Does COVID-19 related symptomatology indicate a transdiagnostic neuropsychiatric disorder? - Multidisciplinary implications

Abstract

The clinical presentation that emerges from the extensive coronavirus disease 2019 (COVID-19) mental health literature suggests high correlations among many conventional psychiatric diagnoses. Arguments against the use of multiple comorbidities for a single patient have been published long before the pandemic. Concurrently, diagnostic recommendations for use of transdiagnostic considerations for improved treatment have been also published in recent years. In this review, we pose the question of whether a transdiagnostic mental health disease, including psychiatric and neuropsychiatric symptomology, has emerged since the onset of the pandemic. There are many attempts to identify a syndrome related to the pandemic, but none of the validated scales is able to capture the entire psychiatric and neuropsychiatric clinical presentation in infected and non-infected individuals. These scales also only marginally touch the issue of etiology and prevalence. We suggest a working hypothesis termed Complex Stress Reaction Syndrome (CSRS) representing a global psychiatric reaction to the pandemic situation in the general population (Type A) and a neuropsychiatric reaction in infected individuals (Type B) which relates to neurocognitive and psychiatric features which are part (excluding systemic and metabolic dysfunctions) of the syndrome termed in the literature as long COVID. We base our propositions on multidisciplinary scientific data regarding mental health during the global pandemic situation and the effects of viral infection reviewed from Google Scholar and PubMed between February 1, 2022 and March 10, 2022. Search in-clusion criteria were “mental health”, “COVID-19” and “Long COVID”, English language and human studies only. We suggest that this more comprehensive way of understanding COVID-19 complex mental health reactions may promote better prevention and treatment and serve to guide implementation of recommended administrative regulations that were recently published by the World Psychiatric Association. This review may serve as a call for an international investigation of our working hypothesis.

Transdiagnostic considerations of mental health for the post-COVID era: Lessons from the first surge of the pandemic

“…Because our findings span different diagnostic categories, we propose that this argues for the need for a broader, transdiagnostic perspective[ 4 , 21 , 22 ]. We note that even prior to the pandemic others suggested a transdiagnostic approach for better treatment[ 23 - 26 ].…”

“…One limitation of our bi-national research is that we did not assess the full range of the possible neuropsychiatric spectrum, including neuropsychiatric symptoms and patterns evident in individuals recovering from infection. This extended transdiagnostic approach is discussed in our recent review published in the World Journal of Psychiatry, suggesting a neuropsychiatric syndrome, Complex Stress Reaction Syndrome, combining emotional-psychological symptoms (Type A) with neuropsychiatric (the non-systemic portion of Long-COVID) symptoms (Type B)[ 4 ]. Although the Israeli sample size is modest compared to the Italian sample, the Israeli data were collected by national probability-based representative sampling.…”

“…This occurred more frequently in individuals with prior psychiatric illness and with the continued duration of the pandemic. This unique clinical picture that characterizes the reaction to the pandemic may raise broader thoughts on diagnostic considerations regarding a new category beyond pandemic mental health symptomatology[ 4 ]. This suggested category may involve transdiagnostic criteria resulting from multiplicity of stressors.…”

“…The pervasive and persistent stress of the Coronavirus disease 19 (COVID-19) pandemic resulted in psychopathology afflicting millions world-wide. The unique impact of the pandemic on mental health is still pervasive and a significant burden on society[ 3 ], including the difficulties in diagnosis[ 4 ], which span diagnostic boundaries in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and International Classification of Diseases 11 th Revision (ICD-11) defined disorders[ 5 , 6 ]. Past pandemics have raised similar concerns regarding mental health[ 7 , 8 ].…”

International study of the Complex Stress Reaction Syndrome: Implications for transdiagnostic clinical practice

“…According to WHO reports, 22% of the population develops mental health problems in a dimensional pattern, reactive to emergencies[ 30 ]. Accordingly, we related the CSRS to the COVID-19 situation and included CSRS, Type A (psychiatric symptoms) and Type B (psychiatric and neuropsychiatric symptoms in COVID-infected and recovered individuals, excluding systemic symptoms of long-COVID)[ 26 , 31 ]. However, the possibility that CSRS is relevant in the post-COVID era, to capture the mixed clinical picture resulting from concomitant daily stressors in the general population, has only recently been proposed[ 16 ].…”