© 2005 By Robert R. Perkinson, Ph.D.

 

Patient Name _____________________ BP _____ Pulse ____ Res _____Temp ______

Amphetamine Withdrawal Scale Score _____________________ Date _______

______________________________________

AGITATION-Observation

0         Normal activity

1         Somewhat more than normal activity

2

3

4      Moderately fidgety and restless

5

6

7      Paces back and forth or constantly thrashes about

_______________________________________

SWEATING Observation

0        No sweat visible

1        Palms moist

2

3

4        Beads of sweat on forehead

5

6

7        Drenching sweats

_______________________________________

ANXIETY-Ask “Do you feel nervous or

                afraid?” Observation

0              No anxiety, calm and tranquil

1              Mildly anxious

2

3

4    Moderately anxious, defensive or guarded.

5

6

7    Severely anxious, equivalent to panic

_______________________________________

PARANOIA-Ask “Do you feel people are paying special attention to you? Do you feel anyone is out to get you or give you a hard time?

0    No paranoia

1    Mildly suspicious

2

3

4    Moderately paranoid or suspicious.

5

6

7    Severely paranoid with delusions of persecution

____________________________________________

CRAVING-Ask “Are you craving drugs or alcohol?

0    No craving

1    Mild or occasionally thinking about drug use

2

3

4    Moderate craving drug use throughout the day.

5

6

7    Severe can’t stop craving.


 

____________________________________________

DEPRESSION Ask “Do you feel sad or depressed? ”If yes, “On a scale of one to seven how depressed do you feel?”

0    None

1    Mild depression

2

3

4    Moderate depressed most of the day

5

6

7    Severe depressed all day every day.

____________________________________________

TACTILE DISTURBANCES-Ask “Have you had any itching or burning or do you feel bugs crawling on or under your skin?”

0    Not present

1    Mile itching burning or pins and needles

2   

3    Moderate itching burning or pins and needles

4    Moderately severe hallucinations

5

6

7    Continuous hallucinations

____________________________________________

AUDITORY DISTURBANCES Ask “Do sounds seem too loud or harsh? Do they frighten you? Are you hearing things that are not there?”

0    Not present

1    Very mild harshness or ability to frighten

2    Mild harshness or ability to frighten

3    Moderate harshness or ability to frighten

4    Moderate hallucinations

5    Severe hallucinations

6    Extremely severe hallucinations

7    Continuous hallucinations

____________________________________________

VISUAL DISTURBANCES Ask “Does the light appear to be too bright? Does it hurt your eyes? Are you seeing things that are not there?”

0    Not present

1    Very mild sensitivity

2    Mild sensitivity

3    Moderate sensitivity

4    Moderate hallucinations

5    Severe hallucinations

6    Extremely severe hallucinations

7    Continuous hallucinations

____________________________________________

ORIENTATION Ask “What day is this? Where are you? Who am I? What is your name?”

0    Oriented

1    Uncertain about date

2    Disoriented by date by no more than 2 days

3    Disoriented to date by more than 2 days

4    Disoriented to place and/or person

 

Scores:

0-8   = indicates mild withdrawal

8-20 = indicates moderate withdrawal

20+  = indicates severe withdrawal

 

Observation of over 1000 amphetamine addicts indicates acute withdrawal usually lasts 7-15 days.

 

Physicians can use benzodiazepines and antipsychotics to modulate withdrawal symptoms

 

Copyright © 2005 Robert R. Perkinson, Ph.D.

All rights reserved.

Copyright © 2005 [www.robertperkinson.com]. All rights reserved.
Revised: July 03, 2009.

For permission to copy contact: Dr. Robert R. Perkinson

                                                     P.O. Box 159

                                                     1010 East Second Street

                                                     Canton, SD  57013

                                                     (605) 987-2872

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