Psychological distress of patients suffering from restless legs syndrome: a cross-sectional study
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RESEARCH
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Psychological distress of patients suffering from restless legs syndrome: a cross-sectional study Hanna Scholz1*, Heike Benes2, Svenja Happe3, Juergen Bengel4, Ralf Kohnen5 and Magdolna Hornyak1
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. Keywords: restless legs syndrome, psychological impairment, psychopathology, depression, anxiety, compulsivity, somatisation
Background Restless legs syndrome (RLS) is a common neurological disorder in Western countries with a lifetime prevalence of 7 to 10% [1]. Approximately 1 to 3% of patients require treatment [2]. The disease specific, health-related, and psychosocial quality of life of this population is reduced compared to the general population and is comparable to that of patients with type 2 diabetes mellitus and osteoarthritis [2,3]. The lifetime prevalence of comorbid depression and anxiety disorders is elevated by odds ratios of 2.1 to 5.3 in RLS compared to the community at large [4-6]. Sleep * Correspondence: [email protected] 1 Interdisciplinary Pain Centre, University Medical Centre, Breisacher Strasse 64, Freiburg 79106, Germany Full list of
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