibians, reptiles, birds, and mammals), the thorax is the chest, with the chest being that part of the body between the neck and the abdomen. The vertebrate thorax contains the chief organs of respiration and circulation—namely, the lungs, some air passages, the heart, and the largest blood vessels (see thoracic cavity). Below, it is bounded by the diaphragm. The bony framework is encased with muscles, fat, and cutaneous tissues (skin). The bony framework of the human thorax consists of the 12 thoracic vertebrae, 12 pairs of ribs, and the sternum (breastbone).  Encyclopedia Brittanica [ my favourite information source] accessed Dec 29 2021

All parts of the thorax are important to the ventilatory system so important to life and the quality of that life.

It bears repeating that skeletal muscle must generate enough physical force to generate negative pressure in the thorax: This is necessary to exchange oxygen from the outside air and to convert fuel to fuel and water and carbon dioxide. Water and C02 is continuously produced by cell metabolism in exact ratios and exact amounts to sustain energy and life. The body is used to fluctuating amounts in the blood, tissue and cells…up to a point. This is especially important to the cells and tissues of the brain since the brain is locked inside bone [ the skull ] and so there is finite wiggle room compared to the rest of the body.

Life requires being having a body that is strong enough and intact enough to be able to do the physical and mechanical work required to generate this negative pressure in the chest and neck in order for lungs [healthy or not] to do their job properly.

Muscles and the nerve fibres [nerve fibres exist in the periphery- in the thorax and the rest of the body below the thorax] are vulnerable from the start of life and all through our lives and are subject to periods of weakness from many causes , and can become permanently weak and floppy due to injury , temporary or permanent.

This is what we are looking at when we observe the function of the ventilatory pump in the form of baseline constant respiratory rate and rest. This is why respiratory rate is so important, especially if the person shows obvious signs of being unwell, to the point of not being their normal selves and perhaps having lost the normal function of their mind due to personal retrograde memory loss affecting personality traits and baseline cognitive ability, This loss of normal function of the mind is oddly both hard to detect yet easy to detect but not easy to to define.

Subtle and not so subtle physical skeletal weakness and injury affecting the gas exchange and affecting brain cell tissues and intracranial pressure due to problems in the head and brain, can cause chronic but reversible issues affecting the function of the mind and also mood. Mood, especially abnormal mood, and especially severely abnormal mood accompanied by retrograde memory loss and cognitive impairment appearing as failure to function.

Only by observing a person while they are trying to do something, say something, go about their daily life, only then can we see this functional defect that they are experiencing privately.

Making matters more complicated is the retrograde amnesia. With retrograde amnesia the person will only be able to tell you about their memory deficit at the moment they try to perform or speak, they will forget shortly after they stop doing what they are trying to do……more or less. They must be caught in the act and in that moment of insight they will be able to speak of their lack of memory….before they forget.

In the end, we are all dependent on the function of our physical bodies, our muscles, in order to have the energy to think, to speak, to remember, to move, to breathe, to swallow, to stand up straight, to climb stairs, to get up from a sitting position, etc…and our muscles must be strong enough to withstand the constant pressure of gravity and of the pressure of gases we live in.

Think of the can crushing experiment, where an empty can gets crushed by normal atmospheric pressure under certain conditions:

How does the can crushing experiment work?

When the inverted can is placed in cold water, the steam condenses, leaving the can mostly empty, and thus with a very low pressure inside of it. The difference between the low pressure inside and the atmospheric pressure outside exerts an inward force on the walls of the can, causing it to implode.
Can Crushing – American Physical Society

Our external frame of bone and muscle keeps us from imploding even when we physically create negative pressure in our chest in order to be able to bring fresh air into our lungs. Our external physical frame of flesh and bone are key to our lives, our ability to move and breath and function, which in turn is also the key to the function of the brain and the mind.

Or something like that…. [we are not scientists so we only kind of understand these things and no no one seems interested in helping us so…but we think we have got the right idea here.]….If the reader is a scientist please help us if you have anything to add or if we have gotten something wrong.

Our external frame of flesh and bones and the function of our organs and of the blood [and the mind] are intimately connected and yet we are very blasé about our external frame.

Paula can exist and function with a ventilation rate of 3 very deep breathes per minute at rest all day long [when reading a book sit-in down-we have checked this with a respiratory plesysmograph embedded in a ” Hexoskin”smart shirt. Her tidal volume seems large enough to ensure good enough minute ventilation…..but not when she get s sick enough with an upper respiratory infection or when chronically exposed too poorly ventilated overcrowded environments or to both [resulting in additive effects and overwhelming her remaining compensatory mechanisms]. Once unwell [which happens less frequently than you might think], it takes a long time for Paula to recover [without some kind of medical support and respiratory rehabilitation] because of her ventilatory defect or injury.

When unwell [infection, inflammation, and the like] Paula is unable to raise her respiratory rate at rest, even though the biology textbooks imply that all humans do this as a normal reflex and never consider what could happen if this reflex is impaired in a living human. If some of the parts of the external skeleton and its muscles are broken or floppy, then raising respiratory rate becomes too hard and the body and brain finds other solutions that work but affect the function of the brain, the personal memory for facts and energy and locomotor speed and activity…..

Who could have guessed?

Kraepelin guessed . In 1926. Really How? Kraepelin counted respiratory rates at rest in unmedicated patients with altered mood and mental status and found their respiratory rates to be grossly abnormal at rest. Kraepelin understood that pressure and gas exchange inside the brain had to be affected as a result because he understood physiology and biology and physics and math and medicine. Wow, genius! Or common sense and a keen eye for detail, a very good education, and understanding the value of objective measurement and accepting that reversible insanity or altered mental status could explain the sorry states of his long suffering patients with attacks of manic depressive insanity .

Kraepelin monitored and followed his patients long term and noticed that unlike most patients in the asylums, spontaneous lifting of these attacks of insanity restored the normal mental status, even after decades of psychomotor retardation or excitement or mixed states. Somehow, these patients healed and left the asylum and they were the only ones to do so [if they did not die, that is]. Hypercapnia is reversible, unless you die.

Kraepelin understood that technology and medications were being developed that could help manage the respiratory defect he noted in these patients. Their spontaneous recovery meant that no permanent brain damage occurred , at least not during the initial attacks, no matter how long the patient was affected.

This was great news then and could be great news now.

But only if we see if Kraepelin’s hypothesis of a respiratory defect affecting the ventilatory system holds up in certain non medicated psychiatric patients with the pattern of manic depressive insanity.

And this is easy to do, just do what Kraepelin did, measure respiratory rate to see if it is grossly abnormal at baseline thus affecting the energy status of the brain and body.

Why are we not doing this?

We can improve any defect of the body with modern treatments and technology, BUT, it means accepting Kraepelin’s findings…or at least trying to see if his findings can be replicated in some psychiatric patients, especially unmedicated bipolar patients [medications affect muscle and the respiratory rate] and accepting that there is no such thing as a psychiatric disease. There are only diseases and injuries that affect the body, causing organs to malfunction to some degree and accepting that some mechanical failures can lead to failure of the function of the mind and rescuing a person’s mind may involve helping the body to move air in and out in any way possible.

Who doesn’t want to investigate the possibility that degrees of mechanical failure of neck and torso muscle [deep and superficial] might cause the failure of the mind and the suffering felt by patients displaying a syndrome of manic depressive insanity?

And why not investigate this possibility?

And why not look at ways to help them recover their minds and lessen their suffering more quickly?

Why not?

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