Abstract
Background
Symptoms of anxiety and depression in patients with restless legs syndrome (RLS) have been observed. However, it is unclear whether rates of threshold depression and anxiety disorders according to DSM-IV criteria in such patients are also elevated.
Methods
238 RLS patients were assessed with a standardized diagnostic interview (Munich-Composite International Diagnostic Interview for DSM-IV) validated for subjects aged 18–65 years. Rates of anxiety and depressive disorders were compared between 130 RLS patients within this age range and 2265 community respondents from a nationally representative sample with somatic morbidity of other types.
Results
RLS patients revealed an increased risk of having 12-month anxiety and depressive disorders with particularly strong associations with panic disorder (OR=4.7; 95% CI=2.1–10.1), generalized anxiety disorder (OR=3.5; 95% CI= 1.7–7.1), and major depression (OR=2.6; 95% CI=1.5–4.4). In addition, lifetime rates of panic disorder and most depressive disorders as well as comorbid depression and anxiety disorders were considerably increased among RLS patients compared with controls.
Conclusions
The results suggest that RLS patients are at increased risk of having specific anxiety and depressive disorders. Causal attributions of patients suggest that a considerable proportion of the excess morbidity for depression and panic disorder might be due to RLS symptomatology.
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References
Aikens JE, Vanable PA, Tadimeti L, Caruana-Montaldo B, Mendelson WB (1999) Differential rates of psychopathology symptoms in periodic limb movement disorder, obstructive sleep apnea, psychophysiological insomnia, and insomnia with psychiatric disorder. Sleep 22:775–780
Allen RP, Early AJ (2001) Restless Legs Syndrome. A review of clinical and pathophysiological features. J Clin Neurophys 18:128–147
Anderson RJ, Freedland KE, Clouse RE, Lustman PJ (2001) The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care 24:1069–1078
Benca RM, Obermeyer WH, Thised RA, Gillin JC (1992) Sleep and psychiatric disorders. A meta-analysis. Arch Gen Psychiatry 49:651–668
Dimmitt SB, Riley GJ (2000) Selective serotonin reuptake inhibitors can reduce restless legs symptoms. Arch Intern Med 160:712
Gorman CA (1965) Dyck PJ, Pearson JS. Symptom of Restless Legs. Ach Intern Med 115:155–160
Heiman EM, Christie M (1986) Lithium-aggravated nocturnal myoclonus and restless legs syndrome. Am J Psychiatry 143:1191–1192
Jacobi F, Wittchen H-U, Müller N, Hölting C, Sommer S, Lieb R, Höfler M, Pfister H (2002) Estimating the prevalence of mental and somatic disorders in the community: aims and methods of the German National Health Interview and Examination Survey. Int J Methods Psychiatr Res 11:1–18
Kuny S (1991) Psychiatrische Katamnese bei Patienten mit “restless legs”. Schweiz med Wschr 121:72–76
Kuny S, Blättler W (1988) Psychische Beschwerden bei vermeintlich phlebologischen Beinbeschwerden. Schweiz med Wschr 118:18–22
McCullagh P, Nelder JA (1989) Generalized linear models. 2nd edition. London: Chapman and Hall
Musselman DL, Evans DL, Nemeroff CB (1998) The relationship of depression and cardiovascular disease. Epidemiology, biology, and treatment. Arch Gen Psychiatry 55:580–592
Oppenheim H (1923) Lehrbuch der Nervenkrankheiten. 7th ed. Berlin, Karger, p 1774
Paik IH, Lee C, Choi BM, Chae YL, Kim CE (1989) Mianserin-induced restless legs syndrome. Br J Psychiatry 155:415–417
Pfister H, Wittchen H-U (1995) MCIDI Computerprogramm. München: Max Planck Institut für Psychiatrie, Klinisches Institut
Reed V, Gander F, Pfister H, et al. (1998) To what degree does the Composite International Diagnostic Interview (CIDI) correctly identify DSM-IV disorders? Testing validity issues in a clinical sample. Inter J Meth Psychiatr Res 7:142–155
Rothdach AJ, Trenkwalder C, Haberstock J, Keil U, Berger K (2000) Prevalence and risk factors of RLS in an elderly population: the MEMO study. Neurology 54:1064–1068
Royall RM (1986) Model Robust Confidence Intervals using Maximum Likelihood Estimators. Int Statist Rev 54:221–226
Roy-Byrne PP, Uhde TW, Post RM (1986) Effects of one night’s sleep deprivation on mood and behavior in panic disorder. Arch Gen Psychiatry 43:895–899
Saß H, Wittchen H-U, Zaudig M, Houben I (1998) Diagnostische Kriterien DSM-IV. Hogrefe Verlag für Psychologie
Sellick SM, Crooks DL (1999) Depression and cancer: An appraisal of the literature for prevalence, detection, and practice guideline development for psychological interventions. Psychooncology 8:315–333
StataCorp (2001) Stata Statistical Software: Release 7.0. College Station, TX: Stata Corporation
Walters AS (1995) Toward a better definition of the restless legs syndrome. The International Restless Legs Syndrome Study Group. Mov Disord 10:634–642
Winkelman JW, Chertow GM, Lazarus JM (1996) Restless legs in end-stage renal disease. Am J Kidney Disord 28:372–378
Winkelmann J, Müller-Myhsok B, Wittchen H-U, et al. (2002) Complex segregation analysis of restless legs syndrome provides evidence for etiologic heterogeneity with a clear autosomal dominant mode of inheritance in early age at onset families. Ann Neurol 12:297–302
Winkelmann J, Wetter TC, Collado-Seidel V, Gasser T, Dichgans M, Yassouridis A, Trenkwalder C (2000) Clinical characteristics and frequency of hereditary restless legs syndrome in a population of 300 patients. Sleep 23:597–602
Wittchen H-U (1994) Reliability and validy studies of the WHO Composite International Diagnostic Interview (CIDI): a critical Review. J Psychiat Res 28:57–84
Wittchen HU, Pfister H (1997) DIA-XInterviews. Manual für Screening-Verfahren und Interview; Interviewheft Längsschnittuntersuchung (DIA-XLifetime); Ergänzungheft (DIA-X-Lifetime); Interviewheft Querschnittsuntersuchung (DIA-X-12 Monate); Ergänzungheft (DIA-X-12 Monate); PC-Programm zur Durchführung des Interviews (Längs- und Querschnittuntersuchung); Auswertungsprogramm. Frankfurt: Sweets and Zeitlinger
Wittmaack T (1861) Pathologie und Therapie der Sensibilitäts-Neurosen. Leipzig, E Schäfer, p 459
Zaubler TS, Katon W (1996) Panic disorder and medical comorbidity: A review of the medical and psychiatric literature. Bull Menninger Clin 60:5–11
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Winkelmann, J., Prager, M., Lieb, R. et al. “Anxietas Tibiarum”. J Neurol 252, 67–71 (2005). https://doi.org/10.1007/s00415-005-0604-7
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DOI: https://doi.org/10.1007/s00415-005-0604-7