Trying to find a magic pill without exploring the pathophysiology of adult onset disturbance of mind, mood and motor activity is unlikely to succeed and blind attempts to try , may cause damage and impede recovery. Antipsychotics may make patients more manageable but do not restore their original baseline adult function . Without their original mental function these patients are unlikely to have a successful or independent life. Antipsychotics also cause horrible side effects. They are used only because there is nothing else.
The treatment approaches to mental illness so far have been simplistic, devoid of any thought to possible deranged physiology in these patients. No one has examined these patients to look for physical problems which could lead to metabolic derangements which could cause set patterns of delirium.
Caretaking of patients while they are incapacitated, [in the community or in the hospital] is an important part of taking care of these patients when we do not have good options. Often,though, once the initial flurry of known treatments are exhausted, patients are just left behind in whatever altered state that has become the new normal. No one follows their physical conditions.
There has never been a serious attempt to understand these diseases from a physiological point of view, involving the entire body, because the care of people while in these different patterns of altered states plus searching for possible pathophysiology is hard.
Yet it is the job of the specialist, in this case, a psychiatrist, to find out what has happened to alter the state of the patients, psychiatrists supposedly look after.
One major problem, in my opinion, with the field of psychiatry is that psychiatrists are not interested in the field of medicine and are not even allowed to touch or examine their patients. And yet, altered mental states, often are accompanied by altered physical signs vital to life and also to the circulation of blood and nutrients and vital to the full function of the brain.
Manic Depressive Insanity, especially, is a useful disease to study because [if not sustained by incorrect medications], attacks will be remitting/relapsing and full recovery of baseline mood, mental status and motor activity between attacks, often occurs.
This is the case with Paula, the patient I have been discussing. Full recovery of one’s wits, mood and motor activity can take months, years or decades without treatments, though.
No one knows why a serotonin agonist [Paxil] brings back Paula’s baseline function, but it seems that serotonin plays a big role in many physiological functions. Serotonin is a big part of the clotting system of the blood and so it is expected that it could help to repair injury in the body. Serotonin might need to be enhanced in bipolar patients, much like thiamine needs to be enhanced in malnourished patients.
Serotonin plays a part in breathing, although no one knows whether it helps the lungs and/or the breathing muscles needed to inhale and exhale. As both are required to function for life, As both are required to function for life, and both are needed to maintain normal blood gases in the blood, regular repair of all parts of the respiratory system would be vital to normal mood, mental status and motor activity.
Slight changes to blood gases will cause a range of reversible symptoms, affecting mood [unpleasant mostly, although euphoria can occur], cognitive ability [ dulling cognitive ability and memory] and motor activity [from lethargy to excitement].
Blood gases are difficult to measure and the resting breathing rate maintained by the brain and the circulatory systems of the body will determine its pattern.
Dr Emile Kraepelin studied the vital signs of bipolar patients during the extremes of manic and depressive attacks and noted abnormalities to the feedback system of the ventilatory system.
Paula, whose vital signs were taken in a first aid class and then regularly by herself and by me, has very abnormal ventilatory rate and pattern.
This is an example of an pathophysiological physical sign which could be very important in explaining bipolar illness attacks.