Not one thing at a time:When concomitant multiple stressors produce a transdiagnostic clinical picture

A condition of exposure to multiple stressors resulting in a mixed clinical picture spanning conventional categories without meeting any of them in full,encompasses a risk for a list of comorbidities preventing appropriate prevention and treatment.New transformative transdiagnostic approaches suggest changes spanning conventional categories.They base their systems of classification on biomarkers as well as on brain structural and functional dysregulation as associated with behavioral and emotional symptoms.These new approaches received critiques for not being specific enough and for suggesting a few biomarkers for psychopathology as a whole.Therefore,they put the value of differential diagnosis at risk of avoiding appropriate derived prevention and treatment.Multiplicity of stressors has been considered mostly during and following catastrophes,without considering the resulting mixed clinical picture and life event concomitant stressors.We herewith suggest a new category within the conventional classification systems:The Complex Stress Reaction Syndrome,for a condition of multiplicity of stressors,which showed a mixed clinical picture for daily life in the post coronavirus disease 2019 era,in the general population.We argue that this condition may be relevant to daily,regular life,across the lifespan,and beyond conditions of catastrophes.We further argue that this condition may worsen without professional care and it may develop into a severe mental health disorder,more costly to health systems and the suffering individuals.Means for derived prevention and treatment are discussed.

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

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 inclusion 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.