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An T, Sun H, Yuan L, Wu X, Lu B. Associations of anxiety and depression with restless leg syndrome: a systematic review and meta-analysis. Front Neurol 2024; 15:1366839. [PMID: 38562425 PMCID: PMC10982394 DOI: 10.3389/fneur.2024.1366839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/23/2024] [Indexed: 04/04/2024] Open
Abstract
Background The levels of anxiety and depression among patients with restless leg syndrome (RLS) are controversial. The aim of this systematic review and meta-analysis was to compare the levels of depression and anxiety among individuals with RLS with those of healthy controls. Methods We conducted an extensive electronic search of the PubMed, Web of Science, EMBASE, and Cochrane Library databases from their inception dates to 20 June 2023. Studies presenting data on depression and anxiety in individuals with RLS were included, and a comprehensive meta-analysis was performed. Results Twenty-one studies matched the inclusion criteria. Significantly more depressive symptoms were present in the individuals with RLS than in those without RLS, as measured by the Beck Depression Inventory [mean difference (MD) = 6.58, 95% confidence interval (CI) = 5.54-7.62, p < 0.01; heterogeneity I2 = 0%, p = 0.99]. Similarly, the results from the Beck Anxiety Inventory indicated that there were significantly more pronounced anxiety symptoms in the individuals with RLS than in those without RLS (MD = 9.30, 95%CI = 7.65-10.94, p < 0.01; heterogeneity I2 = 0%, p = 0.92). The other anxiety and depression scales also yielded statistically significant results. Significant heterogeneity was observed in the Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale, with the primary contributing factor probably being the scoring criteria of the scales. Conclusion This meta-analysis found that the levels of depression and anxiety symptoms were significantly higher in individuals with RLS than in their healthy counterparts.Systematic review registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023410364, (identifier CRD42023410364).
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Affiliation(s)
- Tianyang An
- College of Clinical Medicine, North China University of Science and Technology, Tangshan, Hebei, China
| | - Haiyang Sun
- Cangzhou Center for Disease Control and Prevention, Cangzhou, Hebei, China
| | - Lu Yuan
- College of Psychology and Mental Health of North China University of Science and Technology, Tangshan, Hebei, China
| | - Xiuling Wu
- Department of Neurology, Tangshan Gongren Hospital, Tangshan, Hebei, China
| | - Baoquan Lu
- Department of Neurology, Tangshan Gongren Hospital, Tangshan, Hebei, China
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Kocakaya H, Say B. Evaluation of emotional dysregulation in patients with restless legs syndrome. Sleep Biol Rhythms 2023; 21:447-454. [PMID: 38476182 PMCID: PMC10899912 DOI: 10.1007/s41105-023-00467-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/21/2023] [Indexed: 03/14/2024]
Abstract
The aim of this study is to examine patients with restless legs syndrome (RLS) in terms of difficulty in emotion regulation and insomnia. A total of 52 patients with RLS and 57 healthy volunteers were enrolled. Difficulties in Emotion Regulation Scale Short Form (DERS-16), Insomnia Severity Index (ISI), Hospital Anxiety and Depression Scale (HADS), and International Restless Legs Syndrome rating scale were applied to participants. The mean age was 34.00 ± 8.27 years in patients and 31.70 ± 9.12 years in control. The scores of DERS-16, ISI, HADS-A, and HADS-D were significantly higher in the patients than the controls (p = 0.000). The DERS-16 total score showed a significant correlation with age (r = 0.404, p = 0.003), ISI (r = 0.281, p = 0.043), IRLS score (r = 0.422, p = 0.002), HADS-A (r = 0.409, p = 0.003), and HADS-D (r = 0.416, p = 0.002). The factors (age, gender, ferritin, ISI, and IRLS scores) that may be associated with the DERS-16 total scores were assessed with stepwise regression analysis. It was seen that the IRLSs variable had the most ability and could predict 45% (β = 0.625, p < 0.001, ∆R2 = 0.450) of difficulty in emotion regulation. In addition, the variable of insomnia could predict difficulty in emotion regulation by 17% (β = 0.097, p = 0.001, ∆R2 = 0.170). Patients with RLS may experience more emotion regulation difficulties than healthy controls. RLS severity and insomnia may be factors affecting emotion regulation difficulties in patients with RLS. According to our knowledge and our literature review, this finding seems to be the first report in the literature.
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Affiliation(s)
- Hanife Kocakaya
- Faculty of Medicine, Department of Psychiatry, Kirikkale University, Kirikkale, Turkey
| | - Bahar Say
- Faculty of Medicine, Department of Psychiatry, Kirikkale University, Kirikkale, Turkey
- Faculty of Medicine, Department of Neurology, Kirikkale University, Kirikkale, Turkey
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Evaluation of affective temperament profile and levels of depressive symptoms and anxiety in patients with restless legs syndrome. Sleep Breath 2021; 26:381-388. [PMID: 33884556 DOI: 10.1007/s11325-021-02375-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/25/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Restless legs syndrome (RLS) is a sleep-related sensorimotor disorder associated with mood and anxiety disorders. Although affective temperaments are considered subclinical manifestations of mood disorders (MDs), to date, no previous research has explored the relationship between affective temperaments and RLS. We aimed to evaluate affective temperaments, depressive symptoms, and anxiety among newly diagnosed, drug-naive patients with RLS. Additionally, our study identified possible associations between clinical variables and affective temperaments, depressive symptoms, and anxiety profiles in this group. METHODS The study included 74 patients with RLS and 90 healthy volunteers. All participants performed the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire, Beck Depression Inventory, and Hamilton Anxiety Inventory. RESULTS Temperament, depression, and anxiety scores in patients with RLS were significantly higher than those in healthy controls (p ≤ 0.05). Linear regression analysis showed that anxious temperament scores were positively related to longer disease duration (β = 0.658, p = 0.000), whereas disease severity (as measured by the International RLS Study Group Rating Scale) (β = 0.447, p = 0.006) and lower educational status (β = - 0.803, p = 0.008) correlated with the anxiety profile. CONCLUSIONS Results suggested that higher scores on the affective temperament, depression, and anxiety scales indicate subclinical MDs and psychiatric comorbidities in RLS. Therefore, exploring the predictors of mood and anxiety disorders in patients with RLS may improve treatment strategies and clinical outcomes.
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Harrison EG, Keating JL, Morgan PE. The experience of living with restless legs syndrome: A qualitative study. J Health Psychol 2019; 26:1154-1167. [DOI: 10.1177/1359105319871632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Restless legs syndrome is a sensorimotor disorder that significantly affects quality of life. This study explored the experience of people living with restless legs syndrome. Focus groups were analysed thematically resulting in five themes. Participants described disempowerment in managing symptoms, difficulty coping and poor understanding of the condition. Participants tried many therapies with little relief and were unable to monitor treatment effects. Concerns with healthcare services were common. Feeling understood provided validation and empowerment. Healthcare providers can help people with restless legs syndrome by improving restless legs syndrome awareness, providing psychosocial support and education, and assisting people to monitor treatment effects.
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Zhuang S, Na M, Winkelman JW, Ba D, Liu CF, Liu G, Gao X. Association of Restless Legs Syndrome With Risk of Suicide and Self-harm. JAMA Netw Open 2019; 2:e199966. [PMID: 31441941 PMCID: PMC6714009 DOI: 10.1001/jamanetworkopen.2019.9966] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Restless legs syndrome (RLS) is a common neurologic disorder that has been previously found to be associated with higher odds of suicidal ideation. In the context of the increasing suicide rate in the United States, the evidence regarding the association between RLS and the risk of suicide and self-harm is limited. OBJECTIVE To investigate the association between RLS and risk of suicide and self-harm. DESIGN, SETTING, AND PARTICIPANTS This cohort study was performed using Truven Health MarketScan national claims data from 2006 to 2014; the baseline data were from 2006 to 2008, and the follow-up data covered 6 years (January 1, 2009, to December 31, 2014). Included were 24 179 nonpregnant participants with RLS and 145 194 age- and sex-matched participants without RLS at baseline (2006-2008), who were free of suicide, self-harm, cardiovascular disease, or cancer at study baseline. Data analysis was performed from February 1, 2018, to January 1, 2019. EXPOSURE Diagnosis of RLS, as identified by the International Classification of Diseases, Ninth Revision code. MAIN OUTCOMES AND MEASURES Incident suicide and self-harm event, identified by the International Classification of Diseases, Ninth Revision diagnosis code. RESULTS Among 169 373 participants in the current analysis, the mean (SD) age was 49.4 (9.1) years; 53 426 (31.5%) participants were men. During a mean (SD) follow-up duration of 5.2 (2.2) years, 119 incident suicide and self-harm cases were identified. Individuals with RLS had a higher risk of suicide or self-harm compared with those without RLS (adjusted hazard ratio, 2.66; 95% CI, 1.70-4.15), after adjusting for lifestyle factors (eg, alcohol and obesity), presence of chronic diseases (eg, depression, insomnia, diabetes, chronic kidney disease, peripheral neuropathy, iron-deficiency anemia, and Parkinson disease), and use of medications. Excluding those with depression, insomnia, obstructive sleep apnea, and other common chronic conditions, the significant association between RLS and suicide or self-harm persisted (adjusted hazard ratio, 4.14; 95% CI, 2.17-7.92). CONCLUSIONS AND RELEVANCE Restless legs syndrome was associated with a high risk of suicide and self-harm, and the risk was independent of most identified diseases and conditions.
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Affiliation(s)
- Sheng Zhuang
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Muzi Na
- Department of Nutritional Sciences, Pennsylvania State University, State College, University Park
| | - John W. Winkelman
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Department of Neurology, Massachusetts General Hospital, Boston
| | - Djibril Ba
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey
| | - Chun-Feng Liu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Guodong Liu
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey
| | - Xiang Gao
- Department of Nutritional Sciences, Pennsylvania State University, State College, University Park
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Heim B, Pertl MT, Stefani A, Delazer M, Heidbreder A, Zamarian L, Brandauer E, Seppi K, Högl B, Poewe W, Djamshidian A. Haste makes waste: Decision making in patients with restless legs syndrome with and without augmentation. PLoS One 2017; 12:e0174793. [PMID: 28380045 PMCID: PMC5381880 DOI: 10.1371/journal.pone.0174793] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 03/15/2017] [Indexed: 01/15/2023] Open
Abstract
Objectives To investigate decision making in patients with primary restless legs syndrome (RLS) with and without augmentation treated with dopaminergic medication. Methods A total of 64 non-demented RLS patients treated with dopaminergic medication with and without augmentation were included in this study. We used an information sampling task to assess how much evidence participants gather before making a decision. Performance was compared to the results of 21 healthy controls. Results All patients with and without augmentation gathered less information than healthy controls before making a decision (p<0.001), but there was no difference between the two patient groups (p = 1.0). Furthermore, both patient groups made more irrational decisions (e.g. decisions against the evidence they had at the time) than healthy controls (p≤0.002). In addition, RLS patients with augmentation made significantly more irrational decisions than RLS patients without augmentation (p = 0.037) and controls (p<0.001). Conclusions Our results show that RLS patients treated with dopaminergic drugs, regardless of having augmentation or not, jumped to conclusions and decided significantly more often against the evidence they had at the time of their decision. However, those with augmentation performed worse than all other groups and made more often irrational decisions, a phenomenon which is also common in patients with substance abuse or behavioural addictions. Thus, jumping to conclusions and deciding with a higher degree of uncertainty as well as irrational decision making is more common in RLS patients treated with dopaminergic medication particularly in those with augmentation.
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Affiliation(s)
- Beatrice Heim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
| | - Marie-Theres Pertl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
| | - Margarete Delazer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
| | - Laura Zamarian
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
| | - Elisabeth Brandauer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
| | - Atbin Djamshidian
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Tyrol, Austria
- Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies, University of London, London, United Kingdom
- * E-mail:
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Trautmann E, Barke A, Frisch JU, Schmidt AL, Kunert F, Canelo M, Sixel-Döring F, Trenkwalder C. Restless Legs Syndrome: Psychiatric Comorbidities Are More Important Than Neuroticism. Behav Sleep Med 2015; 13:375-86. [PMID: 24945565 DOI: 10.1080/15402002.2014.919917] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Restless legs syndrome (RLS) is often associated with psychopathological symptoms. We compared psychiatric diagnoses, psychological complaints, sleep and personality traits in RLS patients and a control group The RLS patients also answered the IRLS, RLS-6, and QoL-RLS. The RLS patients showed more depressive disorders, psychopathological symptoms, and lower well-being than controls, but no differences in personality traits. The slightly, but not significantly, higher neuroticism found in RLS patients can be explained by the higher rates of depression among the patients. It is advisable to screen RLS patients for psychiatric comorbidities. The design using a matched control group without sleep disorders limits the conclusions that can be drawn regarding the frequency of psychiatric diagnoses and controls with sleep problems.
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Marconi S, Scarlatti F, Rizzo G, Antelmi E, Innamorati M, Pompili M, Brugnoli R, Belvederi Murri M, Amore M, Provini F. Is nocturnal eating in restless legs syndrome linked to a specific psychopathological profile? A pilot study. J Neural Transm (Vienna) 2015; 122:1563-71. [DOI: 10.1007/s00702-015-1435-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 07/24/2015] [Indexed: 10/23/2022]
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Turkel Y, Oguzturk O, Dag E, Buturak SV, Ekici MS. Minnesota Multiphasic Personality Inventory profile in patients with restless legs syndrome. Asia Pac Psychiatry 2015; 7:153-6. [PMID: 25220107 DOI: 10.1111/appy.12151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 08/05/2014] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Restless legs syndrome (RLS) is associated with psychiatric disorders. We aim to investigate the personality traits of RLS patients using the Minnesota Multiphasic Personality Inventory. METHODS Twenty adult patients with RLS (14 females and 6 males) and 20 healthy controls (14 females and 6 males) who were referred to university neurology were enrolled in the present study. Diagnosis of RLS was established using International Restless Legs Syndrome Study Group. Psychometric evaluation was made with the Turkish version of the Minnesota Multiphasic Personality Inventory. RESULTS RLS patients have significantly higher absolute and clinical elevation scores on hypochondriasis and hysteria, and clinical elevation scores on psychasthenia, compared with the controls. Absolute scores on depression were higher at the border in RLS patients compared with the controls. DISCUSSION RLS patients have hypochondriac, hysterical, depressive, and anxious personality traits.
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Affiliation(s)
- Yakup Turkel
- Department of Neurology, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
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Magalhães SC, Kaelin-Lang A, Sterr A, do Prado GF, Eckeli AL, Conforto AB. Transcranial magnetic stimulation for evaluation of motor cortical excitability in restless legs syndrome/Willis-Ekbom disease. Sleep Med 2015; 16:1265-73. [PMID: 26429756 DOI: 10.1016/j.sleep.2015.03.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 02/27/2015] [Accepted: 03/29/2015] [Indexed: 11/30/2022]
Abstract
There is no consensus about mechanisms underlying restless legs syndrome (RLS), also known as Willis-Ekbom disease (WED). Cortical excitability may be abnormal in RLS. Transcranial magnetic stimulation (TMS) can provide insight about cortical excitability. We reviewed studies about measures of excitability to TMS in RLS. Original studies published between January 1999 and January 2015 were searched in PubMed, Scopus, and Web of Science databases. Inclusion criteria were as follows: original studies involving primary RLS in patients from both sexes and ages between 18 and 85 years; TMS protocols clearly described; and they were written in English, in peer-reviewed journals. Fifteen manuscripts were identified. TMS protocols were heterogeneous across studies. Resting motor threshold, active motor threshold, and amplitudes of motor-evoked potentials were typically reported to be normal in RLS. A reduction in short-interval intracortical inhibition (SICI) was the most consistent finding, whereas conflicting results were described in regard to short-interval intracortical facilitation and the contralateral silent period. Decreased SICI can be reversed by treatment with dopaminergic agonists. Plasticity in the motor cortex and sensorimotor integration may be disrupted. TMS may become a useful biomarker of responsiveness to drug treatment in RLS. The field can benefit from increases in homogeneity and sizes of samples, as well as from decrease in methodological variability across studies.
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Affiliation(s)
| | | | | | | | - Alan Luiz Eckeli
- Hospital das Clínicas da Faculdade de Medicina da USP, Ribeirão Preto, São Paulo, Brazil
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Altunayoglu Cakmak V, Gazioglu S, Can Usta N, Ozkorumak E, Ayar A, Topbas M, Boz C. Evaluation of temperament and character features as risk factors for depressive symptoms in patients with restless legs syndrome. J Clin Neurol 2014; 10:320-7. [PMID: 25324881 PMCID: PMC4198713 DOI: 10.3988/jcn.2014.10.4.320] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 05/10/2014] [Accepted: 05/13/2014] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND PURPOSE Restless legs syndrome (RLS) is a common sleep-related movement disorder that is frequently associated with psychological disturbances. Personality traits are of considerable importance with respect to coping with chronic illness and disease vulnerability. This study assessed the temperament and character traits of RLS patients using an approach that involves the psychobiological model of personality. METHODS The personality features of 65 newly diagnosed and untreated RLS patients with no neurological or psychiatric diseases and 109 healthy controls were determined using the Temperament and Character Inventory and compared using covariance analyses. The International RLS Study Group Severity Scale was used to assess the severity of the RLS symptoms, and the Beck Depression Inventory was used to assess the presence and severity of depressive symptoms. RESULTS RLS patients scored significantly higher than healthy controls on the temperament dimension of harm avoidance (HA, p=0.02) and significantly lower on self-directedness (SD, p=0.001). No significant difference was observed in terms of the temperament dimension of novelty seeking (p=0.435). HA scores were significantly correlated with the BDI score but not with the RLS severity or duration. CONCLUSIONS High HA and low SD scores are the main characterizing personality features of RLS patients. These personality dimensions may be among the factors predisposing patients to development of the depressive symptoms that are frequently associated with RLS.
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Affiliation(s)
| | - Sibel Gazioglu
- Department of Neurology, Karadeniz Technical University Medical Faculty, Trabzon, Turkey
| | - Nuray Can Usta
- Department of Neurology, Karadeniz Technical University Medical Faculty, Trabzon, Turkey
| | - Evrim Ozkorumak
- Department of Psychiatry, Karadeniz Technical University Medical Faculty, Trabzon, Turkey
| | - Ahmet Ayar
- Department of Physiology, Karadeniz Technical University Medical Faculty, Trabzon, Turkey
| | - Murat Topbas
- Department of Public Health, Karadeniz Technical University Medical Faculty, Trabzon, Turkey
| | - Cavit Boz
- Department of Neurology, Karadeniz Technical University Medical Faculty, Trabzon, Turkey
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Brand S, Beck J, Hatzinger M, Holsboer-Trachsler E. Patients suffering from restless legs syndrome have low internal locus of control and poor psychological functioning compared to healthy controls. Neuropsychobiology 2014; 68:51-8. [PMID: 23774053 DOI: 10.1159/000350957] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 03/24/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Restless legs syndrome (RLS) is a disturbing sensorimotor disorder negatively influencing both sleep and psychological functioning. The aim of the present study was to assess RLS patients with respect to locus of control, sleep-related personality traits, quality of life, and sleep as compared to healthy controls. METHOD Thirty-eight patients (18 females and 20 males; mean age: 56.06 years) diagnosed with RLS and an age- and gender-matched control group (n = 42) were recruited. Participants completed a series of questionnaires related to locus of control, personality traits, quality of life, and sleep. RESULTS Compared to healthy controls, RLS patients had a lower internal locus of control, unfavourable sleep-related personality traits such as low self-confidence and higher mental arousal, poorer quality of life, and more depressive symptoms. Sleep was also affected. Multiple regression analyses showed that a low internal and a high external locus of control were predicted by RLS. CONCLUSIONS The pattern of results suggests that RLS is associated with a low locus of control, negative personality traits, and poor quality of life as compared to healthy controls.
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Affiliation(s)
- Serge Brand
- Center for Affective, Stress and Sleep Disorders, Psychiatric Hospital, University of Basel, Basel, Switzerland.
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Steinig J, Reess T, Klösch G, Sauter C, Zeitlhofer J, Happe S. Personality traits in patients with restless legs syndrome. SOMNOLOGIE 2013. [DOI: 10.1007/s11818-013-0623-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Cuellar NG. The psychopharmacological management of RLS in psychiatric conditions: a review of the literature. J Am Psychiatr Nurses Assoc 2012; 18:214-25. [PMID: 22529225 DOI: 10.1177/1078390312442569] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Restless legs syndrome (RLS) is a movement disorder treated with dopamine agonists. RLS is often diagnosed as a comorbid condition with psychiatric disorders, which are treated with dopamine antagonists or antidepressants resulting in onset or exacerbation of RLS symptoms. OBJECTIVES The objectives of this article are to provide a review of the literature to (a) describe the comorbidity of psychiatric disorders associated with RLS, (b) identify the treatment of psychiatric disorders that cause or exacerbate symptoms of RLS, and (c) provide clinical recommendations for psychiatric health care providers. DESIGN A review of the literature of English articles included the databases of Medline, Pubmed, PsychINFO, and CINAHL for "Restless Legs Syndrome" with major psychiatric disorders including mood disorders (depression and bipolar), schizophrenia, and anxiety disorders (anxiety, panic disorder, obsessive compulsive disorder). The PRISMA guidelines were used to improve the reporting of the review of the literature. RESULTS There were 61 articles that met the inclusion and exclusion criteria identified for the review of the literature, including RLS with mood disorders (n = 36), schizophrenia (n = 9), and anxiety disorders (n = 16). CONCLUSIONS Clinical trials are lacking on the best treatment for persons with RLS and psychiatric disorders; the most rigorous research found in the literature related to depression and anxiety. Studies lack evidence to document the best practice for persons with RLS and comorbid psychiatric disorders. Psychiatric health care providers should be aware of RLS, which is influenced by psychiatric medications.
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Yeh P, Walters AS, Tsuang JW. Restless legs syndrome: a comprehensive overview on its epidemiology, risk factors, and treatment. Sleep Breath 2011; 16:987-1007. [PMID: 22038683 DOI: 10.1007/s11325-011-0606-x] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 10/05/2011] [Accepted: 10/11/2011] [Indexed: 12/19/2022]
Abstract
PURPOSES Restless legs syndrome (RLS) is underdiagnosed and poorly understood by clinicians and the general public alike; accordingly, a broad literature review with information most relevant to general practice is needed to help dispel misconceptions and improve level of care. METHODS Specifically, this review comprehensively provides an epidemiological analysis of RLS and examines the risk factors and treatment options for RLS by compiling the findings of past RLS studies. These RLS studies were identified through a retrospective PubMed search. The epidemiological analysis was conducted by calculating a weighted mean average of all the relevant general population RLS prevalence studies, separated into geographical/racial categories. RESULTS A comprehensive analysis of RLS epidemiological studies finds the prevalence rate of RLS to be 5-15% in the general population with 2.5% of adults having symptoms severe enough to require medical intervention. Some of the risk factors for RLS include female gender, pregnancy, low iron levels, lower socioeconomic status, poor health, elderly age, comorbidity with Parkinson's disease, positive family history of RLS, and comorbidity with psychiatric disorders. A wide array of treatment options exist for RLS including pharmacological and nonpharmacologic interventions. CONCLUSIONS Clinicians' understanding of RLS enigma has recently improved due to the increased intensity of RLS research over the past decade. This review summarizes the current findings in the RLS field as well as providing guidelines for future RLS-related research.
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Affiliation(s)
- Paul Yeh
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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Scholz H, Benes H, Happe S, Bengel J, Kohnen R, Hornyak M. Psychological distress of patients suffering from restless legs syndrome: a cross-sectional study. Health Qual Life Outcomes 2011; 9:73. [PMID: 21933380 PMCID: PMC3187724 DOI: 10.1186/1477-7525-9-73] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 09/20/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Restless legs syndrome (RLS) is a chronic disorder with substantial impact on quality of life similar to that seen in diabetes mellitus or osteoarthritis. Little is known about the psychological characteristics of RLS patients although psychological factors may contribute to unfavourable treatment outcome. METHODS In an observational cross-sectional design, we evaluated the psychological features of 166 consecutive RLS patients from three outpatient clinics, by means of the Symptom Checklist 90-R (SCL-90-R) questionnaire. Additionally, the Beck Depression Inventory-II (BDI-II) and the International RLS Severity Scale (IRLS) were measured. Both treated and untreated patients were included, all patients sought treatment. RESULTS Untreated patients (n = 69) had elevated but normal scores on the SCL-90-R Global Severity Index (GSI; p = 0.002) and on the sub-scales somatisation (p < 0.001), compulsivity (p = 0.003), depression (p = 0.02), and anxiety (p = 0.004) compared with a German representative sample. In the treated group, particularly in those patients who were dissatisfied with their actual treatment (n = 62), psychological distress was higher than in the untreated group with elevated scores for the GSI (p = 0.03) and the sub-scales compulsivity (p = 0.006), depression (p = 0.012), anxiety (p = 0.031), hostility (p = 0.013), phobic anxiety (p = 0.024), and paranoid ideation (p = 0.012). Augmentation, the most serious side effect of dopaminergic, i.e. first-line treatment of RLS, and loss of efficacy were accompanied with the highest psychological distress, as seen particularly in the normative values of the sub-scales compulsivity and anxiety. Generally, higher RLS severity was correlated with higher psychological impairment (p < 0.001). CONCLUSION Severely affected RLS patients show psychological impairment in multiple psychological domains which has to be taken into account in the treatment regimen.
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Affiliation(s)
- Hanna Scholz
- Interdisciplinary Pain Centre, University Medical Centre, Freiburg 79106, Germany.
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Cuellar NG, Hanlon A, Ratcliffe SJ. The relationship with iron and health outcomes in persons with restless legs syndrome. Clin Nurs Res 2010; 20:144-61. [PMID: 21041807 DOI: 10.1177/1054773810388557] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Restless Legs Syndrome (RLS) is a sleep disorder cause by inadequate iron metabolism. However, no studies have identified the impact of iron in RLS patients on sleep, depression, fatigue, or quality of life (QoL). OBJECTIVE The aims of this secondary data analysis was to determine relationships (a) between serum iron with RLS symptom severity, sleep quality, daytime sleepiness, depression, fatigue, and quality of life (QoL); and (b) based on demographics, specifically age and ethnicity. METHOD Data were collected on iron and ferritin concentrations in 48 persons with RLS. RESULTS Low serum iron levels were measured in 32% of the participants with only 1 person (4%) treated with iron supplementation. General linear models identified age and race as covariants: (a) being White (p = .047) and higher iron levels (p = .019) were independent predictors of higher social functioning; (b) being White (p = .047) and higher iron levels (p = .004) were independent predictors of less sleepiness; (c) younger age (p = .001) and lower iron levels (p = .025) were independent predictors of depression; and (d) younger age (p = .006) and lower iron levels (p = .005) were independent predictors of fatigue. DISCUSSION Findings from this study show that iron supplementation for persons with RLS not only improves motor and sensory symptoms but might also improve sleep, sleepiness, depression, fatigue, and QoL and should be considered by health care providers for treatment of RLS.
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Vecchierini MF, Léger D. Syndrome des jambes sans repos et ses formes cliniques : bilan diagnostique. Presse Med 2010; 39:556-63. [DOI: 10.1016/j.lpm.2009.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 09/07/2009] [Accepted: 09/10/2009] [Indexed: 11/16/2022] Open
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Nomura T, Kusumi M, Uemura Y, Nakashima K, Inoue Y. Reply: QOL score is primarily affected by the mental rather than the physical components in patients with RLS. Mov Disord 2010. [DOI: 10.1002/mds.22773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Increased prevalence of nocturnal smoking in restless legs syndrome (RLS). Sleep Med 2010; 11:218-20. [PMID: 20064746 DOI: 10.1016/j.sleep.2009.05.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 04/07/2009] [Accepted: 05/09/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We investigated the prevalence of nocturnal smoking (NS) in patients with RLS. METHODS One hundred RLS patients living in Emilia-Romagna (Northern Italy) and 100 matched controls, randomly selected from the general population, underwent interviews for the presence of nocturnal smoking and for obsessive-compulsive traits, depression, excessive daytime sleepiness (EDS) and subjective sleep quality. RESULTS NS was more prevalent in RLS patients than controls (lifetime prevalence: 12% vs. 2%, P=0.012). Patients with NS had more frequently Sleep-Related Eating Disorders (SRED) than patients without NS (83.3% vs. 26.1%, P=0.0002). Pathological and borderline Maudsley Obsessive-Compulsive Inventory (MOCI) values as well as pathological values at the Beck Depression Inventory (BDI) increased from controls to RLS patients without NS to RLS patients with NS (P=0.005 and P=0.01, respectively). CONCLUSIONS We demonstrate an increased prevalence of NS in patients with RLS, in many cases associated with increased SRED. NS may be associated with psychopathological traits in RLS and may be relevant in the management of RLS patients.
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