Stimulant and methamphetamine use — structured clinical viva

Assessment spine. Medical first: BP/HR already abnormal — ECG, consider troponin if chest symptoms, temperature, glucose, CK; exclude evolving ACS and other medical crises. Substance timeline (route, binge length, last use, polysubstance), MSE with examples, risk (violence, suicide as she crashes), capacity/legal principles, collateral, dual-diagnosis screen.^[1][4]

"Schizophrenia forever?" Working diagnosis: methamphetamine-associated psychosis with clear consciousness. Dose-related psychotic symptoms are recognised. Label evolves with abstinence course; treat now; avoid fatalism and avoid complacency.^[1]

"Tablet like methadone?" Honest answer: no licensed methadone-equivalent standard for methamphetamine. Psychosocial treatments are first-line. Selected options (mirtazapine 30 mg nocte in trials; naltrexone XR 380 mg IM q3 weeks + bupropion XL 450 mg daily in ADAPT-2) may be considered in specialist contexts — not universal cure pills.^[1][2]

"Dangerous fits when she stops?" Withdrawal typically features crash and dysphoria peaking around day 2, improving over 1–2 weeks — not alcohol-like seizure syndrome as the defining threat. Still plan for suicide risk and CV complications of use itself.^[3][4]

"What works?" Contingency management, CBT/CRA/Matrix multi-element care, harm reduction, integrated dual diagnosis, short-course antipsychotic if dangerous psychosis persists, housing and sexual health. Name CM specifically.^[5]