Sample CASC-Opiate (opioid) Withdrawal Assessment

Opiate Withdrawal History and Physical Examination 

Opiate withdrawal symptoms peak between 36-72 hours. Symptoms run their course in 5-7 days, though craving continues for some time. 

Withdrawal from Heroin

Withdrawal from heroin may begin up to 8 hours after the last use. During the next few hours, the person experiences muscle pain, sneezing, sweating; tearfulness; yawning excessively. At 36 hours after the last use, symptoms are most severe. These symptoms include chills, muscle cramps, flushing, sweating, tachycardia, hypertension, inability to sleep, vomiting & diarrhoea. Symptoms typically continue for about 72 hours & gradually diminish over 5-10 days.

History 

This history part is in Urdu/Hindi. I will add the "Objective Opiate Withdrawal Scale" soon here so anyone can benefit.

 

For now: COWS 

1. Aap kia istemal karty
2. Akhri bar kab lia hai aap ne
3. Abhi dil chahta ke aap dobara se kar lyn? Kitna had tak? 
4. Gutno ya baqi jorhon mai dard ho raha hai? Baqi jisam or pat’tho mai takleef? Sar dard? 
5. Pait ma dard waghera? Ulti ya matli to nai arhaii? Pechas ya ihsal ki shikayat?
6. Hot and cold flushes? 
7. Cheenk to naii a rahy baar baar?
8. Nend kesi hai? Araam se soe rehty han?   
9. Koi bechainee, pareshani ki keffyat ya ghussa ata ho?  

Physical examination

Start from the hands. 

1. Inspect the hands and run a hand over the palm. Note any sweating or palmar erythema. 
2. Note if there is any piloerection if hair visible on the dorsal side of the hands. 
3. Then check the pulse. 
4. Inspect the arms for any signs of IV drug abuse. 
5. Check blood pressure, and then check the temperature. 
6. Check respiratory rate while checking the above. 
7. Inspect the face for lacrimation, rhinorrhea and check pupil size for dilation. 
8. Comment if the patient is shaking or yawning. 
9. Perform a cardiovascular examination and look for murmurs. 
10. Examine for the signs of liver failure

What are the aims of the Counseling Sessions?

Counseling Sessions are an important part of psychiatric management. The following list sums up the Aims of Counselling Sessions; 

1. Establish mutual trust
2. Clarification and explanation
3. Freely expresses emotions
4. Reassurance
5. Understanding of health
6. Indent various choices
7. Making decisions
8. Seeking support
9. Learning the necessary skills

What are the Basics of Communication Skills?

The Basics of Communication Skills

Communication skills are central to clinical assessment. The following are the basic techniques that improve communications Skills. 

1. Attending and listening
2. Active listening
3. Verbal techniques
4. Funneling
5. Paraphrasing
6. Selective reflection
7. Empathy building
8. Checking for understanding.

CATIE Clinical Antipsychotic Trials of Intervention Effectiveness

A Multicenter, double-blind, parallel-group, randomized, controlled trial

Open Ended Questions

An open-ended question is one that puts the least restrictions over the answer to a select option-list. For example, an open-ended question to assess the thoughts would be:

What do you think about most often?

You can already notice, it is impossible to ask an absolute-open ended question. 

For the purpose of the Research Workshop, the College of Physicians and Surgeons states: 

Open-ended questions elicit detailed responses and provide no preselected options. These types of questions are the hallmark of qualitative research.  

Also, learn the advantages of open-ended questions. 

Advantages of Open-Ended Questions

What are the advantages of open-ended questions?

During the clinical assessment, open-ended questions are always preferred to close-ended questions. there are several advantages to the open-ended questions. 

If you still don't know What are Open-Ended Questions?

1. Open-ended questions allow patients to start talking about themselves and puts them at ease as they have the floor. 
2. Allows you time to think and plan areas of questioning as you assess their style and content of the response.
3. Allows a period of non-verbal response from interviewer; listening and facilitating. 
   
   >> Just slight info: To Have the floor means to have the right or opportunity to speak in a group, especially at a formal event or gathering. 

Please, Dr. Dunstaple, your colleague has the floor. You'll have the opportunity to reply when he has finished speaking.