The time to act: Early recommendations on patient care for psychiatric disorders in post-acute COVID-19 syndrome (PDPACS); Response to Llach and Ammella´s letter to the editor (Llach and Anmella, 2022).

Dear Editor,

As authors of the article by Paez et al. (2022), we thank the comments given by Lach and Anmella to our letter (Llach and Anmella, 2022). In our letter (Paez et al., 2022), we provide recommendations for which Lach and Anmella's response highlights important aspects to consider in the evolving forefront of medical and scientific actions to fight COVID-19 (Llach and Anmella, 2022). Clinical recommendations towards guidelines are needed, especially in countries affected most by the pandemic (due to the lockdown, delayed access to vaccines, and high mortality).

Clinical guidelines to optimize the care of patients who are at risk of suffering from psychiatric disorders in post-acute COVID-19 syndrome (PDPACS) should include all neurocognitive disorders observed to be highly prevalent after six months of the initial infection (Premraj et al., 2022). On average, 28% of post-COVID-19 patients present memory impairment which should be differentiated from dementia (Llach and Vieta, 2021; Premraj et al., 2022). Due to the course of dementia and early reversible cognitive decline in PDPACS, having a differential diagnosis among these disorders within the first six months could result challenging. Therefore, we recommend a follow-up after six months of recovery from COVID-19 infection.

We agree that patients at risk of suffering from post-acute COVID-19 syndrome (PACS) should be referred to a mental health specialist in a timely manner and according to severity criteria based on structured guidelines. In order to effectively take this recommendation to clinical practice, primary care professionals (PCPs) should have a key role in providing swift and effective patient assessment to dispense appropriate care and further referral to a specialist in mental health. PCPs should be trained to assess PDPACS in settings where the healthcare system lacks sufficient mental health specialists as the demmand for treatment would probably grow. The criteria for referral should include 1. refractoriness of the symptoms despite management provided by PCP, 2. presence of baseline mental illness, 3. structured suicidal ideation, but also include 4. psychotic features in any of PDPACS.

Objective methods are needed to improve current PDAPCS diagnostics. Without a doubt, longitudinal studies are essential to develop evidence-based methods and recommendations to prevent, diagnose and treat psychiatric disorders in PDPACS. However, this represents an immense challenge and may take valuable time when an urgent public health solution is needed. Each country has a different social setting with direct effects on the population's mental health, which may influence the incidence, risk of development, symptoms, and progression of PDPACS. A Delphi panel may be considered a timely option for PDAPCS guidelines while researchers wait for data from longitudinal studies. A notable example where this methodology was applied is the WHO consensus on post-COVID-19 conditions (Soriano et al., 2021).

Towards this end, agreements to respond to this need are essential to overcome the mind-long COVID-19. The timely response of the healthcare community worldwide will provide crucial recommendations to benefit patients' mental future, maintaining their quality of life and daily functioning to a healthy state.

Author contributions

AF, BN, CEV, YLT, MV and AC wrote the manuscript, reviewed and cured data; KZ and AC revised the manuscript data, JO, SF, GC revised the 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, MV, KZ, JO, SF, GC and AC reviewed and commented on the manuscript to its final form and approval. AF, BN, CEV, YLT, MV, AC conceptualization of the response letter.

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.

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.