1.  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 Mental Health Case Study (1) Outline

2. 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? Mental Health Case Study (2) Questions – in small or large group(s)

3. 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? Mental Health Case Study (3) Questions – in small or large group(s)

4. 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) Mental Health Case Study (4) Brief guide to answers for the questions

5. 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/GL2008_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 24hr (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) Mental Health Case Study (5) Brief guide to answers for the questions