Mental Health Case Study 1 Outline A 26

Mental Health Case Study (1) Outline § A 26 year old woman called Jess has presented while you are on intake § She has a past history of self harm, hospitalisations for overdose and past use of benzodiazepines & ‘ice’ § She is homeless & does not have an open file at your service § Jess presents saying she wants some valium or she will kill herself. She is tearful, agitated and distracted but orientated to place and time § She states she is very anxious, feels paranoid about people watching her on TV and complains of tinnitus 0

Mental Health Case Study (2) Questions – in small or large group(s) 1. What signs & symptoms that Jess is experiencing? Could it be related to drug or alcohol intoxication or withdrawal? 2. Your drug & alcohol assessment indicates that Jess is diazepam dependent & may be experiencing benzodiazepine withdrawal as she ran out 5 days ago – when would withdrawal be expected to commence & what could you do to manage this? 3. Your drug and alcohol assessment also indicates she has been bingeing on ‘ice’ (methamphetamines) over the last 4 days – what could you do to manage this? 1

Mental Health Case Study (3) Questions – in small or large group(s) 4. What are the main risks from withdrawal and intoxication for Jess 5. Where could you find information or advice on how to manage this situation? 2

Mental Health Case Study (4) Brief guide to answers for the questions 1. Benzodiazepine intoxication: sedation, slurred speech, confusion, poor memory recall, decreased anxiety. Withdrawal: anxiety, paranoia, distracted, agitation, tearful & tinnitus (see Chapter 9. 3 & 9. 4 in the guidelines) 2 & 3. Benzodiazepine withdrawal commences approx 2 -5 days after cessation (depending on half life) – Amphetamine crash commences 12 -24 hrs after use. Management is a thorough mental health/suicide risk & drug & alcohol assessments, reassurance/support, information re withdrawal & signs & symptoms, monitor withdrawal symptoms & signs, look for other causes & seek medical advice/assessment/admission – diazepam is the drug of choice to manage Benzodiazepine withdrawal symptoms (see Chapter 9. 3, 6 and 9. 4 in the guidelines) 3

Mental Health Case Study (5) Brief guide to answers for the questions 4. Jess could pose a risk of harm to self or others. Benzodiazepine withdrawal does have a risk of seizures following sudden cessation and it is best to gradually reduce use. Methamphetamine intoxication can lead to a presentation similar to paranoid schizophrenia with severe agitation and may lead to hospitalisation (Refer to NSW Drug and Alcohol Withdrawal Clinical Practice Guidelines NSW Health 2007 http: //www. health. nsw. gov. au/policies/gl/2008/GL 2008_011. html) 5. For advice speak to team members (including medical officers), obtain collaborative information (family/GP etc), clinical case review, local D&A services & NSW D&A Specialist Advisory Service 1800 023 687 24 hr (refer to a Framework for Suicide Risk Assessment and Management for NSW Health Staff http: //www. health. nsw. gov. au/pubs/2005/suicide_risk. html) 4