Stimulant intoxication and withdrawal — structured clinical viva

This is an acute dual-diagnosis and toxicology viva, not a pure chronic addiction counselling station. Clear consciousness with persecutory delusions and formication after a multi-day ice binge favours MAP / substance-induced psychosis temporally linked to use, with dual formulation held open if symptoms persist after abstinence. Partner pressure for lifelong schizophrenia label is a classic trap — use timeline, collateral, and planned review rather than day-one diagnostic fatalism.^[3]

Medical surveillance remains active even with T 37.9°C: serial vitals, ECG already done, watch for rising fever, chest pain, CK, agitation escalating to excited delirium-type risk. Behavioural ladder first; time-limited antipsychotic if psychosis is dangerous or impairing, with early review (NMA efficacy signals for MAP antipsychotics).^[4]

Craving "like methadone" must be answered honestly: ASAM/AAAP — psychosocial first-line; no FDA-approved anti-craving/substitution standard analogous to OAT. You may mention selected trial signals (e.g. ADAPT-2 XR-naltrexone 380 mg IM every 3 weeks + bupropion XL 450 mg daily; mirtazapine 30 mg nocte in selected trials) as specialist discussions after acute stabilisation — not as ED methadone-equivalent starts.^[1][5]

Crash plan: McGregor time course — early hypersomnia/fatigue, peak dysphoria ~day 2, improvement over 1–2 weeks — with explicit suicide monitoring and AOD follow-up. Name contingency management as the highest-yield psychosocial modality for ongoing stimulant use reduction.^[2][6]

Legal status: assess risk and capacity; use jurisdiction-appropriate least-restrictive options if danger persists — do not invent section numbers for the wrong country. ^[1]