Polyfarmacy and unjustified use of high dosages of medicaments represent an unmet need in modern psychiatry. Therefore, tidal medication review of hospitalized geriatric patients is an essential step of the disease management as it can be often of vital importance and, as illustrated by current case, can exhibit a tremendeus impact on their quality of life.

A case rapport on geriatric patient with iatrogenic damage due to ultra high dosage of ropinirole as a treatment for restless legs syndrome

Authors of current paper address pharmacodynamic particularities of psychopharmaca and their reasonable choice in context to RLS

A clinical case of a 72 y.o. patient, known with chronic minor depressive symptomes over the past decades. Since few years he did not take any medicaion, except ropinirol for RLS. Because of the worsening of RLS symptomes, he decided on his own to increase the dose of ropinirol up to 12 mg/day. Two moths later he has been admitted to the psychiatric ward with major depression symptomes, suicidal plans, insomnia and profound edema of his both lower legs.

Current case demonstrates that high dose of ropinirole led to tremendous decrease of quality of life of the patient, and pushed him towards concrete suicidal plans. We advocate for careful assessing of the dose of every drug used; avoiding of polypharmacy by any means and for keeping in consideration that the majority of psychopharmaca leads to deterioration of RLS symptoms through modulation of dopamine pathways.

No significant relationships.

Using as a starting point a clinical case, the authors performed a literature review to clarify the relationship between visual hallucinations and treatment with ropinirole.

Analysis of the patient's clinical process and brief review of the latest available literature on the subject, published in PubMed/Medline databases.

Female patient, 89 years old, without psychiatric illness, brought to the emergency room by visual hallucinations, in the past 3 days “I see red, blue and green spots and roses on your sweater and a lot of flowers on that lady's blouse”sic. She recognised them as unreal (pseudo hallucinations) “no, nothing is there. It's from my eyes. I am fine of the head”sic. She has a personal history of glaucoma for decades, and restless legs syndrome for about 1 year, medicated with ropinirole. Adherence to therapeutic has been explored and it was found that she has been increasing, progressively and by its own initiative, the dose of ropinirole. She claims to be currently taking two pills of 8 mg twice daily (the recommended daily dose is 24 mg).

Studies indicate that the incidence of hallucinations during the treatment of RLS with ropinirole is less than 1%, which can be justified by its high affinity for D3 receivers compared to D2 receivers. However, it is also known that the over-stimulation of dopamine receptors (by overdose or rapid titration) can cause hallucinations, which may have been the cause of the patient's clinical condition. This clinical case also allows to alert for the importance of excluding organic causes in the diagnosis of visual hallucinations.