Dual diagnosis

[Dynamohum]

Hi Guys.

I was looking for some opinions on a bit of a conundrum I am facing - in short; I am a community Psych Nurse. I have a middle aged woman on my case load whom I suspect is using Amphetamines. She has insisted from some ime now that she is not. The clinical landscape is fairly complex, but the real bare bones of it, are as follows. I have noticed a change in her behaviour in the past few weeks - increased sneezing, slight twitching, vague redness around the nostrils, and bad breath. For many reasons, a high index of suspicion (by me) is warranted due to her frequent relapse into drug use over the years (and of course, a history of illicit drug use). I am on the edge of my knowledge when it comes to drug addiction and do not wish to (confront) her with what may be circumstantial 'evidence' I have observed (or at least, not yet!!). I just thought that somone on the message boards might know more about the signs of drug use. The ones I have listed are of course not exhaustive - though there are no obvioous signs of weight loss, or overactivity etc...

Thanks for your thoughts

Dynamohum

[Thunderwolf, MSN, RN]

Ah, the world of community mental health nursing.

The possible way around this is a referral for a general physical exam with a PCP. Prior to this, you may ask for a release of information in order to share general client health information....share your objective data then...with maybe a request for a drug screen in addition to other lab tests of concern (electrolytes, Creat/BUN, H+H), especially if the patient is taking meds for a health condition in order to check for therapeutic drug levels (ie dig, lithium, etc).

Yes, it is a different world in which you work in.

My best to you.