RLS Management and Psychiatric Comorbidity Considerations

Restless Legs Syndrome (RLS) is a neurological disorder which results in an irresistible urge to keep the limbs in motion, particularly at night when patients are lying down. Getting up to move around provides partial relief of leg discomfort. There is currently no known cure and the diagnosis is made clinically. There are several FDA approved medications for the treatment of RLS and other medications may be used off-label. RLS is commonly comorbid with psychiatric conditions. Pharmacotherapy for psychiatric disorders can lead to new onset or worsening of RLS while pharmacotherapy for RLS can lead to new onset or worsening of psychiatric symptoms. This program will provide participants an opportunity to learn about the existing treatment options for patients with RLS as well as treatment strategies for those with comorbid psychiatric conditions.

Consider making this session part of your BPS Continuing Professional Development plan! Please refer to the BPS Psychiatric Pharmacy Content Outline to see how this activity may align.

Target Audience

If you are a pharmacist, nurse practitioner, or other health care professional involved in the comprehensive medication management of individuals living with mental health and/or substance use disorders, we invite you to participate in this online course.

Course Requirements

To receive ACPE credit for this session, you must:

  • Register for this course.
  • Review the full content of the activity and reflect upon its teachings.
  • Complete the evaluation at the end of the activity.
  • Provide the necessary details in your profile to ensure correct reporting by AAPP to CPE Monitor.

Faculty Information

Arthur Walters, MD
View biographical information

Arthur Walters, MD
Professor of Neurology
Vanderbilt University School of Medicine
Nashville, TN

Arthur S. Walters, M.D. is a graduate of Wayne State University School of Medicine 1972. Dr. Walters is currently a Professor of Neurology at Vanderbilt University School of Medicine in Nashville, Tennessee, USA since 2008. Upon arriving in Nashville, he was given a “Distinguished Faculty medical license” by the state of Tennessee. Originally trained in Movement Disorders and secondarily in Sleep Disorders, Dr. Walters has combined his interests and is a pioneer in the development of the newly emerging field of sleep-related Movement Disorders. He co-edited the first book on sleep-related movement disorders in 2003 — revised edition 2013. He was chosen by the American Academy of Sleep Medicine to head up the committee for formulating new diagnostic clinical criteria for the sleep-related movement disorders (International Classification of Sleep Disorders ICSD-2 published in 2005 and ICSD-3 published in 2014). He was also chosen by the American Academy of Sleep Medicine to head up the committee for formulating new polysomnographic scoring criteria for the sleep-related movement disorders (The AASM Manual for the Scoring of Sleep and Associated Events published in 2007). From 1993 to 2007 he founded and served as the first chair of the International Restless Legs Syndrome Study Group (IRLSSG), comprised of over 130 physicians and scientists from 17 countries dedicated to research on Restless Legs Syndrome (RLS) and its allied condition Periodic Limb Movements in Sleep. Under his leadership, universal clinical criteria for the diagnosis of RLS were established and the first validated scale for the scoring of RLS severity was created and validated. This scale is now used as the primary outcome measure in all the major pharmaceutical company studies of RLS. He served as the first chair of the Medical Advisory Board of the Restless Legs Syndrome Foundation from 1992-1998, a nation-wide support group for RLS patients and their families. He continues as an active member of the board. In 2003/2004 while at Seton Hall University he was named “Researcher of the Year”, one of 4 such awards given by the university that year for excellence in (1) Medicine, (2) The Arts, (3) The Humanities and (4) The Social and Physical Sciences. In 2010 he was the recipient of the American Academy of Neurology Senior Sleep Science Award for excellence in sleep research. In 2017 his name was added to a list of 120 "notable alumni" graduates from Wayne State University School of Medicine in the 20th and 21st centuries. Dr. Walters has published close to 450 peer reviewed articles, co-edited books, book chapters, letters to the editor, editorials and abstracts combined. He has been funded as principal investigator by the NIH, Veterans Affairs, university and industry sponsored grants. He is currently a member of the American Academy of Sleep Medicine Standards and Practice Committee for therapy of RLS 2023. 
 
Dr. Walters research on RLS has focused on:
 
(a) Treatment studies of opioids, dopaminergic agents, anticonvulsants such gabapentin and pregabalin, benzodiazepines and lesser known agents as therapies for RLS 
(b) The role of the endogenous opiate system with its endorphins, enkephalins and dynorphins in the pathogenesis of RLS and its allied condition Periodic Limb Movements in Sleep (PLMS).  He has also studied the role of the endogenous opiate system in the pathogenesis of another condition characterized by restlessness, Neuroleptic-Induced Akathisia.  
(c) RLS and PLMS as a risk factor for hypertension, cardiovascular and stroke and also the reverse -- hypertension, cardiovascular disease and stroke as a risk factor for RLS and PLMS.
(d) The similarities and differences between Pediatric RLS and Growing Pains
(e) The relationship between RLS and PLMS to inflammatory and auto-immune disease.
(f) The possible role of Zinc in the pathogenesis of RLS.
(g) The overlap between Attention Deficit Hyperactivity Disorder (ADHD) and RLS
(h) The role of circadian rhythms in RLS
(i) The interconnection between Gastrointestinal Disease and RLS.

Learning Objectives

  1. Describe the pathophysiology and diagnostic criteria for restless legs syndrome (RLS).
  2. Identify treatment options appropriate for patients with comorbid RLS and psychiatric conditions.
  3. Develop a pharmacotherapy treatment plan for an individual with RLS when given a clinical scenario.

Continuing Education Credit and Disclosures

Activity Dates: 04/09/2024 - 04/09/2027
ACPE Contact Hours: 1
ACPE Number: 0284-0000-24-032-H01-P (Knowledge)
Nursing Credit Reminder: Note that ACPE credit is accepted for ANCC Certification Renewal and AANPCB advanced practice provider content. For specific questions related to your organization's acceptance of ACPE continuing education units, please contact your organization directly.

ACPEThe American Association of Psychiatric Pharmacists is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

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View planning committee disclosures

2024 Program Committee and Recertification Editorial Board

Elayne D. Ansara, PharmD, BCPP, BCPS
Mental Health Clinical Pharmacist Practitioner
VISN23 Clinical Resource Hub
Indianapolis, IN
Non-Financial Interests: The Board of Pharmaceutical Specialties (Psychiatric Pharmacy Specialty Council)

Bridget Bradley, PharmD, BCPP
Clinical Pharmacist
Oregon Health & Science University
Beaverton, OR
External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: ACCP PSAP May 2021, Neurology and Psychiatry Book
Educational Grants, Research Grants or Contracts: NACDS Community Pharmacy Residency Grant

Katie L. Brase, MA
Program Specialist
American Association of Psychiatric Pharmacists
Lincoln, NE
No Relevant Financial Relationships to Disclose
Dana Chiulli, PharmD, BCPP
Clinical Pharmacist Practitioner - Mental Health
VISN 06 Mental Health Clinical Resource Hub
Flower Mound, TX
No Relevant Financial Relationships to Disclose
Marissa Cullen, PharmD, BCPP
Clinical Pharmacist
UPMC Western Psychiatric Hospital
Pittsburgh, PA
No Relevant Financial Relationships to Disclose
Beth DeJongh, PharmD, BCPS, BCPP
Director of Continuing Professional Development
American Association of Psychiatric Pharmacists
Lincoln, NE
No Relevant Financial Relationships to Disclose
Chelsea N. Di Polito, PharmD, BCPP
Assistant Director, Pharmacy Administration - Clinical Services
University of Maryland School of Pharmacy
Baltimore, MD
No Relevant Financial Relationships to Disclose
Alisha D. Donat, PharmD, BCPP
Clinical Pharmacy Specialist - Mental Health
South Texas Veterans Health Care System
San Antonio , TX
No Relevant Financial Relationships to Disclose
Bennett J. Doughty, PharmD, BCPP, BCPS
Clinical Assistant Professor
Binghamton University School of Pharmacy and Pharmaceutical Sciences
Binghamton, NY
External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: PsychU- Speaker's Bureau
Traci M. Dutton, PharmD, BCPP, BCPS
Clinical Pharmacy Specialist - Mental Health; Program Director - PGY2 Psychiatric Pharmacy Residency
VA Tennessee Valley Healthcare System
Murfreesboro, TN
Employment: Tennessee Valley VA Healthcare System, Clinical Pharmacy Specialist - Mental Health, Member of VA PBM Educational Advisory Committee which
oversees Board Certification Study Groups

Megan J. Ehret, PharmD, MS, BCPP
BCPP Program Director
Professor
University of Maryland
Baltimore, MD
External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: Saladex Biomedical Consultant, Lexi-Comp Consultant/Reviewer, SMI Adviser; Pharmacist Consultant
Educational Grants, Research Grants or Contracts: FDA/University of Maryland CERSI, Maryland Behavioral Health Department, NIH

Kimberly Ehrhard, PharmD, BCPP
Clinical Pharmacist, Psychiatry
The University of Kansas Health System
Kansas City , KS
No Relevant Financial Relationships to Disclose
Robert J. Haight, PharmD, BCPP
Program Committee Chair
Clinical Pharmacist | Forensic Services
Saint Peter Regional Treatment Center (SPRTC), Minnesota Department of Human Services
Saint Peter, MN
No Relevant Financial Relationships to Disclose
Abigail Hampton, PharmD, BCPP
Clinical Pharmacy Practitioner- mental health
Kansas City Veterans Affairs
Kansas City, MO
No Relevant Financial Relationships to Disclose
Suzanne C. Harris, PharmD, BCPP
Associate Professor/Director of Well-being and Resilience/Clinical Pharmacist Practitioner
UNC Eshelman School of Pharmacy
Chapel Hill, NC
No Relevant Financial Relationships to Disclose
Jordan Haygood, PharmD, BCPP
Clinical Pharmacy Specialist - Psychiatry
Medical University of South Carolina
Charleston, SC
No Relevant Financial Relationships to Disclose
Courtney A. Iuppa, PharmD, BCPP
Clinical Pharmacy Manager & Residency Program Director
Center for Behavioral Medicine
Kansas City, MO
No Relevant Financial Relationships to Disclose
Archana R. Jhawar, PharmD, BCPP
Clinical Pharmacist
Jesse Brown VAMC/ UIC College of Pharmacy
Chicago, IL
No Relevant Financial Relationships to Disclose
Kayla D. Johnson, PharmD, BCPP, BCPS
Clinical Pharmacist Specialist
Vanderbilt University Medical Center
Thompsons Station, TN
External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: Pharmacy Times Continuing Education Speaker
Dongmi Kim, PharmD, BCPP, BCPS
Assistant Clinical Professor
Fairleigh Dickinson University School of Pharmacy
Florham Park, NJ
No Relevant Financial Relationships to Disclose
Jamie C. Kneebusch, PharmD, BCPP, BCPS
Assistant Clinical Faculty
UC San Diego, Skaggs School of Pharmacy
La Jolla, CA
No Relevant Financial Relationships to Disclose
Erin D. Knox, PharmD, BCPP
Director of Experiential Education
UCI School of Pharmacy & Pharmaceutical Sciences
Irvine, CA
Non-Financial Interests: Santa Ana Community College, Pharmacy Technology Program, Advisory Committee
Lauren E. Leiby, PharmD, BCPP
Behavioral Health Patient Care Pharmacist
Nationwide Childrens Hospital
Columbus, OH
No Relevant Financial Relationships to Disclose
Linda D. Logan, PharmD, BCACP, BCPP, BCPS
Public Service Associate
University of Georgia
Athens, GA
Educational Grants, Research Grants or Contracts: HRSA Graduate Psychology Education Grant, UGA Mental Health Seed Grants for MHFA and Virtual Dementia Tour,
UGA College Pharmacy Ansel Fund
Megan Maroney, PharmD, BCPP
Clinical Associate Professor
Ernest Mario School of Pharmacy at Rutgers, the State University of New Jersey
Long Branch, NJ
External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: Pharmacy Times - speaker and medical writing honoraria, Otsuka Pharmaceuticals - Excel Speakers
Bureau (former, through March 2022), Novus Medical Education - consultant/medical writing, Boehringer Ingelheim - advisory board, Sunovion Pharmaceuticals –
consultant/advisory board, Biogen and Sage Therapeutics - advisory board
Monica Mathys, PharmD, BCGP, BCPP
Professor
Texas Tech University School of Pharmacy
Dallas, TX
Non-Financial Interests: AAPP Foundation Board member
Maren McGurran, PharmD, BCPP, BCPS
Clinical Pharmacist, Psychiatry
Northwest Missouri Psychiatric Rehabilitation Center
MO
No Relevant Financial Relationships to Disclose

Lindsey N. Miller, PharmD, BCPP
Clinical Pharmacist and Associate Professor
Lipscomb University and Vanderbilt Psychiatric Hospital
Nashville, TN
External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: Social Security Administration- Board of Adjudication: Presentations on various disease states
Financial Interests: Pharmacy Times Panel Discussant- Payer Forum Sponsored by Alkermes (January 2020), Pharmacy Times- CE Presentation Sponsored by Otsuka (August 2019)

Breanna L. Moody, PharmD, BCPP
Clinical Pharmacy Specialist - Mental Health Clinic
Lexington VA Health Care System
Lexington, KY
Non-Financial Interests: BPS - BCPP Item Writer for 2022 cycle
Brianne Mosley, PharmD, BCPP, BCPS
Psychiatric Clinical Pharmacist
McLean Hospital
Belmont, MA
No Relevant Financial Relationships to Disclose
Jessica L. Mulhollan, PharmD, BCPP
Clinical Pharmacy Specialist, Substance Use Disorders and Mental Health Clinical Pharmacy Supervisor
Louis Stokes Cleveland VA Medical Center
Cleveland, OH
No Relevant Financial Relationships to Disclose
Kristen Neumeister, PharmD, BCPP
Clinical Pharmacist
North Texas State Hospital
Fort Worth, TX
No Relevant Financial Relationships to Disclose
Megan O'Connell, PharmD, BCPP
Clinical Pharmacy Specialist - Psychiatry and Neurology
Michigan Medicine
Ann Arbor, MI
No Relevant Financial Relationships to Disclose
Melissa C. Palmer, PharmD, BCPP, BCPS
Clinical Pharmacy Specialist - Mental Health
Alaska VA Healthcare System
Anchorage, AK
No Relevant Financial Relationships to Disclose
Haley Pals, PharmD, BCPP
Substance Use Disorder/Psychiatric Clinical Pharmacist
Tomah VA Medical Center
Tomah, WI
No Relevant Financial Relationships to Disclose
Brittany L. Parmentier, PharmD, MPH, BCPS, BCPP
Clinical Pharmacy Specialist in Psychiatry
The Harris Center for Mental Health and IDD
Houston, TX
No Relevant Financial Relationships to Disclose
Jake R. Peters, PharmD, BCPP, BCPS
Assistant Professor of Pharmacy Practice/Clinical Pharmacy Specialist - Psychiatry
Butler University College of Pharmacy/Indiana University Health
Indianapolis, IN
No Relevant Financial Relationships to Disclose
Sarah J. Popish, PharmD, BCPP
VA PBM Academic Detailing Services, Program Manager
Department of Veterans Affairs
Sarasota, FL
No Relevant Financial Relationships to Disclose

Devon A. Sherwood, PharmD, BCPP
Associate Professor of Pharmacy Practice
University of New England
Portland, ME
External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: New Hampshire MCAP (Mental Health Care Access in Pediatrics) - Subject Matter Expert –
Psychiatric Pharmacy / Psychopharmacology Consultative Services
Educational Grants, Research Grants or Contracts: SAMHSA funded grant - Collaborative SBIRT Training for Maine’s Future Health Professions Leaders

Rosana Steavenson, PharmD, BCPP, BCPS
Program Manager, Mental Health Clinical Pharmacy Programs; Mental Health Clinical Pharmacy Specialist
South Texas Veterans Health Care System
San Antonio, TX
No Relevant Financial Relationships to Disclose
Abby Stocks, PharmD, BCPP
Inpatient Behavioral Health Pharmacist
Inova Fairfax Medical Campus
Falls Church, VA
Educational Grants, Research Grants or Contracts: College of Psychiatric and Neurologic Pharmacists "Defining the Future" research grant
Nina Vadiei, PharmD, BCPP
Clinical Associate Professor
University of Texas at Austin
San Antonio, TX
No Relevant Financial Relationships to Disclose
Heidi J. Wehring, PharmD, BCPP
Adjunct Associate Professor of Psychiatry
Maryland Psychiatric Research Center, University of Maryland School of Medicine
Baltimore, MD
No Relevant Financial Relationships to Disclose
Kara R. Wong, PharmD, BCPP
Recertification Editorial Board Chair
Clinical Pharmacist Practitioner, Mental Health
Minneapolis VA Health Care System
Minneapolis, MN
No Relevant Financial Relationships to Disclose

All relevant relationships have been mitigated.

View disclaimer and disclosure of off-label use

Off-Label Use: This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA (see faculty information). The opinions expressed in the educational activity do not necessarily represent the views of AAPP and any educational partners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer: Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Presentation-Specific Disclosure: This presentation will include discussion of off-label, experimental, and /or investigational use of drugs or devices: alprazolam, clonazepam, diazepam, gabapentin, iron therapy, levodopa, lorazepam, oxycodone/naloxone, pitolisant, pramipexole ER, pregabalin, ropinirole ER, trazodone

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It is the policy of AAPP to ensure independence, balance, objectivity, scientific rigor, and integrity in continuing education activities. Those involved in the development of this continuing education activity have made all reasonable efforts to ensure that information contained herein is accurate in accordance with the latest available scientific knowledge at the time of accreditation of this continuing education activity. Information regarding drugs (e.g., their administration, dosages, contraindications, adverse reactions, interactions, special warnings, and precautions) and drug delivery systems is subject to change, however, and the reader is advised to check the manufacturer’s package insert for information concerning recommended dosage and potential problems or cautions prior to dispensing or administering the drug or using the drug delivery systems.

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View nursing education availability

ACPE approved contact hours are accepted for ANCC Certification Renewal: At least 50% (37.5 hours) of your 75 continuing education hours must be formally approved continuing education hours. Formally approved continuing education hours meet one or more of the criteria listed below:

  1. Continuing nursing education (CNE) approved for nursing contact hours by an accredited provider or approver of nursing continuing education
  2. Continuing medical education (CME) approved for CME hours
  3. Sponsored by organizations, agencies, or educational institutions accredited or approved by the American Nurses Credentialing Center (ANCC) or the Accreditation Council for Continuing Medical Education (ACCME) or the Accreditation Council for Pharmacy Education (ACPE) or the Commission on Dietetic Registration

All relevant relationships have been mitigated.