Psychological distress of patients suffering from restless legs syndrome: a cross-sectional study
1 Interdisciplinary Pain Centre, University Medical Centre, Breisacher Strasse 64, Freiburg 79106, Germany
2 Somni bene Institute for Medical Research and Sleep Medicine Schwerin Ltd, Goethe Strasse 1, Schwerin 19053, and Neurology Department, University of Rostock, Gehlsheimer Strasse 20, Rostock 18147, Germany
3 Department of Clinical Neurophysiology, Klinikum Bremen-Ost, Züricher Strasse 40, Bremen 28325, and Department of Clinical Neurophysiology, University of Göttingen, Robert-Koch-Strasse 40, Göttingen 37079, Germany
4 Institute for Psychology, Rehabilitation Psychology and Psychotherapy, University of Freiburg, Engelberger Strasse 41, Freiburg 79085, Germany
5 Research Pharmaceutical Services Inc., 520 Virginia Drive, Fort Washington PA 19034, USA, and Department of Psychology, University of Erlangen-Nuremberg, Regensburger Strasse 160, Nuremberg 90478, Germany
Health and Quality of Life Outcomes 2011, 9:73 doi:10.1186/1477-7525-9-73Published: 20 September 2011
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.
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.
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).
Severely affected RLS patients show psychological impairment in multiple psychological domains which has to be taken into account in the treatment regimen.