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Restless Leg Syndrome: Elevation to its own Diagnostic Category in DSM 5

Ruth O'Hara, PhD
Stanford University

We will report on the rationale for elevation of Restless Legs Syndrome (RLS) to its own diagnostic category within the DSM V. The rationale for the separation of RLS from the classification of dyssomnia not otherwise specified, was based upon the recent emergence of strong empirical evidence of:

1. substantial prevalence of RLS in the general population;
2. the association of RLS with significant psychiatric, cognitive, behavioral and functional impairment;
3. documented genetic liability;
4. defined pathophysiological bases; and
5. successful treatment response to dopaminergic agents.

We will review the empirical data from each domain that led to the elevation of RLS to its own diagnostic category. Additionally, the impact of RLS on psychiatric disorders will be examined, and recommendations for the clinically relevant measures of severity and duration will be discussed.

The DSM-5 Sleep-Wake Disorders Nosology: Update

Charles F. Reynolds III, MD
University of Pittsburgh

DSM-5 Process: Timeline:
DSM-5 Research Planning Conferences and White Paper

• 2007: Appointment of DSM-V Work Groups
• 2010: Public Posting of Proposed Changes
• 2013: Anticipated Publication of DSM-5

Moving Away from the Causal Attributions Inherent in DSM-IV:

• drop the diagnosis of "primary insomnia" in favor of "insomnia disorder", with concurrent specification of clinically comorbid conditions (medical and psychiatric)
• drop "sleep disorder related to another mental disorder" and "sleep disorder related to a general medical condition" in favor of "insomnia disorder" or "hypersomnia disorder" with concurrent specification of clinically comorbid conditions
• these changes underscore that the patient has a sleep disorder warranting independent clinical attention, in addition to the psychiatric and medical disorders also present
• the changes also acknowledge bidirectional or interactive effects between sleep disorders and co-existing medical/psychiatric conditions
• aggregate hypersomnia and narcolepsy without cataplexy
• distinguish narcolepsy/hypocretin deficiency from other forms of hypersomnia
• subtype breathing-related sleep disorder into obstructive versus central in order to inform treatment planning

Decrease the Use of "Not Otherwise Specified" (NOS):

• elevate REM sleep behavior disorder and Restless Legs Syndrome into full-fledged diagnostic status
• further subtype circadian rhythm sleep disorder to include advanced sleep phase syndrome