sanity starts combat at 0 and can fall to -45 or be raised to 45.
sanity can be raised by landing attacks +5
defeating an enemy +15
rolling a 20 +5
it can be decreased by
certain attacks varies
failing a check/ saving throw -5
ally hp hitting 0 -15
sinking varies
all these apply to enemies as well
Effects of Sanity
Gain a +1 to attack rolls and saving throws equal to every 10 sanity from 0. Ex: +10 sanity equals +1, -25 sanity equals -2

sanity related topics
distortions