Gambling disorder — structured clinical viva

This viva tests whether the candidate can hold two formulations at once: (1) a behavioural addiction meeting DSM-5-TR gambling disorder criteria with depression and nicotine comorbidity; and (2) a probable dopamine-agonist-associated impulse-control disorder temporal to pramipexole. Refusing neurology liaison is a risk — candidates must explain why agonist review is medically necessary without bullying, and arrange safe contact pathways.^[1][2][5]

Risk. Marital crisis plus severe financial harm demands suicide assessment, domestic conflict screening, and practical financial safeguarding (self-exclusion, banking controls). Depression treatment is not optional window-dressing.^[1]

Treatment hierarchy. CBT and harm reduction remain core regardless of pharmacotherapy interest. Naltrexone may be discussed as off-label adjunct for urges with LFT monitoring, but it does not replace agonist review if the ICD pathway is active.^[3][4]