Psychiatric disorders in Post-acute COVID-syndrome (PDPACS): Recommendations for health care professionals

Abstract

The number of patients recovering from the coronavirus disease 2019 (COVID-19) is increasing worldwide; however, they may still be at risk of suffering from Post-acute COVID-syndrome (PACS) with severe repercussions in their mental health. PACS is a complex sequel of systemic symptoms that persist in patients after four weeks of an acute COVID-19 infection (Nalbandian et al., 2021). PACS´s prevalence is 10 to 35% in the general population and up to 85% in previously hospitalized patients (Pavli et al., 2021). Psychiatric disorders in PACS (PDPACS) are multiple and include post-traumatic stress disorder (PTSD) (prevalence up to 20%), depression and anxiety (prevalence up to 23%), and insomnia (prevalence up to 26%) (Pavli et al., 2021). Health professionals providing primary care (primary care providers, PCPs) are the front line that identifies COVID-19 patients with a high risk of suffering from PDPACS and are responsible to give timely support. Nevertheless, there is still a need for guidelines and standardized procedures to achieve this task. This letter highlights the importance of the timely assessment of patients at risk of PDPACS, providing recommendations for health care professionals. The risk factors for severe acute COVID-19 are related to a higher risk of PDPACS (Pavli et al., 2021; Su et al., 2022). These risk factors include old age (>60), chronic diseases, SARS-CoV-2 RNAemia, Epstein-Barr virus viremia, increased levels of procalcitonin, D-Dimer, and IL-1, IL-6, and specific autoantibodies such as anti-SARS-CoV-2 nucleocapsid protein IgG (Nalbandian et al., 2021; Pavli et al., 2021; Su et al., 2022)(Fig. 1 ). Signs of PTSD, depression, anxiety, insomnia, brain fog, acute stress disorder, or adjustment disorder should be treated with prompt psychiatric support. Psychiatric screening and follow-up should be performed at four key moments: two weeks after clinical recovery (10 days since first symptoms) and then at the first, third, and sixth months after. Furthermore, if mental health issues or psychiatric symptoms appear at any time during or after COVID-19 recovery, a visit to PCPs should not be delayed (Fig. 1 ) Fig. 1 Recommendations regarding PDPACS based on pathophysiology and its recommended follow-up appointments. Fig 1 Early detection of psychiatric problems improves the patient's quality of life and reduces the risk of PDPACS. PCPs need to have training in providing accurate and evidence-based information about the course of illness and prognosis to the patients and their relatives, relieving the social and psychological stress (Gonçalves Júnior et al., 2020; Pavli et al., 2021). We recommend using the SPIKE protocol to deliver bad news and ease the conversations with patients mitigating their discomfort (Gonçalves Júnior et al., 2020). It is highly recommended that PCPs provide recommendations and guidance regarding the use of social media, as misinformation can cause population distress (Pavli et al., 2021; Polizzi et al., 2020). Encouraging social interaction and self-care (healthy eating habits, sleep hygiene, and regular exercise) may improve patient´s mental health (Pavli et al., 2021; Polizzi et al., 2020). However, these recommendations should be personalized according to patients' characteristics (Fig. 1 ). The proposed follow-up of COVID-19 patients, recovering or recovered, is essential and should be practiced by all health care professionals. Taking into account the recommendations mentioned in this letter may help decrease the burden of PDPACS in our society. Additionally, we hope that this letter will serve as a stepping stone for future clinical guidelines in the management of neuropsychiatric disorders in PACS. Funding Sistemas Médicos de la Universidad San Francisco de Quito, USFQ. Escuela de Medicina, Colegio de Ciencias de la Salud COCSA, USFQ, Quito, Ecuador. These funding sources had no role in the design of this study and will not have any role during its execution, analyses, interpretation of the data, or decision to submit results. Author contributions AF, BN, CEV, YLT wrote the manuscript, reviewed and cured data; KZ and AC revised the manuscript basic science, JO, SF, GC revised manuscript clinical data and applications. GC provided the initial idea to target PDPCS and key information to analyze the subject. JO, SF and GC revised the neurological aspects of this article and provided feedback for a holistic approach. AC supervised, mentored and administered the work. AF, BN, CEV, YLT, KZ, JO, SF, GC and AC reviewed and commented on the manuscript to its final form and approval. AF, BN, CEV, YLT, AC conceptualization. Declaration of Competing Interest Other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.