Post-COVID-19 condition—Clinical phenotyping in practice, 2024, Karen Humkamp et al

[Mij]

Abstract
Background
The high number and clinical heterogeneity of neurological impairments in patients with a post-COVID-19 condition (PCC) poses a challenge for outpatient care.

Objective
Our aim was to evaluate the applicability of the proposed subtypes according to the guidelines “Long/Post-COVID” (30 May 2024) and their phenotyping using clinical and neuropsychological findings from our post-COVID outpatient clinic.

Methods
The evaluation was based on cross-sectional neurological and psychological test examinations of the patients, which were carried out using standardized questionnaires and test batteries. In addition, a detailed anamnesis of the current symptoms and a retrospective survey of the acute symptoms up to 4 weeks after the confirmed infection was conducted. The subtypes were classified according to the abovementioned guidelines based on the medical history and selected patient questionnaires, to which we added a 5th subtype with reference to the previous guidelines “Long/Post-COVID” (as of 5 March 2023).

Results
A total of 157 patients were included between August 2020 and March 2022. The presentation was at a median of 9.4 months (interquartile range, IQR = 5.3) after infection, with a mean age of 49.9 years (IQR = 17.2) and more women (68%) presenting, with a total hospitalization rate of 26%.

Subtype 1 (postintensive care syndrome) showed the highest proportion of men, highest body mass index (BMI) scores and the highest rates of subjective complaints of word-finding difficulties (70%). Subtype 2 (secondary diseases) was dominated by cognitive impairment and had the highest depression scores. Subtype 3 (fatigue and exercise-induced insufficiency) was the most common, had the most symptoms and most severe subjective fatigue and the largest proportion of women. Subtype 4 (exacerbation) mainly showed affective symptoms. Subtype 5 (complaints without relevance to everyday life) had the lowest scores for depression, fatigue and BMI. Neurological and psychological conditions were frequently pre-existing in all groups.

Discussion
The management of PCC can be improved at various levels. A standardized subtype classification enables early individually tailored treatment concepts. Patients at risk should be identified at the primary care level and informed about risk factors and prevention strategies. Regular monitoring of cardiovascular risk factors and physical activity are essential for PCC treatment. In the case of cognitive deficits and concurrent affective symptoms, psychotherapeutic support and drug treatment with selective serotonin reuptake inhibitors (SSRI) should be provided at an early stage.
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[NelliePledge]

SSRIs are appropriate based on what evidence?

 

[rvallee]

SSRIs are appropriate based on what evidence?

Furthermore, the generous administration of an SSRI should be discussed, as PCC patients reported a positive effect on fatigue, cognition and quality of life

References this study from 2023: Treatment of 95 post-Covid patients with SSRIs. Based on this flimsy reasoning:

This study used an exploratory questionnaire and found that two-thirds of patients had a reasonably good to strong response on SSRIs, over a quarter of patients had moderate response, while 10% reported no response

The main weakness of this study is that it is not a randomized controlled trial (RCT). We had no control group. Therefore, a placebo effect cannot be ruled out.

LMAO at the idea that RCTs rule out placebo effects, when bad methodology and biased questionnaires are basically the noise usually referred as placebo. There are so many bad RCTs out there, including for ME/CFS, and none have validated such efficacy.

However, it is known that 85% of patients who have symptoms two months after Covid-19 infection still have them after one year1. ME/CFS and dysautonomia are usually lifelong1

Basically bad evidence supporting bad evidence, aka evidence-based medicine.