{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T20:07:02Z","timestamp":1778616422196,"version":"3.51.4"},"reference-count":15,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Prim Care Community Health"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:p>Treatment resistant restless legs syndrome (RLS) in the setting of psychiatric comorbidities can be difficult to manage. Our patient is a 69-year-old Caucasian gentleman with bipolar disorder type I, unspecified anxiety disorder, obstructive sleep apnea (OSA), and treatment-refractory RLS. At initial presentation, the patient\u2019s prescribed medication regimen included fluoxetine 40\u2009mg daily, gabapentin 800\u2009mg in the morning and 3200\u2009mg at bedtime, pramipexole 0.375\u2009mg daily, lamotrigine 200\u2009mg daily, trazodone 200\u2009mg at bedtime, and temazepam 15 to 30\u2009mg as needed for insomnia and RLS. Over the course of nearly 4\u2009years, treatment interventions for this patient\u2019s RLS included: cognitive behavioral therapy for insomnia, discontinuation of exacerbating medications, switching dopamine agonists, use of pregabalin and iron supplement. This report demonstrates a challenging case of RLS in the setting of psychiatric comorbidities, development of augmentation, and polypharmacy.<\/jats:p>","DOI":"10.1177\/21501327211019590","type":"journal-article","created":{"date-parts":[[2021,5,25]],"date-time":"2021-05-25T07:32:23Z","timestamp":1621927943000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Challenges in the Treatment of Restless Legs Syndrome: A Case Report"],"prefix":"10.1177","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4930-4497","authenticated-orcid":false,"given":"Audrey","family":"Umbreit","sequence":"first","affiliation":[{"name":"Southwest Minnesota Region, Mankato, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7114-4480","authenticated-orcid":false,"given":"Shirshendu","family":"Sinha","sequence":"additional","affiliation":[{"name":"Southwest Minnesota Region, Mankato, MN, USA"},{"name":"Mayo Clinic, Rochester, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bhanu Prakash","family":"Kolla","sequence":"additional","affiliation":[{"name":"Mayo Clinic, Rochester, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2351-5640","authenticated-orcid":false,"given":"Meghna P.","family":"Mansukhani","sequence":"additional","affiliation":[{"name":"Mayo Clinic, Rochester, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,5,25]]},"reference":[{"key":"bibr1-21501327211019590","doi-asserted-by":"publisher","DOI":"10.1007\/s11325-011-0606-x"},{"key":"bibr2-21501327211019590","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa072743"},{"key":"bibr3-21501327211019590","first-page":"523","volume":"61","author":"Miyamoto M","year":"2009","journal-title":"Brain Nerve"},{"key":"bibr4-21501327211019590","doi-asserted-by":"publisher","DOI":"10.1002\/mds.27260"},{"key":"bibr5-21501327211019590","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2007.03.022"},{"key":"bibr6-21501327211019590","doi-asserted-by":"publisher","DOI":"10.1176\/jnp.2008.20.1.101"},{"key":"bibr7-21501327211019590","doi-asserted-by":"publisher","DOI":"10.1177\/1078390312442569"},{"key":"bibr8-21501327211019590","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2017.11.007"},{"key":"bibr9-21501327211019590","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2013.06.016"},{"key":"bibr10-21501327211019590","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2017-001762"},{"key":"bibr11-21501327211019590","doi-asserted-by":"publisher","DOI":"10.1007\/s11940-015-0390-1"},{"key":"bibr12-21501327211019590","doi-asserted-by":"publisher","DOI":"10.1378\/chest.08-1665"},{"key":"bibr13-21501327211019590","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2016.01.017"},{"key":"bibr14-21501327211019590","unstructured":"GoodRx\n                      \u00a9\n                      . 2020. 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