Review BMJ - Cognitive and mental health outcomes in long covid, 2025, Aretouli et al

Kalliope

Kalliope

Senior Member (Voting Rights)

Abstract​

Roughly one in five adults who meet criteria for long covid present with objective or subjective cognitive dysfunction or elevated symptoms of depression or anxiety lasting ≥12 weeks from an acute covid illness.

These neuropsychiatric sequelae have considerable functional consequences at the level of the individual, society, and the broader economy. Neuropsychiatric long covid symptoms are thought to be causally diverse, and a range of risk factors as well as biological, psychological, and environmental mechanisms have been hypothesized to contribute to symptom development and persistence.

When present, objective cognitive deficits tend to be modest for most individuals, with some evidence suggesting increased risk of dysfunction and decline specifically for older adults with a history of severe acute illness. Longitudinal data suggest a delayed emergence of psychiatric symptoms may occur in the weeks and months after an acute covid illness.

Emerging research points to the early recovery period as a potential window of opportunity for intervention to alter patient trajectories, though evidence based treatment remains lacking.


www.bmj.com

Cognitive and mental health outcomes in long covid

Roughly one in five adults who meet criteria for long covid present with objective or subjective cognitive dysfunction or elevated symptoms of depression or anxiety lasting ≥12 weeks from an acute covid illness. These neuropsychiatric sequelae have considerable functional consequences at the...
www.bmj.com www.bmj.com
 
One of the rapid responses is from an Alexis J Gilbert - Consultant in Health Protection, medically retired due to Severe Long Covid and M.E.

quote:

As a public health consultant forced into medical retirement by Long Covid and M.E., I commend Aretouli et al. for their comprehensive review of neuropsychiatric outcomes. However, its focus solely on the neuropsychiatric impacts of long covid illustrates a fundamental problem with the way long covid, Myalgic Encephalomyelitis, and other Infection-Associated Chronic Conditions (IACCs) are managed by health systems; patients with complex multi-system illnesses do not have a specialty that provides the holistic care they need and multi-disciplinary care does not exist.

Full response
 
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Snap!

Consent to treatment is not a static thing. It is an ongoing process and can be withdrawn at any time, as long as you have mental capacity to consent.

Given my age and my health, I had a long conversation with my solicitors this morning concerning an enduring power of attorney for health and social care which we discussed earlier in the year. So she knows I have capacity as of today's date. The trouble I have is who in the heck would want that role for me! Plus its expensive.

So I started re-checking the other available options I'd looked at before, and came across this:

NSW Australia where it is confined in it's application to criminals - forensic psychiatry.

Mental Health and Cognitive Impairment Forensic Provisions Act 2020​

Summary​

This Information Bulletin is to inform staff about changes made by new legislation.
File link: Mental Health and Cognitive Impairment Forensic Provisions Act 2020
File size: 395 KB
Document type: Information Bulletin
Document number: IB2021_013
Publication date: 24 March 2021
Author branch: Mental Health
Branch contact: (02) 9461 7074
Review date: 24 March 2026
Policy manual: Not applicable
File number: H21/65832
Status: Active

Functional group​

  • Clinical/Patient Services - Mental Health

Applies to​

  • Local Health Districts
  • Chief Executive Governed Statutory Health Corporations
  • Specialty Network Governed Statutory Health Corporations

Distributed to​

  • Public Health System

Audience​

  • Mental Health Staff
  • Area Mental Health Directors
Click to expand...


Being aware the the new Mental Health Bill 2025 legislation is still going through Parliament. It was published on 7 November 2024. I checked the Bill does not include the phrase cognitive impairment. Unfortunately, I'm going to have to read the whole thing. together with a refresh of the Mental Health Act 1983 to be doubly sure, for my own purposes.
 
and the broader economy.​

Guess who the target audience is for this paper.

Emerging research points to the early recovery period as a potential window of opportunity for intervention to alter patient trajectories, though evidence based treatment remains lacking.​

As we have been suggesting for [checks notes] decades.
 
Sean said:
Emerging research points to the early recovery period as a potential window of opportunity for intervention to alter patient trajectories, though evidence based treatment remains lacking.
As we have been suggesting for [checks notes] decades.
Click to expand...
Except that our proposals is to leave the patients alone and let them get enough rest. They are probably proposing CBT and/or physical rehab of some sort.
 
So, this is a literature review of a flawed literature mostly built out of flawed data, leading, unsurprisingly, to a flawed review, which misses most of the important points, and brings entirely unrelated ones to the forefront. As is tradition with a flawed process analyzing flawed data.

If they would just drop everything related to mental health or psychology, especially the awful biopsychosocial nonsense, it would already be massively improved. As it is, it's just mostly flawed and misleading.

And it shows how hopeless this all is. The flawed data leading to flawed literature leading to flawed reviews are never corrected. If this were software, it would be a bug-ridden mess where bugs never get corrected, they just write new code using the old code to bring entirely new bugs and not much more. All the bugs are still there, they just duplicate functionality, making the whole thing unusable, because usability is not even part of the evaluation process, and they can't even do it competently anyway.
About five years after the onset of the covid-19 pandemic, a reliable diagnostic marker for long covid is lacking, as is a consensus definition or generally agreed upon set of diagnostic criteria
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So clearly this is all that matters. For better or worse, medicine is built entirely around those markers and an understanding of the problems with biology. The rest is so under-performing it's completely wasted since the only meaningful progress will be made with an understanding of the biology, all of which will render the rest obsolete, so might as well not do the things that are useless and will be made obsolete since all it does is slow down the process of finding the problem, and thus the solution.

Medicine had the choice between doing something useful, or holding on to their ideology. And they have so far held on to the ideology. To great harm and misery, and it's not about to change. Just a fully impotent profession without its tools, literally less useful than software developers without a computer.
 
Utsikt said:
Except that our proposals is to leave the patients alone and let them get enough rest. They are probably proposing CBT and/or physical rehab of some sort.
Click to expand...
And the O' Dowd et al. 2020 early intervention study didn't go well. 8/28 in the intervention group did not complete 6-month questionnaires. Acceptability was low:
Most participants (twelve) found parts of the intervention acceptable, but fifteen reported one or more problems with acceptability.
Click to expand...
and the intervention was not effective:
1755613857482.png
 
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