Chronic Dread

Chronic dread is what Paula was most aware of during her eighteen month attack of bipolar depression. Chronic dread and psychomotor retardation [psychiatric term for cognitive and memory impairment and lethargy with hidden internal agitation] . These are not part of normal emotion; these are not anxiety or “generalized anxiety disorder” or any other psychological entity. Chronic dread and psychomotor retardation is something else entirely. From * Dr Emile Kraepelin’s research studies, we learnt that the diagnosis is found by performing careful measurement of physiological baseline vital signs at rest, including counting baseline respiratory rates. No wonder the patient cannot explain what they are experiencing. * E Kraepelin Manic Depressive Insanity Chapter three Bodily Signs 1926.

Chronic dread is impossible to describe to anyone who has not had this sensation. And sensation is a better word to describe this than emotion. It is not an emotion. Any more than starvation or suffocation or poisoning is an emotion.

Chronic dread is a form of *dyspnea. Chronic dread is, to my mind, a sensation of being close to death without knowing why and is easily mistaken for an emotion. * Dyspnea : Few sensations are as frightening as not being able to get enough air. Shortness of breath — known medically as dyspnea — is often described as an intense tightening in the chest, air hunger, difficulty breathing, breathlessness or a feeling of suffocation. When dyspnea is a part of ventilatory failure, the visible signs of difficult breathing may be missing and neither the patient the doctor will understand what is causing such immense distress.

Paula understands the difference between dread and anxiety; she knew it the minute she experienced it, especially when the dread lasted all day and all night, even through fitful sleep. It was like nothing she had ever experienced before. She “knew” there was something very wrong with her and that no one would do a complete physical examination to figure out the source because of the adequacy of language in communicating symptoms of pathophysiology involving chronic sublethal acid base chemical imbalance of the blood, tissues and organs of the body still working in tandem keep the person alive, while minimizing internal energy expenditure.

Energy expenditure : Definition

Energy expenditure refers to the amount of energy an individual uses to maintain essential body functions (respiration, circulation, digestion) and as a result of physical activity. Total daily energy expenditure is determined by resting or basal metabolic rate (BMR), food-induced thermogenesis, and energy expended as a result of physical activity. Heaney J. (2013) Energy: Expenditure, Intake, Lack of. In: Gellman M.D., Turner J.R. (eds) Encyclopedia of Behavioral Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1005-9_454 https://link.springer.com/referenceworkentry/10.1007/978-1-4419-1005-9_454

Resting,; Clearly, an active body needs more oxygen than a body at rest. So resting does save energy.

Losing weight; Simply put, when you’re lugging around less weight, your body uses less energy to keep you alive.

Peripheral atrophy and loss of muscle mass from inactivity and inappetence and loss of weight may cause slower reflexes and loss of muscle strength, using less energy as a result.

Mild hypothermia……these are ways to save energy during periods of energy shortages. Hypothermia decreases the global cerebral metabolic rate for glucose (CMR(glc)) and oxygen (CMRo(2). Hypothermia progressively depresses the CNS, decreasing CNS metabolism in a linear fashion as the core temperature drops.

It seems that these symptoms and signs make sense if a person is trying to conserve oxygen because of abnormal respiratory rate and effort and minute ventilation.

And these are the signs and symptoms that Paula had during her debilitating episode involving chronic dread. These are also the signs and symptoms that Dr Kraepelin found in patients in the depressive stage of manic depressive insanity.

An inadequate respiratory rate with increased “work of breathing” explains this syndrome pretty well.

So why don’t doctors measure vital signs in debilitating depressive episodes with psychomotor retardation to see if there is a simple and straightforward explanation for these signs and symptoms?

Why are doctors so resistant to checking respiratory rate and minute ventilation in bipolar illness ?

Why?

So they forgot about the intangibles of health and illness/injury; intangibles such as energy, oxygen, carbon dioxide, pH and nutrients.

It is not too late to change one’s outlook, to change one’s investigative methods.

It is a little embarrassing maybe, especially since Dr Kraepelin identified acid base issues in bipolar illness over 100 years ago, but it doesn’t’t matter, does it?

The only thing that matters is helping patients to regain their health, and with the help of measurement and knowledge and logic and common sense, we CAN do this and we CAN help these patients with supportive 21st century medical tools, if we do change our outlook and open our minds and our eyes to what is really wrong with these patients.

This is called science, replacing old, outdated, concrete, incorrect ideas with more scientific ones, based on measurement. Measurement of vital signs. Perhaps it is true what Dr Kraeplin and Paula and I have found; perhaps these bipolar patients ARE suffering from different levels of hypercapnic encephalopathy from obvious [if you look] ventilatory failure.

It is easy to check.