Schizoaffective Disorder and Restless Legs Syndrome: A Case Report

Introduction Schizoaffective disorder is a complex psychiatric condition that presents with both psychotic and mood disorder symptoms (1). Patients with this disorder often experience significant impairment in their quality of life, particularly when comorbid neurological disorders are present. This case report presents a patient diagnosed with schizoaffective disorder whose condition which was complicated by restless legs syndrome (RLS), highlighting the challenges of managing overlapping psychiatric and neurological conditions. Case Presentation A 45-year-old male was diagnosed with schizoaffective disorder, depressive type. Despite multiple pharmacological treatments, including antipsychotic and antidepressant medications, symptom control improved, but remained inadequate. The introduction of Clozapine (400 mg/day) led to improvements in psychotic symptoms, however, depressive episodes persisted. Over time, the patient developed nightly motor symptoms, characterized by an uncontrollable urge to move his legs, worsening at night, significantly impairing sleep quality. These symptoms led to an RLS diagnosis, necessitating additional treatment. Gabapentin (600 mg/day) and Diazepam (7.5 mg to 10 mg/day) were introduced to manage motor symptoms. RLS persisted as a complicating factor, contributing to sleep disturbances and emotional instability, which further hindered his psychiatric treatment. Discussion The coexistence of schizoaffective disorder and RLS presents unique therapeutic challenges. Antipsychotic medications, particularly dopamine receptor antagonists, are known to exacerbate RLS symptoms by interfering with dopamine pathways and iron metabolism (2). Distinguishing between primary RLS and antipsychotic-induced RLS is crucial for effective treatment. Such cases require a multidisciplinary approach involving psychiatrists, neurologists, and sleep specialists to optimise psychiatric stability and neurological symptoms. While Diazepam alleviates motor symptoms, its long-term use poses dependency risks, necessitating cautious administration. Conclusions Managing schizoaffective disorder complicated by RLS requires a multidisciplinary approach, emphasizing accurate differential diagnosis, complex pharmacotherapy, and close collaboration between psychiatric and neurological specialists.