Long COVID neuropsychiatry — assessment, pacing and the disability letter (MEQ)

(i) Definitions and further history — 5 marks

Name the definition you are using. WHO post-COVID-19 condition: usually 3 months from probable or confirmed infection, symptoms for at least 2 months, not explained by an alternative diagnosis, often fluctuating or relapsing. NICE separates ongoing symptomatic COVID-19 (4 to 12 weeks) from post-COVID-19 syndrome (beyond 12 weeks). RECOVER is a weighted research symptom index at six months or more, built for cohort consistency rather than clinic use.^[1][2][3]

The history that changes management:^[17][8][6]

• PEM probe — "what happens the day after you overdo it?" Delayed, disproportionate, prolonged worsening is PEM and it decides the rehabilitation plan.^[17][15]
• Functional timeline — pre-morbid function, acute illness, nadir, best and worst day now; a seven-day activity diary.^[1][17]
• Orthostatic symptoms — standing, heat and post-prandial triggers; relief on lying down.^[8]
• Mood, anxiety, PTSD, alcohol, sleep and suicidality, screened openly with the reason stated aloud.^[6][14]
• Occupational and financial context, and whether she ever had a documented positive test.^[20][1]