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© 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. 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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