19
Managing Stimulant Intoxication And Withdrawal
Behavioral and Psychiatric Symptoms of Stimulant Intoxication
55. Clinicians should evaluate the patient to identify causal factors
for agitation and/or psychosis other than stimulant intoxication;
treatment should address all underlying causes (CC-S).
56. Clinicians should use verbal and nonverbal de-escalation strategies
to calm patients who are agitated, delirious, and/or psychotic to
support their cooperation with care (CC-S).
57. Clinicians can consider treating stimulant-induced agitation or
confusion with medication (H-C).
a. Benzodiazepines can be considered a first-line treatment for managing
stimulant-induced agitation and/or confusion (H-C).
58. De-escalation strategies should not delay the use of medication to
manage patients who are agitated, delirious, and/or psychotic and at
imminent risk for severe complications (H-S).
59. Clinicians should treat stimulant-induced psychotic symptoms with
an antipsychotic medication (H-S).
a. The urgency, formulation, and duration of antipsychotic pharmacotherapy
should be based on etiolog y and symptomatolog y (H-S).
b. Clinicians should avoid the use of chlorpromazine and clozapine for stimulant-
induced psychosis as these medications may place patients at increased risk for
seizures (H-S).
60. For agitation and/or psychosis that is moderate to severe or
escalating, clinicians should:
a. conduct a medical evaluation focused on identifying life-threatening medical
signs and symptoms that require referral for emergent hospital workup and
management (CC-S), and
b. conduct a mental status evaluation focused on evaluating the patient's danger
to self and others that would require immediate referral for full psychiatric
assessment and/or involuntary containment and evaluation (CC-S).
61. If agitation and/or psychosis does not respond to the setting's
available de-escalation and/or medication management
interventions, clinicians should coordinate transition to a more
intensive level of care (CC-S).
a. When possible, interventions that address agitation, confusion, delirium and/
or psychosis should be initiated while arranging for transport (CC-S).
62. Clinicians should monitor for progression of psychiatric symptoms,
breakthrough psychosis, suicidality, and emergence of trauma-
related symptoms; in particular, suicidality may increase during
waning intoxication and acute withdrawal (CC-C).
