RLS ( Psychiatric Times June, July) is indeed a major physical symptom that patients often won't volunteer to talk about, even to their psychiatrists, because their symptoms have previously been trivialized by other health professionals and they are afraid that they are crazy. The following is a description of the first patient I encountered with RLS in the 1960s, when I didn't know anything about the condition. The quote is from Virginia Wilson's book, Sleep Thief:
"A young woman was admitted by her family because of her RLS problem. She developed helpless dependency on asylum life because of the severity of her RLS and resultant lack of ability to lead/form contacts for a normal social life. No one knew how to treat it; I tried all kinds of maneuvers to no avail. She didn't fit into any psychiatric category, but in those days we just sheltered her."
Today, I urge patients with RLS to get a good workup for possible underlying causes, including low iron stores and unsuspected Lyme disease, which in some cases seems to be a factor in this endemic area. I insist each patient know his own ferritin level and monitor it until it is at least up to 50.
The results are gratifying. Patients often get 100% relief when properly diagnosed and treated. The reports from Richard P. Allen, Ph.D., are welcome reading for patients and doctors alike. We have come a long way in our understanding now to increase our psychiatric skills in asking patients about the non-sexual events occurring in bed.