Sjögren syndrome

Page most recently updated 7 September 2026

This page focuses on the reported psychiatric associations, which may be the initial presenting manifestation, and on other clinical features that may assist the psychiatrist or primary care physician in identifying the underlying diagnosis, considered through the lenses of the diagnostic lenses framework.

Sjögren syndrome is a connective tissue disease.

It can present with psychiatric features such as depression, anxiety, cognitive dysfunction ("brain fog"), fatigue-related cognitive symptoms, mood disturbance, and, less commonly, psychosis or behavioural change.

Other characteristic features include peripheral neuropathy (particularly sensory neuropathy or small-fibre neuropathy), cranial neuropathies, cognitive impairment, headache, myelopathy, and, less commonly, encephalopathy. Distinctive features include sicca symptoms (xerophthalmia and xerostomia), parotid gland enlargement, and positive autoimmune serology (particularly anti-SSA/Ro and anti-SSB/La antibodies).

From a multisystemic lens perspective, clinical features in other body systems include (but are not limited to):

  • Renal/electrolytes: tubulointerstitial nephritis and distal renal tubular acidosis may occur.

  • Respiratory: chronic dry cough, bronchial dryness, and interstitial lung disease may occur.

  • Gastrointestinal: xerostomia may lead to dysphagia, dental caries, and oral candidiasis.

  • Hematologic: hypergammaglobulinemia, leukopenia, and an increased risk of B-cell non-Hodgkin lymphoma may occur.

  • Musculoskeletal: arthralgia and non-erosive inflammatory arthritis are common.

  • Dermatologic: xerosis, cutaneous vasculitis (including palpable purpura), and annular erythematous lesions may occur.

Early diagnosis is important to enable appropriate symptomatic and immunomodulatory treatment, identify and manage systemic organ involvement, reduce the risk of irreversible neurological and renal complications, recognize patients at increased risk of lymphoma, and improve long-term prognosis and quality of life.

Selected references and further reading — Multisystemic lens

Cardinal RN, Bullmore ET. The diagnosis of psychosis. Cambridge: Cambridge University Press; 2011.

Sachdev PS, Keshavan MS, editors. Secondary schizophrenia. Cambridge: Cambridge University Press; 2010.

Levenson JL, editor. The American Psychiatric Association Publishing textbook of psychosomatic medicine and consultation-liaison psychiatry. 3rd ed. Washington (DC): American Psychiatric Association Publishing; 2019.

Stern TA, Beach SR, Smith FA, Freudenreich O, Vranceau AM, Fava M, editors. Massachusetts General Hospital handbook of general hospital psychiatry. 8th ed. Philadelphia: Elsevier; 2025.

Arciniegas DB, Yudofsky SC, Hales RE, editors. The American Psychiatric Association Publishing textbook of neuropsychiatry and clinical neurosciences. 6th ed. Washington (DC): American Psychiatric Association Publishing; 2018.

Agrawal N, Faruqui R, Bodani M, editors. Oxford textbook of neuropsychiatry. Oxford: Oxford University Press; 2020.

Boland R, Verduin M, editors. Kaplan and Sadock's comprehensive textbook of psychiatry. 11th ed. Philadelphia: Wolters Kluwer; 2024.

Loscalzo J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, editors. Harrison's principles of internal medicine. 22nd ed. New York: McGraw Hill; 2025.