Vignette Number SM05
Speciality:
Substance Misuse
Date:
10 October 2001
Vignette:
A 22 year old woman, 12 weeks pregnant with her first child has
been referred to your clinic for treatment of her drug dependence.
She has no previous psychiatric history, but has taken drugs for 6
years. Currently she takes heroin intravenously, temazepam and,
occasionally, smokes crack cocaine. She has been with the child's
father, who also takes drugs, for 4 years. She says she wants to
sort herself out for the sake of the baby.
How would you go about the assessment and management of this
case?
Suggested Probes:
- What are the issues with regard to her physical health?
- What thoughts would you have about the baby's safety?
- What medication is suitable for this patient?
- Full assessment for dependence on stated drugs, other drugs,
and alcohol. Counselling concerning HIV, Hepatitis C and B.
- Adopt a harm reduction approach - abstinence may be an
unrealistic target.
- Stabilisation on methadone and, if indicated, benzodiazepines
followed, if possible, by gradual reduction.
- Child protection issues. Seek advice from Social Services.
Ensure antenatal care. Awareness of risks to foetus.
- Involvement of boyfriend