is a puzzle to be solved, we think.
Restoring baseline memory and cognition should be the goal in attacks of bipolar illness. It should be the goal in other syndromes as well, such as acute delirium, depression, dementia and the many presentations of any altered mental status. Any prolonged disturbances of normal physiological processes can cause acute changes in cognition and memory. There is no reason to concentrate only on the brain, as the number of possible diagnosis is very wide. ……….
Since altered mental status and delirium and early dementia is easy to miss, a systematic approach to detect physiologic derangement in any and every case, is to carefully and mindfully measure the vital signs of every patient seen in emergency departments and also in walk in visits to the doctor and whenever the doctor is suspicious that the patient is not quite themselves. This is a basic and easy thing to do and will lead to more detailed investigations if the patterns of vital signs is abnormal.
Baseline respiratory rate must be measured , as well as heart rate, blood pressure and body temperature, because it is the most sensitive of the vital signs and may prove to be the most sensitive in disturbance of mental status, including depression. Studies are needed in order to confirm this. The patient can be given a short mental status test and the doctor can ask the patient if their mental state, memory, mood and cognition is normal. The patient will most likely be able to report acute changes to mental status, if asked directly. The forgetful patient may otherwise “forget” to mention it or the doctor may discount what they say. A memory screening test will clearly suggest if there is a problem or not.
Ventilatory failure is easy to miss in patients with unknown neuromuscular injuries affecting the strength or pattern of the ventilatory muscles because of the lack of obvious physical signs of breathing difficulty seen in normal patients.
To be continued ……