Multi-disciplinary collaborative consensus guidance statement on the assessment and treatment of mental health symptoms in...(PASC),2023, Cheng et al

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Multi-disciplinary collaborative consensus guidance statement on the assessment and treatment of mental health symptoms in patients with post-acute sequelae of SARS-CoV-2 infection (PASC)

INTRODUCTION
Post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC), also called Long COVID (coronavirus disease), is the experience of new or worsened signs, symptoms, or conditions that develop after resolution of the acute phase of a COVID-19 infection. Although some people with COVID-19 recover well, others have persisting symptoms.1 PASC can manifest as a wide-ranging constellation of disabling sequelae, including mental health conditions.2 Anxiety and depression have been reported as the second and third most common symptoms of PASC, respectively.3 Furthermore, in a narrative review summarizing neuropsychiatric dimensions of PASC, anxiety, post-traumatic stress disorder (PTSD), and depression were among the most reported symptoms of both ongoing symptomatic COVID-19 and PASC. Pooled prevalence of each was: anxiety 19.1% (95% confidence interval [CI], 13.3%–26.8%), PTSD 15.7% (95% CI, 9.9%–24.1%), and depression 12.9% (95% CI, 7.5%–21.5%).4 Despite the high prevalence and often disabling impact of PASC and PASC-related mental health symptoms and the emerging data that PASC can persist for months or years,5 limited guidance currently exists regarding the assessment and treatment of mental health conditions in patients with PASC.

Addressing mental health symptoms in the setting of PASC involves several unique complexities, including addressing stigma that may interfere with appropriate diagnosis(es) and treatment, insufficient availability of mental health professionals, and differentiating mental and physical health diagnoses. Many patients have described being questioned about their PASC-related symptoms in a way that feels dismissive of their experience and/or mistakenly attributed to an underlying mental health condition.6 Although the effects of the COVID-19 pandemic on individuals and society can exacerbate direct sequelae from SARS-CoV-2 infection, increasingly evidence supports that new mental health symptoms can also be a component of PASC or caused by SARS- CoV-2 infection, and pre-existing mental health conditions can be exacerbated by PASC, yet mental health conditions are not, in and of themselves, the overall cause of PASC.7-9 Another challenge in addressing mental health disorders is the national and global shortage of mental health professionals.10 This challenge is further intensified because clinicians who are not mental health specialists often express discomfort and a perception of insufficient training to discuss mental health with their patients.

Nevertheless, most patients report that they want clinicians who are not mental health specialists to broach the topic and acknowledge the interplay between mental and physical health.11-13 Finally, studies have found that PASC can manifest as symptoms that are not due to a mental health condition, but that can mimic and/or be exacerbated by a mental health disorder. These symptoms include fatigue, dysautonomia, disordered sleep, and cognitive dysfunction,14, 15 which can also interfere with a patient's ability to fully participate in first-line treatment recommendations.

The goal of this consensus statement is to present practical guidance for clinicians who treat patients with PASC. Specifically, this statement addresses the assessment and initial treatment of PASC-related mental health symptoms including depression, anxiety disorders (including panic), and PTSD. People with PASC have also reported new or worsening suicidal ideation, psychosis, obsessive compulsive disorder (OCD), and pandemic-related grief and survivor's remorse8, 16-18; however, specific focus on these conditions is outside the scope of this statement. The recommendations in this statement are applicable to all patients with PASC who are experiencing mental health symptoms, regardless of the time course. Of note, this guidance statement reflects the current evidence base and related recommendations from an expert panel of health care professionals who regularly care for people with PASC. The recommendations should not preclude clinical judgment and must be applied in the context of each specific patient, with adjustments for patient preferences, comorbidities, and other factors.



https://onlinelibrary.wiley.com/doi/full/10.1002/pmrj.13085

 

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differentiating mental and physical health diagnoses

Something this paper also fails at, so that's not especially encouraging. If only this could be done, but instead it's blatantly obvious that medicine cannot tell the difference. Almost all of what they describe as mental illness is just illness, illness they don't understand and, because of that, misattribute. If you remove the illness and all the "mental health" complaints go away, then you have regular illness, just a type you don't understand. But most important, the mental health aspects are merely secondary to this, downstream from the problem.

No one who is ill will be happy or functional, the very idea is absurd. They will always rate positive on mental health questionnaires because the questions overlap on purpose, so that the illness can be retroactively attributed as its own cause. The idea that you can somehow improve the mental health of sick people this way is equally absurd.

This is the nightmare that the psychosomatic industry has built. You will not be improving the mental health of sick people this way. Not in this century, not even in the next. And any stigma (discrimination, really) that needs to be addressed stems entirely from within medicine itself, there is no work to be done towards patients here. It's no different than sexual abuse, you need to stop the offenders, not somehow try to get the victims to live with it.

Finally, studies have found that PASC can manifest as symptoms that are not due to a mental health condition, but that can mimic and/or be exacerbated by a mental health disorder. These symptoms include fatigue, dysautonomia, disordered sleep, and cognitive dysfunction,14, 15 which can also interfere with a patient's ability to fully participate in first-line treatment recommendations.

None of those are mental health problems. You have simply mismanaged this because of psychosomatic ideology, and this paper continues to perpetuate the confusion and failure. As is tradition. Again, if you fix the illness, the "mental health" aspects go away entirely, because you simply cannot tell the difference, and choose to overlook that in the perpetuation of psychosomatic ideology.