Neuro-Behçet's Disease and Psychiatric Disorders: From a Case Report to a Systematic Review

Behçet's disease is a chronic, relapsing systemic vasculitis that can affect multiple organ systems. Neurological involvement, known as neuro-Behçet's disease, occurs in a subset of patients, while psychiatric manifestations-termed neuro-psycho Behçet's disease-remain poorly characterized. Understanding the clinical course, pathophysiology, and management of this condition is crucial for interdisciplinary care.

To present a detailed case of a patient with neuro-psycho Behçet's disease and to explore its pathophysiology, clinical features, psychiatric symptoms, temporal progression, and therapeutic considerations.

A clinical case of a 42-year-old male with neuro-Behçet's disease who developed a manic episode is described. Concurrently, a systematic review of published cases of neuro-psycho Behçet's disease was conducted using the Web of Science, PubMed, and Embase databases on July 19, 2024, following the criteria of the PRISMA-ScR Statement.

The clinical case illustrates a multiphasic disease course, with systemic Behçet's disease symptoms preceding neurological and subsequently psychiatric manifestations. The systematic review included thirty-four cases, showing diverse psychiatric symptoms, including psychotic, affective, and behavioral disturbances. Neuroimaging frequently revealed parenchymal lesions correlating with psychiatric symptoms. Management typically combined immunosuppressive therapy for Behçet's disease with psychiatric treatment, including antipsychotic medications and mood stabilizers.

Neuro-psycho Behçet's disease represents a clinically and pathophysiologically complex entity. The correlation between parenchymal lesions and psychiatric symptoms supports the hypothesis of a shared neurobiological substrate mediated by inflammatory and immunological mechanisms. A biphasic model, in which initial vascular involvement evolves into neurochemical and structural dysfunction, provides a coherent framework for understanding the relationship between Behçet's disease and psychiatric symptoms.