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INVITED SESSION A Psychosomatic Framework for Considering the Long-term Sequelae of COVID-19
Please join us for the live review of this session at 4:00 EST on Thu Nov 11:
https://clp21.secure-platform.com/a/solicitations/8/sessiongallery/schedule/items/121
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Millions of people have been infected with the SARS-CoV-2 virus in the United States and around the world. As the pandemic continues, it is becoming increasingly apparent that a significant portion of patients have not been able to return to their pre-infection health status. The large numbers of individuals with persistent (Long COVID) symptoms present important problems for public health officials, health care and disability payers, employers, communities, families, and patients themselves. They present an equally difficult conundrum for health care professionals across many specialties who are attempting to manage their COVID sequelae. Initial clinical observations and emerging epidemiologic research has identified several key challenges: (1) Myriad persistent symptoms have been reported in patients who have been infected with SARS-CoV-2, some linked to specific complications of acute infection, many not. (2) The time course of persistent symptoms is variable with some emerging during the acute stage of infection and continuing chronically whereas others appear later in the course of illness. (3) Relationships between the severity and recovery from acute illness, the nature and severity of persistent symptoms, and severity of long-term handicap are variable. These and other factors have made it difficult to conceptualize specific clinical phenotypes that may organize diagnostic evaluations, lead to specific therapeutic interventions, and inform research into potential pathogenic mechanisms. It is not yet clear if Long COVID arises from pathophysiologic processes uniquely triggered by SARS-CoV-2 or mechanisms of illness (structural, functional, and psychiatric) that have been observed as sequelae of other viral infections or other acute diseases more generally. This symposium will not attempt to answer all of these questions, but rather frame them in a psychosomatic context that will encourage C-L psychiatrists to use their skills and experience to treat patients with symptoms that persist after SARS-CoV-2 infection and contribute to research and education about the various manifestations of Long COVID. Dr. Staab will set the stage for the symposium with an overview of mechanisms that are familiar to C-L psychiatrists (predisposing, precipitating, provoking, and perpetuating processes) and how they may be applicable to Long COVID (10 minutes). Dr. Hurt will review emerging epidemiologic, phenotypic, and pathophysiologic data that have begun to identify mechanisms of structural injury (e.g., cardiac and pulmonary lesions) and alterations in physiologic processes (immunologic, autonomic) that may underlie the presentations of specific groups of patients (20 minutes). Drs. Hamm and Coulter will describe psychiatric disorders (primary and secondary) in patients who have been infected with SARS-CoV-2 and those undergoing treatment for its complications (20 minutes). Dr. Bieber will discuss psychosocial consequences of the pandemic particularly for children of affected families (20 minutes). Then, all presenters will gather as a panel to engage the audience in discussion (20 minutes).
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Millions of people have been infected with the SARS-CoV-2 virus in the United States and around the world. As the pandemic continues, it is becoming increasingly apparent that a significant portion of patients have not been able to return to their pre-infection health status. The large numbers of individuals with persistent (Long COVID) symptoms present important problems for public health officials, health care and disability payers, employers, communities, families, and patients themselves. They present an equally difficult conundrum for health care professionals across many specialties who are attempting to manage their COVID sequelae. Initial clinical observations and emerging epidemiologic research has identified several key challenges: (1) Myriad persistent symptoms have been reported in patients who have been infected with SARS-CoV-2, some linked to specific complications of acute infection, many not. (2) The time course of persistent symptoms is variable with some emerging during the acute stage of infection and continuing chronically whereas others appear later in the course of illness. (3) Relationships between the severity and recovery from acute illness, the nature and severity of persistent symptoms, and severity of long-term handicap are variable. These and other factors have made it difficult to conceptualize specific clinical phenotypes that may organize diagnostic evaluations, lead to specific therapeutic interventions, and inform research into potential pathogenic mechanisms. It is not yet clear if Long COVID arises from pathophysiologic processes uniquely triggered by SARS-CoV-2 or mechanisms of illness (structural, functional, and psychiatric) that have been observed as sequelae of other viral infections or other acute diseases more generally. This symposium will not attempt to answer all of these questions, but rather frame them in a psychosomatic context that will encourage C-L psychiatrists to use their skills and experience to treat patients with symptoms that persist after SARS-CoV-2 infection and contribute to research and education about the various manifestations of Long COVID. Dr. Staab will set the stage for the symposium with an overview of mechanisms that are familiar to C-L psychiatrists (predisposing, precipitating, provoking, and perpetuating processes) and how they may be applicable to Long COVID (10 minutes). Dr. Hurt will review emerging epidemiologic, phenotypic, and pathophysiologic data that have begun to identify mechanisms of structural injury (e.g., cardiac and pulmonary lesions) and alterations in physiologic processes (immunologic, autonomic) that may underlie the presentations of specific groups of patients (20 minutes). Drs. Hamm and Coulter will describe psychiatric disorders (primary and secondary) in patients who have been infected with SARS-CoV-2 and those undergoing treatment for its complications (20 minutes). Dr. Bieber will discuss psychosocial consequences of the pandemic particularly for children of affected families (20 minutes). Then, all presenters will gather as a panel to engage the audience in discussion (20 minutes).
Speakers
Jeffrey Staab
Professor and Chair, Department of Psychiatry and Psychology | Mayo Clinic
Jeffrey P. Staab, MD, MS, FACLP is Professor and Chair of the Department of Psychiatry and Psychology and Director of the Fellowship in Consultation-Liaison Psychiatry at Mayo Clinic, Rochester, MN. He and his colleagues in the Behavioral Medicine Program evaluate and treat more than 2000 patients with psychosomatic problems, functional neurologic, neuro-otologic, and GI disorders, and cancer distress each year. His research centers on problems at the interface of psychiatry and medical-surgical specialties, particularly neurology and otology. He is best known for investigations of chronic dizziness. Dr. Staab received a BS in chemical engineering from Northwestern University, MS in bioengineering from Carnegie-Mellon University, and MD from the University of Pittsburgh. He completed an internship in internal medicine and residency in psychiatry at the National Naval Medical Center (now Walter Reed National Military Medical Center) in Bethesda, MD, followed by a fellowship in traumatic stress disorders. He previously served on the faculties of the Uniformed Services University, University of Florida and University of Pennsylvania. Dr. Staab is author or co-author of over 140 scientific articles, reviews, and chapters. He serves on the editorial boards of six scientific journals in the fields of psychosomatic medicine and otorhinolaryngology and holds leadership positions in the Academy of Consultation-Liaison Psychiatry, Functional Neurological Disorder Society, and Barany Society.
Ryan Hurt
Professor of Medicine | Mayo Clinic
Ryan is a faculty member in the Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota. He has a joint appointment in the Divisions of Gastroenterology and Endocrinology, Mayo Clinic. He received his MD and PhD in physiology from the University of Louisville School of Medicine. He completed his residency and chief residency in internal medicine at the University of Louisville Affiliated Hospitals. He is board certified by the American Board of Internal Medicine. He is the Director of the Post COVID Care Clinical and Research Programs at Mayo Clinic Rochester. He is the Vice Chair of Practice and Vice Chair of Research in General Internal Medicine. He holds the rank of Professor of Medicine in the Mayo Clinic College of Medicine and Science. He has developed a clinical interest in nutrition, obesity, and addiction and most recently Long COVID, and has published over 150 peer-reviewed manuscripts and 14 book chapters in these areas.
Brandon Hamm
Assistant Professor, Consultation Liaison Psychiatry | Northwestern University
Brandon Hamm is currently an assistant professor on the consultation-liaison psychiatry service at Northwestern Memorial Hospital, and provides collaborative care services as well. He was a 2018-2019 Academy of Consultation Liaison Psychiatry Webb Fellow. He was Chief Resident of Academics during his psychiatry residency at Cleveland Clinic, where he also obtained a fellowship in Consultation Liaison Psychiatry. Areas of research include agitation management, leadership in care teams, decision-making capacity evaluations, virtue ethics, care provider experience, frostbite.
Andrew Coulter
Associate Staff | Cleveland Clinic Foundation
Andrew completed his undergraduate degree in psychology at the University of Pittsburgh, then attended medical school at Temple University School of Medicine, graduating with his MD as well as a Masters of Arts in Urban Bioethics. He completed his adult psychiatry residency as well as his consultation-liaison psychiatry fellowship at the Cleveland Clinic, and served as Academic Chief Resident. He currently is an associate staff in the Cleveland Clinic regional hospital system, engaged in inpatient CL and emergency psychiatry. He also currently serves as an Associate Program Director for the Cleveland Clinic Adult Psychiatry Residency. His clinical interests include eating disorders, emergency psychiatry, and proactive consultation.
Ewa Bieber
Child and Adolescent Psychiatrist,
Assistant Professor of Psychiatry and Behavioral Health | Ann and Robert H. Lurie Children's Hospital of Chicago
Northwestern University Feinberg School of Medicine
Ewa Bieber, M.D. is a child and adolescent psychiatrist at Ann and Robert H. Lurie Children's Hospital of Chicago where she works with medically ill children and their families on the psychiatry consult service and in the outpatient setting. Ewa completed residency, child and adolescent and consultation-liaison psychiatry fellowships at Mayo Clinic in Rochester, MN.
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