Prompt

You are the psychiatry registrar. A 55-year-old man with residual GAD has taken ropinirole for 'restless legs' for 4 years. He now needs afternoon doses, symptoms spread to his arms, and he recently lost money gambling online. Ferritin 3 years ago was 40 ng/mL and never repeated. He wants a higher dopamine-agonist dose tonight. Discuss diagnostic hierarchy, augmentation, iron, pharmacologic switch strategy, and impulse-control risk.

Interpretation

Reveal interpretation

This is chronic RLS with dopaminergic augmentation and probable impulse-control disorder on long-term ropinirole, plus stale low ferritin never readdressed. Escalating the agonist is the wrong vector — taper/switch, replete iron, and manage behavioural risk.[1][2][3]

Psychiatry Fellowship Pro

You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Psychiatry Fellowship fellowship atlas.

References6Show ledger

[1]García-Borreguero D, Allen RP, Kohnen R, et al. Diagnostic standards for dopaminergic augmentation of restless legs syndrome Sleep Med, 2007.PMID 17544323
[2]Garcia-Borreguero D, Silber MH, Winkelman JW, et al. Guidelines for the first-line treatment of restless legs syndrome/Willis-Ekbom disease, prevention and treatment of dopaminergic augmentation Sleep Med, 2016.PMID 27448465
[3]Allen RP, Picchietti DL, Auerbach M, et al. Evidence-based and consensus clinical practice guidelines for the iron treatment of restless legs syndrome/Willis-Ekbom disease in adults and children Sleep Med, 2018.PMID 29425576
[4]Silber MH, Buchfuhrer MJ, Earley CJ, et al. The Management of Restless Legs Syndrome: An Updated Algorithm Mayo Clin Proc, 2021.PMID 34218864
[5]Allen RP, Chen C, Garcia-Borreguero D, et al. Comparison of pregabalin with pramipexole for restless legs syndrome N Engl J Med, 2014.PMID 24521108
[6]Winkelman JW, Berkowski JA, DelRosso LM, et al. Treatment of restless legs syndrome and periodic limb movement disorder: an American Academy of Sleep Medicine clinical practice guideline J Clin Sleep Med, 2025.PMID 39324694

Interpretation

Reveal interpretation

Psychiatry Fellowship Pro

You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Psychiatry Fellowship fellowship atlas.

References6Show ledger

[1]García-Borreguero D, Allen RP, Kohnen R, et al. Diagnostic standards for dopaminergic augmentation of restless legs syndrome Sleep Med, 2007.PMID 17544323
[2]Garcia-Borreguero D, Silber MH, Winkelman JW, et al. Guidelines for the first-line treatment of restless legs syndrome/Willis-Ekbom disease, prevention and treatment of dopaminergic augmentation Sleep Med, 2016.PMID 27448465
[3]Allen RP, Picchietti DL, Auerbach M, et al. Evidence-based and consensus clinical practice guidelines for the iron treatment of restless legs syndrome/Willis-Ekbom disease in adults and children Sleep Med, 2018.PMID 29425576
[4]Silber MH, Buchfuhrer MJ, Earley CJ, et al. The Management of Restless Legs Syndrome: An Updated Algorithm Mayo Clin Proc, 2021.PMID 34218864
[5]Allen RP, Chen C, Garcia-Borreguero D, et al. Comparison of pregabalin with pramipexole for restless legs syndrome N Engl J Med, 2014.PMID 24521108
[6]Winkelman JW, Berkowski JA, DelRosso LM, et al. Treatment of restless legs syndrome and periodic limb movement disorder: an American Academy of Sleep Medicine clinical practice guideline J Clin Sleep Med, 2025.PMID 39324694

Restless legs syndrome — structured clinical viva

Interpretation

Restless legs syndrome — structured clinical viva

Interpretation