Conditions
- Withdrawal from:
- alcohol
- benzodiazepines and z-drugs
- cannabis and synthetic cannabinoids
- gamma hydroxybutyrate (GHB)
- novel psychoactive substances
- opioids
- stimulants
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Presentations
- Acute intoxication
- Delirium
- Seizures
Conditions
- Co-existing medical and mental health conditions complicating withdrawal
- Psychosis in context of withdrawal
- Seizures associated with alcohol, benzodiazepine and GHB withdrawal
- Substance withdrawal with acute delirium
- Wernicke encephalopathy
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Benefits and risks associated with withdrawal, both planned and unplanned, for all substances
- Concept of neuroadaptation and the development of both acute withdrawal symptoms and protracted withdrawal
- Neurobiology and pathophysiology of alcohol and other substance withdrawal
- Prevention and management of Wernicke encephalopathy
- Relapse rates and factors in withdrawal
- Relevance of age on withdrawal management
- Risk factors for Wernicke encephalopathy
Clinical tools
- Commonly used tools to assess cognitive function, and their strengths and weaknesses
- Commonly used withdrawal assessment scales, and their strengths and weaknesses
Examinations
- Focused examinations to assess:
- cognitive impairment for Wernicke encephalopathy
- the nature and severity of withdrawal
Investigations
- Blood tests:
- biochemistry
- blood borne virus (BBV)
- haematology
- Breath alcohol meters
- ECG
- Neuroimaging
- Urine drug testing and other methods of assessing substance use
- Culturally safe withdrawal services for Aboriginal and Torres Strait Islander people and Māori
- Decision making capacity when delirium or psychosis are present
- Evidence-based management of withdrawal
- Importance of co-existing physical and mental health problems in both the evaluation of withdrawal and in determining best management
- Indications for need to involve ICU
- Potential complications of withdrawal, their prevention, and management
- Role of managed withdrawal in overall recovery
- Role of multidisciplinary input
- Suitable environments for a patient to withdraw
- Therapies tailored to patients’ concurrent medications, physiological state, and withdrawal severity
