Letter to the editor about the article "Psychiatric disorders in post-acute COVID-syndrome 3 (PDPACS): Recommendations for health care professionals" (Falconi A et al., 2022).

Dear editor,

A recent letter published in your journal, “Psychiatric disorders in Post-acute COVID-syndrome (PDPACS): Recommendations for health care professionals” from Falconi Paez et al. (2022), summarizes the characteristics of the psychiatric sequelae that many patients present after recovering from an acute SARS-CoV-2 infection, and provides a set of recommendations for the primary care providers regarding its early identification, follow-up appointments, and psychosocial management.

First, we would like to express our agreement with the authors concerning the need of structured clinical guidelines to tackle the psychiatric disorders in Post-acute COVID-syndrome (PACS). Despite the apparent end of lockdowns and the decrease in COVID-19 hospitalization ratios, the mounting number of patients that are currently recovering from mild and moderate infections worldwide suggest that the demand for mental health attention will probably grow (Pavli et al., 2021). This will make even more urgent to have appropriate diagnostic and therapeutic tools.

In this sense, we find it relevant to highlight some other aspects that can help optimize the assessment of this syndrome. In a previous article (Llach and Vieta, 2021), we described the constellation of mental symptoms organized around the “Mind Long COVID”. Although the incidence of post-acute COVID-19 dementia (1.6%) in people over 65 years is lower than mood (2%) or anxiety (4.7%) disorders, neurocognitive disturbances including not only brain fog but also difficulties with memory, concentration and executive function should be properly evaluated, as they are reported to impact patient's quality of life and daily functioning. Hence, cognitive impairment should also be ruled out during the first 6 months of follow-up.

In addition, indications for referral to a mental health professional, either to a psychologist or a psychiatrist, should be stated in the guidelines. While it is important to not pathologize the majority, some of the patients may benefit from mental health services. Severity criteria may include, but not be limited to, the refractoriness of the symptoms beyond a basic psychosocial and pharmacological approach, the presence of structured suicidal ideation, or the presence of a baseline severe mental disorder.

Finally, longitudinal studies are required to better define the protective factors and the biological underpinnings of Mind Long Covid. Mental health evaluations are necessary but are still unspecific and experts in the field have not yet agreed upon a stipulated timing or type of evaluations. The authors from the study propose a possibility regarding timing, but they don't explore potential evaluation objective methods. Still, considering the poly-syndromic nature of Mind Long Covid and PACS, it is maybe the time to elaborate useful transdiagnostic and rating tools. By reaching this consensus, future studies will have the possibility to respond yet unanswered questions and provide preventive strategies and treatments for Mind Long Covid.

Declaration of Competing Interest

CDLL has received CME-related honoraria, or consulting fees from Casen Recordati, with no financial or other relationship relevant to the subject of this article. GA has received CME-related honoraria, or consulting fees from Janssen-Cilag, Lundbeck and Angelini with no financial or other relationship relevant to the subject of this article.