title: Psychological distress of patients suffering from restless legs syndrome: a cross-sectional study.
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).
  
  
  CONCLUSIONS
  Severely affected RLS patients show psychological impairment in multiple psychological domains which has to be taken into account in the treatment regimen.
authors.affiliation: Interdisciplinary Pain Centre, University Medical Centre, Freiburg 79106, Germany. hanna.scholz@uniklinik-freiburg.de
authors.forename: Hanna
authors.initials: H
authors.lastname: Scholz
authors.forename: Heike
authors.initials: H
authors.lastname: Benes
authors.forename: Svenja
authors.initials: S
authors.lastname: Happe
authors.forename: Juergen
authors.initials: J
authors.lastname: Bengel
authors.forename: Ralf
authors.initials: R
authors.lastname: Kohnen
authors.forename: Magdolna
authors.initials: M
authors.lastname: Hornyak
mesh_terms: D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012148:Restless Legs Syndrome / Q000523:psychology* / Q000628:therapy; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires