Diagnosis and Intervention – Stimulant Use Disorder (Nursing)

00:01 Unfortunately, the misuse of these medications ends up at a very high cost.

00:09 And just as all substance use disorders, there becomes the tolerance, the dependence, the seeking, and all the other symptoms that we see where the use of the stimulant becomes the primary focus of the person and replaces all other relationships.

00:28 What we see when a person is misusing stimulants is that they do runs and binging of the stimulant where they will go without sleeping for days, sometimes, almost a week which has a very bad impact on the body.

00:46 They won't be eating. They won't be drinking. They won't be sleeping.

00:50 So what is the kind of consequence that we see with the person who has a stimulant use disorder? They may become psychotic.

01:01 Psychosis is not unusual for somebody who is experiencing stimulant use disorder.

01:08 It comes from not sleeping, not eating.

01:10 You are robbing your body of incredibly important nutrients and sleep, and you are also putting something in that makes the person feel that they don't need it.

01:22 They're not missing it. It's very hard to reason with this person.

01:26 You're also going to see that euphoria that you see with most substances, but you will also see hallucinations.

01:34 Unlike opioid use disorder, where you see the pinpoint pupil, when it is stimulant use disorder, you see pupil dilation.

01:45 They will be sweating, tachycardic, they'll have hypertension, they cannot sleep, so they will present with insomnia, and with all of that, comes paranoia.

01:57 They have not been sleeping. They have not been eating.

02:00 They have not been drinking, and they have now starting to have paranoid delusions.

02:07 With stimulant use disorder, the long-term effects are devastating.

02:13 Our patients are going to feel exhausted. There's an increase likelihood for mental illness.

02:20 They will be malnourished. They may have psychosis.

02:25 It is going to have that physiological effect on their brain and cause brain damage.

02:33 Just as most substance use disorders, it affects most of your organs in your body.

02:38 So these patients are also at a very high risk for heart attack, cerebrovascular accidents like stroke and death.

02:49 One of the things that makes stimulant use disorder quite different from many of the other categories is that with stimulant use disorder, there is a heightened risk for violence, and why is that? Because this person suddenly has a lot of energy.

03:10 This person is going to present in the emergency room, and they are going to have pressured talk, they're going to be speaking very loudly.

03:16 They're going to be moving very much.

03:18 They are totally wired, and their pupils are very dilated, and they might have suicidal ideations, they might have homicidal ideations.

03:29 They may have actions that are very dangerous both to themselves, as well as to the people around them.

03:36 So we have to be really careful with these patients.

03:39 They are very mercuric in the way that they are behaving, and without sleep, having gone without sleep, we find that they really have an increased risk for this violent behavior.

03:53 The reason why these patients will go through withdrawal is because they don't have access to the desired drug, or they have done a binge, and now, it's the end of the binge and maybe they have decided, "Okay, I'm going to do this for three days. I'm going to stay high for three days.

04:14 And then I'm going to stop." But when they stop, they actually go through withdrawal.

04:19 And that is their body detoxifying from the medications.

04:25 So what are we going to be looking for in signs and symptoms for a person who has stimulant use disorder withdrawal? So they have severe, severe agitation.

04:35 They will not be eating, and then they may have some appetite changes because now as the drug is going out, they may feel hungry.

04:43 They're going to have terrible, terrible muscle aches and pains, and their anxiety is going to start building.

04:51 They're going to have cravings for their drug of choice.

04:55 You're going to find them falling into a depression.

04:59 And then they will have those mood swings, besides, they will feel elated, and then suddenly, they will start feeling depressed.

05:08 They will feel happy, and then they will feel angry.

05:11 The mood swings are fast, and they're unpredictable.

05:15 These are our patients who are going to have sleep disturbances.

05:19 They've now gone for a number of days without sleeping, without eating, without drinking any water.

05:25 And now, that medication, that drug is coming out of their body, and they are finding that they are sleeping long periods of time, or again, unable to sleep.

05:37 Very hard to get them to concentrate because their body is going through a physical withdrawal.

05:43 And if they have been taking something called meth crystals, it is very, very dangerous.

05:51 These are our patients who have a much higher likelihood to have paranoia, to be hallucinating, to have psychotic moments, and they're totally disordered thoughts.

06:03 So they kind of present almost like a patient who has schizophrenia.

06:08 But in fact, they are withdrawing from meth crystals.

06:13 So one of the things also is to understand that our patients are snorting.

06:19 They are putting it in their mouth.

06:22 They are putting it under their skin, popping it, or they are IV lining.

06:28 So if they're taking the medication in any of these numbers of ways, the difference in the route is how quick it hits their brain.

06:36 But it has, as with most substance use disorders, it has a physiological, mental and behavioral piece to it that we must be aware of.

06:47 And we must know how long, how chronic is this disease.