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      Restless Back Syndrome: A Case Report and Literature Review

      case-report
      1 , 2 , 1 , 2 ,
      Psychiatry and Clinical Psychopharmacology
      Mesut Çetin

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          Abstract

          Restless back syndrome is characterized by uncomfortable pain, burning, ant crawling, or itching sensations in the back. Restless back syndrome is regarded as a back variant of restless legs syndrome. The lack of specific diagnostic criteria makes it difficult to recognize the restless back syndrome, which is usually neglected in clinical practice. Moreover, when a patient was diagnosed with restless back syndrome, the adjustment of medications was the first choice for doctors, which may make the patient’s condition unstable. To describe the restless back syndrome and collect and review the related lecture, and the possible mechanism of restless back syndrome was analyzed. A 50-year-old man was diagnosed with schizophrenia 15 years ago. Starting with 25 mg/day aripiprazole, which was switched to amisulpride 0.6 g/day due to no effectiveness, the patient reported symptoms of restless back syndrome in the 2 weeks since the treatment with 0.6 g/day of amisulpride. With the reduction of amisulpride adjustment, restless back syndrome spontaneously remitted. The central dopaminergic dysfunction may play an important role in the development of restless back syndrome. This case suggests that psychiatrists should pay attention to restless back syndrome when using antipsychotics. Moreover, when a patient manifests restless back syndrome, observation or decreasing medication may be one choice.

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          Most cited references27

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          Diagnostic and statistical manual of mental disorders

          (2013)
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            A clinical and polysomnographic comparison of neuroleptic-induced akathisia and the idiopathic restless legs syndrome.

            Neuroleptic-induced akathisia (NIA) is motor restlessness caused by dopamine receptor blocking antipsychotic agents. Nine patients with NIA and 11 patients with idiopathic restless legs syndrome (RLS) were studied polysomnographically. The sleep disturbances were milder in NIA than idiopathic RLS but increased numbers of awakenings and decreased sleep efficiencies were common to both groups. In addition, RLS patients demonstrated prolonged sleep latencies. Periodic movements in sleep (PMS) were present in only 5 of 9 patients with NIA but in all 11 patients with idiopathic RLS. In no NIA patient did we see the multiple, large amplitude, violent, resting myoclonic jerks of the legs that we saw during wakefulness in some of our more severe cases of idiopathic RLS. NIA patients tended to experience inner restlessness and idiopathic RLS patients tended to experience leg paresthesias as an antecedent to motor restlessness. Idiopathic RLS patients had symptoms that were worse at night and in repose far more frequently than patients with NIA. NIA and idiopathic RLS have similarities and differences. Because both NIA and idiopathic RLS are characterized by motor restlessness and sleep disturbances, the pharmacodynamics of antipsychotic medications may give clues as to both the cause and treatment of idiopathic RLS.
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              Restless leg syndrome associated with atypical antipsychotics: current status, pathophysiology, and clinical implications.

              Restless leg syndrome (RLS) is a common disorder, frequently of unclear origin, which is often associated with significant distress. There are a few case reports of atypical antipsychotic agents (AAP) causing RLS. The pathophysiological mechanisms resulting in emergence of these movements suggest central dopaminergic dysfunction. Dopamine agonists and L-dopa reduce the symptoms of RLS, and some agents that block the dopaminergic system aggravate RLS. Genetic influences are implicated in RLS and an association between gene polymorphisms and antipyschotic-associated onset of RLS has been postulated. Greater awareness of potential causes of RLS, and its differentiation from akathisia and illness related agitation might help in reducing the distress associated with it and improving patient compliance in patients using atypical antipsychotic agents.
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                Author and article information

                Journal
                Psychiatry Clin Psychopharmacol
                Psychiatry Clin Psychopharmacol
                Psychiatry and Clinical Psychopharmacology
                Mesut Çetin
                2475-0581
                December 2022
                01 December 2022
                : 32
                : 4
                : 351-354
                Affiliations
                [1 ]Department of Psychiatry , Zhejiang Province Mental Health Center, Zhejiang Province Tongde Hospital, Hangzhou, Zhejiang, China
                [2 ]Second Clinical College , Zhejiang Chinese Medical University, Hangzhou, China
                Author notes
                Corresponding author: Weidong Jin, e-mail: wdjin@ 123456163.com

                Cite this article as: Sun F, Tao H, Jin W. Restless back syndrome: A case report and literature review. Psychiatry Clin Psychopharmacol. 2022; 32(4): 351-354.

                Author information
                http://orcid.org/0000-0001-8963-8497
                Article
                pcp-32-4-351
                10.5152/pcp.2022.22441
                11082566
                13b0a588-8722-481e-a166-400452c7f68d
                2022 authors

                Content of this journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 6 May 2022
                : 9 October 2022
                Categories
                Case Report

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