Long-COVID syndrome: physical–mental interplay in the spotlight 2023 Thurner and Stengl

Abstract

Patients suffering from Long-COVID syndrome experience a variety of different symptoms on a physical, but also on a psychological and social level. Previous psychiatric conditions such as depression and anxiety have been identified as separate risk factors for developing Long-COVID syndrome. This suggests a complex interplay of different physical and mental factors rather than a simple cause–effect relationship of a specific biological pathogenic process. The biopsychosocial model provides a foundation for understanding these interactions and integrating them into a broader perspective of the patient suffering from the disease instead of the individual symptoms, pointing towards the need of treatment options on a psychological as well as social level besides biological targets. This leads to our conclusion, that the biopsychosocial model should be the underlying philosophy of understanding, diagnosing and treating patients suffering from Long-COVID syndrome, moving away from the strictly biomedical understanding suspected by many patients, treaters and the media while also reducing the stigma still associated with the suggestion of a physical–mental interplay.

Open access, https://link.springer.com/article/10.1007/s10787-023-01174-4

 

When you pay zero attention to the outside world, and are strictly focused on what matters to you, instead of what is actually important.

Medicine without any consideration for patients, only pet ideologies, exactly as lousy as it sounds.

 

Yes, he was also invited to the long covid symposium of the Hungarian Academy of Sciences last year and I wrote about what he said here. He conveniently twisted things the way it fit his narrative.

 

The first order BPS references are to Engel - there's nothing from the UK interpretation or its supporters, which I think is significant. The paper notes that Post acute COVID sequelae (PASC) affect a large and diverse population and that population has diverse medical and social needs which can't be met exclusively from biological treatment, for example data show that pre-existing psychiatric illness is a rick factor for PASC, that must require particular attention from the psychs, as does the possibility of post hospitalisation depression or the psychological impacts of job loss, relationship breakdown etc which are likely in the face the economic impacts of a pandemic. Engel's ideas may not work, but a pandemic is precisely the kind of condition in which his BPS model should have useful application.

Long COVID isn't ME/CFS, even if ME/CFS appears in people following an acute COVID infection, there is just too great a range of reported morbidity in the Long COVID symptom array to equate the two. The key is to ensure that those who meet ME/CFS criteria after having COVID 19 are treated appropriately - and all those who don't are treated appropriate to their symptoms, some of which will inevitably involve psychiatry. There was always a danger that lumping in PASC with PVS, PVFS and ME/CFS would swamp clear identification of ME/CFS - I think that is now a reality both for individual patients and for the understanding of ME/CFS.

Thurner and Stengel's paper isn't without problems, they appropriate PEM to a de-conditioning agenda: "In addition, patients are often afraid of the sometimes very intense “crashes” of post-exertional malaise, leading to a reduction of physical and mental exercise, which in turn further decreases the respective abilities and condition." But lumping allows that - amongst the millions who report PASC, de-conditioning may well be an issue that can affectively be addressed for a greater or lesser number, but for those meeting ME/CFS criteria the difficulties with exercise focused recovery need to be separately (and loudly) stated.