Correlation of Psychiatric Manifestations with Clinical Characteristics and Treatment Outcomes in Neurosarcoidosis
Laya Rao1, John Lincoln2, John Lindsey3, Shaurya Aggarwal1, Sienna Wu1, Tala Alshawa1, Megan Hatcher1, Ivy Zheng1, Rajesh Gupta4
1McGovern Medical School, 2McGovern Medical School, UTHealth, 3University of Texas Health Science Center At Houston, 4UTHealth
Objective:
To identify associations between psychiatric symptoms and health outcomes in neurosarcoidosis (NS) patients
Background:
The relationship between psychiatric symptoms and health outcomes in NS is underexplored. Current literature highlights instances of psychosis, along with the prevalence of mood disorders in general sarcoidosis.
Design/Methods:
We conducted a chart review of patients with definite or probable NS in greater Houston between 2010-2023. We compared the presence of psychiatric symptoms at initial presentation with those that occurred during the disease course to assess correlations with clinical characteristic and treatment outcomes. Analyses performed using IBM SPSS.
Results:
Of the (n=55) patients identified to have NS, 21 (38.1%) had psychiatric symptoms at initial presentation, including but not limited to depression, anxiety, psychosis, and mood disorders. A larger proportion, 27 (49.1%) experienced psychiatric symptoms at some point during their disease course. PHQ9 scores after initiation of treatment indicated that 39 patients (70.9%) had none to minimal depression, 11 (20%) with mild to moderate depression, and 5 (9.1%) with moderate to severe depression. Those with initial psychiatric symptoms had higher CSF WBC (p = 0.019), rates of infections (p < .001), number of hospitalizations (p = 0.013), and rates of malignancy (p = 0.028). Those with psychiatric symptoms during their disease course were also found to have higher rates of chronic infection (p = 0.011) and number of hospitalizations (p = 0.009). Higher PHQ9 scores correlated with greater total number of psychiatric symptoms during the disease course (p = 0.003).
Conclusions:
CSF WBC, malignancy, chronic infections, and hospitalizations positively correlated with NS psychiatric symptoms. Chronic infections and elevated CSF WBC cytokines could disrupt serotonin metabolism, while higher hospitalization and malignancy rates may exacerbate stress or alter neural circuits. Further investigation is needed to understand these correlations and their external validity.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.