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Shao Y, Chen Y, Wang S, Li C, Sun H, Sun X. Suspected duloxetine-induced restless legs syndrome phenotypic variant: a case report. BMC Psychiatry 2024; 24:349. [PMID: 38730422 PMCID: PMC11088019 DOI: 10.1186/s12888-024-05763-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/13/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Restless arms syndrome (RAS) is the most common variant of restless legs syndrome (RLS), which is easy to be ignored in clinical practice due to the lack of specific diagnostic criteria. When effective therapeutic agents induced RAS and symptoms persisted after briefly observation, clinicians will face the challenge of weighing efficacy against side effects. CASE PRESENTATION A 67-year-old woman was admitted to a geriatric psychiatric ward with depression. Upon admission, the escitalopram dose was reduced from 15 mg to 10 mg per day, and the duloxetine dose was increased from 60 mg to 80 mg per day. The next night before bedtime, she developed itching and creeping sensations deep inside bilateral shoulders and arms, with the urge to move, worsening at rest, and alleviation after hammering. The symptoms persisted when escitalopram was discontinued. A history of RLS was confirmed. Treatment with 40 mg of duloxetine and 0.125 mg of pramipexole significantly improved depression, and the paresthesia disappeared, with no recurrence occurring 6 months after discharge. DISCUSSION AND CONCLUSIONS This case suggests that psychiatrists should pay attention to RLS variants when increasing doses of duloxetine. Long-term improvement can be achieved through dosage reduction combined with dopaminergic drugs instead of immediate discontinuation.
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Affiliation(s)
- Yan Shao
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, 51 Huayuan Bei Road, Haidian District, 100191, Beijing, China
| | - Yi Chen
- Ordos Fourth People's Hospital, Ordos, China
| | - Shichang Wang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, 51 Huayuan Bei Road, Haidian District, 100191, Beijing, China
| | - Chaowei Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, 51 Huayuan Bei Road, Haidian District, 100191, Beijing, China
| | - Hongqiang Sun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, 51 Huayuan Bei Road, Haidian District, 100191, Beijing, China
| | - Xinyu Sun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, 51 Huayuan Bei Road, Haidian District, 100191, Beijing, China.
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Saber WK, Almuallim AR, Algahtani R. Restless Legs Syndrome and the Use of Antipsychotic Medication: An Updated Literature Review. Cureus 2022; 14:e27821. [PMID: 36134065 PMCID: PMC9481228 DOI: 10.7759/cureus.27821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 11/12/2022] Open
Abstract
Restless legs syndrome or Willis-Ekbom disease (RLS/WED) is a sleep-related movement disorder characterized by an urge to move the legs. This impulse is usually accompanied by an uncomfortable and unpleasant sensation in the legs, which worsens at night and during periods of inactivity and is relieved by movement. Several studies in the literature reported the association between RLS and different antipsychotic medications. with Olanzapine, Quetiapine, and Clozapine identified as the most common causes. The literature suggests that the development of RLS in antipsychotic users may be attributed to the inhibition of dopaminergic neurotransmission or the impact of antipsychotics on iron metabolism. Diagnosing antipsychotic-induced RLS remains a substantial challenge in clinical practice, with challenges in the management of this condition also being widely reported in the current literature. In this article, we will review the evidence suggesting the association between RLS and the use of antipsychotic medications, differentiate between RLS and other movement disorders, and give a brief review of the pathophysiology, diagnosis, and management of RLS and its challenges among psychotic patients.
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Chen J, Meng N, Cao B, Ye Y, Ou Y, Li Z. Transitory restless arms syndrome in a patient with antipsychotics and antidepressants: a case report. BMC Psychiatry 2021; 21:453. [PMID: 34530775 PMCID: PMC8447733 DOI: 10.1186/s12888-021-03433-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/19/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Restless arms syndrome (RAS) is characterized by uncomfortable aching or burning sensations in the arms. RAS is regarded as an upper limb variant of restless legs syndrome (RLS). The lack of specific diagnostic criteria makes it difficult to recognize the RAS. Therefore, RAS is usually neglected in clinical practice. Moreover, when a patient was diagnosed with RAS, the adjustment of medications was the first choice for doctors, which may make the patient's condition unstable. CASE PRESENTATION A 33-year-old woman was diagnosed with schizophrenia and major depressive disorder. Starting with 0.6 g/d amisulpride, 0.1 g/d quetiapine, 75 mg/d venlafaxine sustained-release tablets, the patient reported symptoms of RAS (itching arms) on the fourth day since the latest hospitalization. After ruling out other factors, her RAS was suspected to be induced by antidepressants or antipsychotics. Without medication adjustment, RAS spontaneously remitted. CONCLUSIONS This case suggests that psychiatrists should pay attention to RAS when using antipsychotics and/or antidepressants. Moreover, RAS may be transitory. When a patient manifests RAS, observation may be one choice instead of an immediate medication adjustment.
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Affiliation(s)
- Juan Chen
- Mental Health Center, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
| | - Na Meng
- Mental Health Center, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
| | - Bingrong Cao
- Mental Health Center, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yinghua Ye
- Mental Health Center, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
| | - Ying Ou
- Mental Health Center, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
| | - Zhe Li
- Mental Health Center, West China Hospital, Sichuan University, No.28 Dianxin South Road, Chengdu, 610041, China.
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China.
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Abstract
Traumatic brain injury is an increasing cause of morbidity worldwide. Neuropsychiatric impairments, such as behavioral dysregulation and depression, have significant impacts on recovery, functional outcomes, and quality of life of patients with traumatic brain injuries. Three patient cases, existing literature, and expert opinion are used to select pharmacotherapy for the treatment of target symptoms while balancing safety and tolerability.
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Zhu C, Bi R, Hu Y, Zhou H, Zhu D, Isaacson B, Li Q, Lin Y. Restless legs syndrome following the use of ziprasidone: a case report. Gen Psychiatr 2020; 33:e100112. [PMID: 32215360 PMCID: PMC7066599 DOI: 10.1136/gpsych-2019-100112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/07/2019] [Accepted: 11/28/2019] [Indexed: 11/29/2022] Open
Abstract
Restless legs syndrome (RLS) is a common sleep-related movement disorder characterised by an uncomfortable urge to move the legs that occurs during periods of inactivity. Although there have been many case reports on antipsychotic-induced RLS, ziprasidone has never been reported as a cause of RLS. We present a case of a female patient with schizophrenia who presented with symptoms of RLS following the administration of high doses of ziprasidone added to quetiapine and valproate. The patient’s symptoms of RLS occurred following the administration and titration of ziprasidone to 160 mg, and were relieved upon reducing the dose to 120 mg/day. Other potential causative medications and differential diagnoses that could have caused similar symptoms were excluded. Clinicians should be aware of the potential for ziprasidone-induced RLS. Dopamine and serotonin interaction could be the mechanism underlying ziprasidone-induced RLS.
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Affiliation(s)
- Cuizhen Zhu
- Department of Sleeping Disorder, Anhui Mental Health Center, Hefei, Anhui, China
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ran Bi
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- School of Public Health, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Yuliang Hu
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Psychiatry and Psychology, Mayo Clinic School of Graduate Medical Education, Rochester, Minnesota, USA
| | - Hui Zhou
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Mental Health Center, Shanghai, China
| | - Daomin Zhu
- Department of Sleeping Disorder, Anhui Mental Health Center, Hefei, Anhui, China
| | - Brian Isaacson
- Psychiatry Department, AtlantiCare Regional Medical Center, Atlantic City, New Jersey, USA
| | - Qingwei Li
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yezhe Lin
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
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Ostroumova T, Ostroumova O, Filippova Y, Parfenov V. Drug-induced restless legs syndrome. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:129-135. [DOI: 10.17116/jnevro2020120041129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Oliveira C, Dehanov S, Vieira C, Maia T. P.158 Restless legs syndrome induced by quetiapine: A case report and review of the literature. Eur Neuropsychopharmacol 2019. [DOI: 10.1016/j.euroneuro.2019.09.205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Ocak D, Kotan VO, Paltun SC, Aydemir MÇ. Is restless legs syndrome related with depression/anxiety disorders or medications used in these disorders? A cross-sectional, clinic-based study. PSYCHIAT CLIN PSYCH 2019. [DOI: 10.1080/24750573.2019.1673943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Davut Ocak
- Department of Psychiatry, Kahramanmaraş Necip Fazıl City Hospital, Kahramanmaraş, Turkey
| | - Vahap Ozan Kotan
- Department of Psychiatry, Başkent University Medical Faculty, Ankara, Turkey
| | - Salih Cihat Paltun
- Department of Psychiatry, Ankara Numune Training and Research Hospital, Ankara, Turkey
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Abstract
OBJECTIVE To review the literature on drug-induced restless legs syndrome (DI-RLS). DATA SOURCES The review included a search for English-language literature from 1966 to December 2017 in the MEDLINE, PubMed, and Ovid databases using the following search terms: restless legs syndrome (RLS), periodic limb movement, adverse effects, and drug-induced. In addition, background articles on the pathophysiology, etiology, and epidemiology of RLS were retrieved. Bibliographies of relevant articles were reviewed for additional citations. STUDY SELECTION AND DATA EXTRACTION All case reports, case series, and review articles of DI-RLS were identified and analyzed. There were only a small number of controlled clinical trials, and most data were from case reports and case series. RESULTS Several drugs and drug classes have been implicated in DI-RLS, with antidepressants, antipsychotics, and antiepileptics having the most evidence. In addition, RLS may be linked with a number of disorders or underlying predisposing factors as well. CONCLUSIONS The prevalence of RLS is variable and ranges from 3% to 19% in the general population. There are many predisposing factors to RLS, but an emerging body of evidence suggests that there is an association between numerous drugs and RLS.
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Affiliation(s)
- Edna Patatanian
- 1 Southwestern Oklahoma State University, Weatherford, OK, USA
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Kumar V, Venkatasubramanian G. Gabapentin treatment in clozapine-induced restless legs syndrome: two cases and a review of the literature. Ther Adv Psychopharmacol 2017; 7:42-47. [PMID: 28101323 PMCID: PMC5228712 DOI: 10.1177/2045125316672133] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Restless legs syndrome (RLS) is a neuro-sensorimotor disorder affecting 2-4% of adults. It is characterized by intense urges to move the legs, associated with unpleasant sensory disturbances in the legs occurring at rest and manifests mostly in the evening and night, relieved by movement. Diagnosis is primarily based on clinical presentation and the consensus criteria for the diagnosis have been established. Antipsychotics, the dopamine antagonists, have been reported to induce RLS. Dopamine agonists, the effective first-line treatment of RLS, carry the risk of inducing or worsening psychosis. Many nondopaminergic agents including antiepileptic medications have also been used in the treatment of primary RLS. In this report we describe clozapine-induced RLS in two patients with schizophrenia and its successful treatment with gabapentin, a nondopaminergic agent. In addition, we have reviewed the available literature on clozapine-induced RLS and its management.
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Affiliation(s)
- Vijaya Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, New Kabini Hostel Complex, Hosur road, Bangalore, Karnataka 560029, India
| | - Ganesan Venkatasubramanian
- The Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
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Semiz M, Solmaz V, Aksoy D, Inanir S, Colak B, Gokbakan MA, Inanir A. Prevalence of Restless Legs Syndrome Among Psychiatric Patients Who are Under Antidepressant or Antipsychotic Monotherapy. ACTA ACUST UNITED AC 2016. [DOI: 10.5455/bcp.20150908024954] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Murat Semiz
- Gulhane Military Medical Faculty, Department of Psychiatry, Ankara - Turkey
| | - Volkan Solmaz
- Turhal State Hospital, Neurology Clinic, Tokat - Turkey
| | - Durdane Aksoy
- Gaziosmanpasa University, Faculty of Medicine, Department of Neurology, Tokat - Turkey
| | - Sema Inanir
- Tokat Mental Health and Diseases Hospital, Tokat - Turkey
| | - Burcin Colak
- Ankara University, Medical Faculty, Department of Psychiatry, Ankara - Turkey
| | - Mehmet Aziz Gokbakan
- Medipol University, Medical Faculty, Department of Psychiatry, Istanbul - Turkey
| | - Ahmet Inanir
- Gaziosmanpasa University, Faculty of Medicine, Department of Physical Therapy and Rehabilitation, Tokat - Turkey
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13
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Abstract
Psychotropic medications such as antidepressants, antipsychotics, stimulants, and benzodiazepines are widely prescribed. Most of these medications are thought to exert their effects through modulation of various monoamines as well as interactions with receptors such as histamine and muscarinic cholinergic receptors. Through these interactions, psychotropics can also have a significant impact on sleep physiology, resulting in both beneficial and adverse effects on sleep.
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Restless Leg Syndrome Induced by Escitalopram and Lithium Combined With Quetiapine Treatment in Bipolar II Disorder: A Case Report. Clin Neuropharmacol 2016; 39:118-9. [PMID: 26818045 DOI: 10.1097/wnf.0000000000000135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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El-Saifi N, Moyle W, Jones C, Tuffaha H. Quetiapine safety in older adults: a systematic literature review. J Clin Pharm Ther 2016; 41:7-18. [DOI: 10.1111/jcpt.12357] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 12/26/2015] [Indexed: 02/06/2023]
Affiliation(s)
- N. El-Saifi
- Menzies Health Institute Queensland; Griffith University; QLD Australia
| | - W. Moyle
- Menzies Health Institute Queensland; Griffith University; QLD Australia
| | - C. Jones
- Menzies Health Institute Queensland; Griffith University; QLD Australia
| | - H. Tuffaha
- Menzies Health Institute Queensland; Griffith University; QLD Australia
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Abstract
INTRODUCTION Drug-induced movement disorders (DIMDs) can be elicited by several kinds of pharmaceutical agents. The major groups of offending drugs include antidepressants, antipsychotics, antiepileptics, antimicrobials, antiarrhythmics, mood stabilisers and gastrointestinal drugs among others. AREAS COVERED This paper reviews literature covering each movement disorder induced by commercially available pharmaceuticals. Considering the magnitude of the topic, only the most prominent examples of offending agents were reported in each paragraph paying a special attention to the brief description of the pathomechanism and therapeutic options if available. EXPERT OPINION As the treatment of some DIMDs is quite challenging, a preventive approach is preferable. Accordingly, the use of the offending agents should be strictly limited to appropriate indications and they should be applied in as low doses and as short duration as the patient's condition allows. As most of DIMDs are related to an unspecific adverse action of medications in the basal ganglia and the cerebellum, future research should focus on better characterisation of the neurochemical profile of the affected functional systems, in addition to the development of drugs with higher selectivity and better side-effect profile.
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Affiliation(s)
- Dénes Zádori
- University of Szeged, Albert Szent-Györgyi Clinical Center, Department of Neurology, Faculty of Medicine , Semmelweis u. 6, H-6725 Szeged , Hungary +36 62 545351 ; +36 62 545597 ;
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Sharon D. Nonpharmacologic Management of Restless Legs Syndrome (Willis-Ekbom Disease). Sleep Med Clin 2015; 10:263-78, xiii. [DOI: 10.1016/j.jsmc.2015.05.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Vohra A. Quetiapine induced restless legs syndrome: A series of four cases. Asian J Psychiatr 2015; 16:73-4. [PMID: 26096664 DOI: 10.1016/j.ajp.2015.05.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 05/31/2015] [Indexed: 12/21/2022]
Affiliation(s)
- Adarsh Vohra
- Mountcroft, Albert Street, FY5 1PQ, United Kingdom.
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Long-Term Treatment of Restless Legs Syndrome (RLS): An Approach to Management of Worsening Symptoms, Loss of Efficacy, and Augmentation. CNS Drugs 2015; 29:351-7. [PMID: 26045290 DOI: 10.1007/s40263-015-0250-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Restless legs syndrome (RLS) is a common, frequently chronic, sensorimotor neurological disorder characterized by nocturnal leg dysesthesias and an irresistible urge to move the legs, usually resulting in sleep disturbance. Dopaminergic agonists, alpha-2-delta calcium-channel ligands, and opioids have all demonstrated efficacy to relieve symptoms of RLS and improve sleep. However, long-term treatment with dopamine agonists (the most commonly prescribed agents) is often characterized by worsening symptoms and loss of efficacy. A more worrisome complication of dopaminergic agents is augmentation, an iatrogenic worsening of RLS symptoms that can produce progressively more severe symptoms resulting in around-the-clock restlessness and near sleeplessness. Recent research has yielded consensus regarding a precise definition of augmentation and has contributed to improved knowledge regarding strategies for preventing this complication. When RLS symptoms worsen during the course of treatment, the clinician must consider the myriad of environmental, medical, pharmacologic, and psychiatric factors that can exacerbate RLS. In the absence of fully developed, evidence-based guidelines there remains uncertainty regarding the optimal management strategy if augmentation develops. However, we discuss several key principles based on the available published data and the authors' clinical experience. We also explore the recent increasing interest in alternative initial treatment strategies that avoid dopamine agonists and their associated complications altogether.
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Zhao M, Geng T, Qiao L, Zhang M, Shi J, Huang F, Lin X, Wang J, Zuo H. Olanzapine-induced restless legs syndrome. J Clin Neurosci 2014; 21:1622-5. [DOI: 10.1016/j.jocn.2014.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 12/23/2013] [Accepted: 01/09/2014] [Indexed: 10/25/2022]
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Abstract
Sleep issues are common in people with psychiatric disorders, and the interaction is complex. Sleep disorders, particularly insomnia, can precede and predispose to psychiatric disorders, can be comorbid with and exacerbate psychiatric disorders, and can occur as part of psychiatric disorders. Sleep disorders can mimic psychiatric disorders or result from medication given for psychiatric disorders. Impairment of sleep and of mental health may be different manifestations of the same underlying neurobiological processes. For the primary care physician, key tools include recognition of potential sleep effects of psychiatric medications and familiarity with treatment approaches for insomnia in depression and anxiety.
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Affiliation(s)
- Eliza L Sutton
- Department of Medicine, University of Washington, 4245 Roosevelt Way Northeast, Box 354765, Seattle, WA 98105, USA.
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Abstract
Restless legs syndrome (RLS) often presents with a primary complaint of sleep initiation difficulty with only ambiguous allusions to motor symptoms. This may result in the condition being misdiagnosed as a psychophysiological insomnia. Further, nocturnal eating is common in RLS and like the classic motor symptoms, patients will describe an inability to initiate sleep until their urge (to eat) is addressed. Restless nocturnal eating arises, intensifies, and subsides in parallel to motor symptoms. Once misdiagnosed as psychophysiological insomnia, RLS patients are frequently treated with benzodiazepine receptor agonists. The CNS actions of these sedating agents, suppression of memory and executive function, unleash predisposed amnestic behaviors. In the case of RLS this would be expected to include the inappropriate ambulatory and eating behaviors of sleep related eating disorder (SRED). The evidence and implications of a link between the restless eating of RLS and SRED is presented here.
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Affiliation(s)
- Michael J Howell
- Department of Neurology, University of Minnesota, 717 Delaware Street SE, Room 516, Minneapolis, MN, 55414, USA.
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Abstract
BACKGROUND Over the past decade, the treatment of Parkinson disease (PD) has undergone tremendous changes. New drugs have been introduced to manage the cardinal motor symptoms of PD, and other agents have been borrowed to treat the nonmotor manifestations of the illness. For neurologists faced with the task of treating PD patients, the available array of medications may be confusing and intimidating. REVIEW SUMMARY In this review, I summarize the newest approved medications for the treatment of PD, including the new dopamine agonists and catechol-O-methyl-transferase inhibitors. I also describe agents that are used to treat common problems in PD patients, including hallucinations, orthostasis, nausea, erectile dysfunction, depression, and memory loss. Guidelines for handling common scenarios in PD patients will be illustrated by 10 case histories. Finally, the most promising PD drugs that are currently in development will be reviewed. CONCLUSIONS Neurologists have a vast armamentarium to treat both motor and nonmotor manifestations of PD. Understanding this array allows the astute clinician to improve the lives of their patients with PD.
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Affiliation(s)
- Steven J Frucht
- Columbia-Presbyterian Medical Center, New York, NY 10032, USA.
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