Psychiatric symptoms and syndromes in sarcoidosis: a systematic review and meta-analysis

Abstract

Introduction: Sarcoidosis is often associated with psychiatric symptoms and syndromes (PSS). This systematic review and meta-analysis aimed to summarize available literature on the prevalence of PSS in sarcoidosis, as well as their potential associations. Methods: A systematic search was conducted across PubMed, including case reports and studies that investigated PSS in sarcoidosis. A meta-analysis was performed on studies that assessed the association between sarcoidosis and PSS, using odds ratios (OR). Results: We included 43 studies and 53 cases on PSS in patients with sarcoidosis. The weighted average prevalence was 24.9% for depression, 28.7% for anxiety, 29.2% for neurocognitive symptoms, 54.4% for fatigue, 50.5% for excessive daytime sleepiness and 26.9% for sleep disturbances and insomnia, with the best available evidence for depression, anxiety and fatigue. The meta-analysis (n = 962) confirms that patients with sarcoidosis have a significant increased risk of developing PSS when compared with healthy controls (OR = 5.498, CI = 0.430–70.238, p < 0.001). Depressive symptoms and fatigue were most reported on and demonstrated the strongest associations as well (resp. OR = 4.855, z = 2.401, p=0.016 and OR = 20.231, z = 2.868, p = 0.004). Significant associations with anxiety and neurocognitive symptoms were also observed, although with less available evidence. Case reports reveal a diagnostic diversity not reflected in study populations, including psychosis and catatonia. Conclusion: Sarcoidosis is associated with a higher prevalence of PSS. Nonetheless research in this area remains limited. Systematic use of standardized psychiatric assessment tools is recommended.