RLS patients can also develop compulsions on dopaminergic agonists

Abstract

Introduction The aim of this study was to assess the frequency of self-reported compulsive behaviours, depressive and stress symptoms and sleep disorders in a population of Restless legs patients treated with DA agonists. Reports by Tippmann-Peikert et al. (2007) and Ritz et al. (2006) extend the risk of developing DA agonists related impulse control disorders such as gambling, heightened sexual drive or unreasonably overinvested repetitive activities to RLS patients. Materials and methods A questionnaire covering RLS severity (IRLSSG-Walters et al. 2003), mood variables, The Beck Depression Inventory II (Beck et al. 2003), a visual Analog Scale of current level of stress and sleep parameters (The MOS Sleepscale, Hays & Stewart 1992) was sent at 3 points in time over twelve months in 2005 (February, June, October) to 150 RLS patients cared for at the Quebec Memory & Motor Skills Disorders Clinic. A last section exploring changes in hobbies, development of new habits and compulsions was added at the third mailing. Results Data derived from a population of 97 patients having answered all three mailings identified 17 positive responses to compulsions. After re-evaluation only 12 (8 women and 4 men) were found to have truly compulsive behaviours. In two women, simple motor stereotyped sequences in response to sensory urge evoked the phenomenology of Gilles de La Tourette Syndrome. In two other, one male, one female, a reactivation of trichotillomania previously exhibited in childhood was observed. For the other eight patients, abnormal behavioural display was similar to complex compulsory behaviours with short-term rewarding properties such as buying clothes, buying food, eating or gambling. In addition BDI and stress scores significantly contrasted the compulsion (+) vs. compulsion (−) patients. Their MOS sub-scale sleep problem Index I and II showed significantly higher scores and finally, the augmentation phenomenon was of higher prevalence in the C + group at the time of the 3rd questionnaire. Conclusion In summary, 12 out of 97 RLS patients on stable DA agonist therapy presented with progressive dishinibition of behaviour possibly shaped by pre treatment gender and individual specificities. None had a previous diagnosis of anxious generalized disorder or obsessive compulsive disorder. They showed more dysphoric and recognized themselves as more stressed than the compulsion (-) group of RLS patients.