In the last few years, dopamine agonists (DA) have been used as first-line treatment for restless legs syndrome (RLS), a disabling sensorimotor disorder. Only recently have they reported some possible iatrogenic side effects, as shown below. The following case presents a RLS patient who developed hallucinatory and delusional symptoms with paranoid ideation after pramipexole assumption; these symptoms gradually decreased after pramipexole suspension and treatment by an oral antipsychotic therapy (quetiapine XR). Correlation between DAs assumption and psychotic symptoms is still not clear. The development of these side effects might be related to many risk factors such as genetic susceptibility, premorbid personality and psychosocial stressor; in order to minimise the risk of iatrogenic psychosis it could be useful to assess patients' vulnerability factors selecting an alternative medication regime.