Long COVID neuropsychiatry

Also known as Post-COVID-19 condition · Post-acute sequelae of SARS-CoV-2 infection · PASC · Post-COVID-19 syndrome · Long haul COVID · Brain fog after COVID · Post-viral fatigue after COVID

Exam-exhaustive fellowship topic on the neuropsychiatry of long COVID — WHO, NICE and RECOVER definitions and why they disagree; the fatigue, cognitive, mood, sleep and dysautonomia phenotype; the four proposed mechanisms graded by evidence maturity; the functional-symptoms framing trap; assessment, exclusion work-up, pacing and the graded-exercise controversy; disability documentation; prognosis; and the ME/CFS lesson about how medicine handles contested illness. FRANZCP-primary, globally tagged.

medium20 referencesUpdated 26 July 202619 min readVerification in progress

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12 MCQs

Meet the patient

A 38-year-old intensive care nurse, fourteen months after an infection she describes as "a bad two weeks, nothing dramatic". She can no longer finish a handover without losing the thread. On a good day she walks four hundred metres; she then spends three days in a darkened room paying for it.^[4]^[17]

Her bloods are normal. Two letters in her file say "anxiety". She arrives at your clinic with a plastic folder and the flat, guarded voice of someone who has rehearsed being disbelieved.^[20]^[14]

The examiner's question is never "is it real?" It is: "What are the first three things you do in this consultation, and what would make you wrong?"^[4]^[14]

References20Show

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[3]Thaweethai T, et al. Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection JAMA, 2023.PMID 37278994
[4]Davis HE, et al. Long COVID: major findings, mechanisms and recommendations Nat Rev Microbiol, 2023.PMID 36639608
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[11]Pretorius E, et al. Persistent clotting protein pathology in Long COVID/Post-Acute Sequelae of COVID-19 (PASC) is accompanied by increased levels of antiplasmin Cardiovasc Diabetol, 2021.PMID 34425843
[12]Fernández-Castañeda A, et al. Mild respiratory COVID can cause multi-lineage neural cell and myelin dysregulation Cell, 2022.PMID 35768006
[13]Teodoro T, et al. A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: systematic review J Neurol Neurosurg Psychiatry, 2018.PMID 29735513
[14]Sharpe M, Greco M Chronic fatigue syndrome and an illness-focused approach to care: controversy, morality and paradox Med Humanit, 2019.PMID 31213482
[15]Kingdon C, et al. What Primary Care Practitioners Need to Know about the New NICE Guideline for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome in Adults Healthcare (Basel), 2022.PMID 36553962
[16]White PD, et al. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial Lancet, 2011.PMID 21334061
[17]Pouliopoulou DV, et al. Prevalence and Impact of Postexertional Malaise on Recovery in Adults With Post-COVID-19 Condition: A Systematic Review With Meta-analysis Arch Phys Med Rehabil, 2025.PMID 39921187
[18]Kuut TA, et al. Efficacy of Cognitive-Behavioral Therapy Targeting Severe Fatigue Following Coronavirus Disease 2019: Results of a Randomized Controlled Trial Clin Infect Dis, 2023.PMID 37155736
[19]Wahlgren C, et al. Two-year follow-up of patients with post-COVID-19 condition in Sweden: a prospective cohort study Lancet Reg Health Eur, 2023.PMID 36855599
[20]Stelson EA, et al. Return-to-work with long COVID: An Episodic Disability and Total Worker Health® analysis Soc Sci Med, 2023.PMID 37918226