141 - 6C4Z Disorders due to substance use, unspecif

6C4Z Disorders due to substance use, unspecified

Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders Disorders due to use of other specified psychoactive substances, including medications Disorders due to use of other specified psychoactive substances, including medications, are characterized by the pattern and consequences of psychoactive substances that are not included among the major substance classes specifically identified above. Examples include khat, anabolic steroids, antidepressants, medications with anticholinergic properties (e.g. benztropine) and some antihistamines. Disorders due to use of multiple specified psychoactive substances, including medications The categories in this grouping are provided for coding purposes. However, in most clinical situations it is recommended that multiple categories from disorders due to substance use should be assigned if these can be discerned, rather than using categories from this grouping. Doing so will provide more useful information for both clinical and coding purposes. Disorders due to use of unknown or unspecified psychoactive substances These categories apply in clinical situations in which it is clear that the disturbance is due to substance use but the specific substance or class of substances is initially unknown. As more information becomes available (e.g. laboratory results, report from a collateral informant) the diagnosis should be changed to indicate the relevant substance or substance class. Disorders due to use of non-psychoactive substances Disorders due to use of non-psychoactive substances are characterized by the pattern and consequences of nonmedical use of non-psychoactive substances. Non-psychoactive substances include laxatives, growth hormone, erythropoietin and non-steroidal anti-inflammatory drugs. They may also include proprietary or over-the-counter medicines and folk remedies. Nonmedical use of these substances may be associated with harm to the individual due to the direct or secondary toxic effects of the non-psychoactive substance on body organs and systems, or a harmful route of administration (e.g. infections due to intravenous self-administration). They are not associated with intoxication or with a dependence or withdrawal syndrome, and are not recognized causes of substance-induced mental disorders. Disorders due to substance use, unspecified 6C4H 6C4E 6C4F 6C4G Disorders due to substance use or addictive behaviours | Substance classes 6C4Z

449 Disorders due to substance use or addictive behaviours Diagnostic categories that apply to the various classes of psychoactive substances Specific diagnostic categories that apply to the classes of psychoactive substances listed above are as follows: • Episode of harmful psychoactive substance use • Harmful pattern of psychoactive substance use • Substance dependence • Substance intoxication • Substance withdrawal • Substance-induced delirium • Substance-induced psychotic disorder • Substance-induced mood disorder • Substance-induced anxiety disorder • Substance-induced obsessive-compulsive or related disorder • Substance-induced impulse control disorder • Other specified disorder due to substance use • Disorder due to substance use, unspecified. Additional categories of disorders induced by psychoactive substances are included in other parts of this chapter on mental, behavioural and neurodevelopmental disorders. These categories relate to substance-induced catatonia, substance-induced amnestic disorder and substance-induced dementia. They are cross-listed in the section below on substance-induced mental disorders for reference. Note that not all possible combinations of disorder and substance class are included in the classification. For example, there is no category for substance withdrawal due to dissociative drugs, including ketamine and PCP, and no category for nicotine-induced psychotic disorder. Allowable categories by substance class for episode of harmful psychoactive substance use, harmful pattern of psychoactive substance use, substance dependence, substance intoxication and substance withdrawal are shown in Table 6.13 (p. 450). Allowable categories by substance class for substance-induced mental disorders (substance-induced delirium, substance-induced psychotic disorder, substance-induced mood disorder, substance-induced anxiety disorder, substance-induced obsessive-compulsive or related disorder and substance-induced impulse control disorder) are shown in Table 6.14 (p. 454). CDDR are provided below for each type of disorder, together with a list of applicable substance classes. Information specific to particular substance classes is also provided when applicable. The first three diagnoses listed above (episode of harmful psychoactive substance use, harmful pattern of psychoactive substance use and substance dependence) describe the use pattern of the substance. One of these three diagnoses – or disorder due to substance use, unspecified, for cases in which the use pattern in unknown at the time of evaluation – is considered to be the primary diagnosis. That is, one of these four diagnoses should be assigned when making a diagnosis of a disorder due to substance use. Diagnostic categories that apply to the various classes of psychoactive substances

Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders The remaining diagnoses reflect the impact of the substance use pattern, and are thus considered to be associated with one of the primary use pattern diagnoses. These diagnoses should therefore be assigned together with the relevant primary diagnosis. For example, 6C49.1/6C49.5 is harmful pattern of use of hallucinogens associated with hallucinogen-induced psychotic disorder, 6C43.2/6C43.70 is opioid dependence associated with opioid-induced mood disorder, and 6C4Z/6C40.3 is disorder due to substance use, unspecified, associated with alcohol intoxication (i.e. the pattern of use in this last case is unknown). Also listed in this section are categories related to hazardous substance use. These categories are not considered to be mental disorders, but may be used when the pattern of substance use appreciably increases the risk of harmful physical or mental health consequences, to the user or to others, to an extent that warrants attention and advice from health professionals, but no overt harm has yet occurred. Table 6.13. Applicable disorders due to substance use by substance class Episode of harmful psychoactive substance use Harmful pattern of psychoactive substance usea Substance dependenceb Substance intoxication Substance withdrawalc Alcohol 6C40.0 6C40.10 E 6C40.11 C 6C40.20 C 6C40.21 E 6C40.22 EF 6C40.23 SP 6C40.24 SF 6C40.3 6C40.40 U 6C40.41 PD 6C40.42 S 6C40.43 PD&S Cannabis 6C41.0 6C41.10 E 6C41.11 C 6C41.20 C 6C41.21 EF 6C41.22 SP 6C41.23 SF 6C41.3 6C41.4 Synthetic cannabinoids 6C42.0 6C42.10 E 6C42.11 C 6C42.20 C 6C42.21 EF 6C42.22 SP 6C42.23 SF 6C42.3 6C42.4 Opioids 6C43.0 6C43.10 E 6C43.11 C 6C43.20 C 6C43.21 EF 6C43.22 SP 6C43.23 SF 6C43.3 6C43.4 Diagnostic categories that apply to the various classes of psychoactive substances

451 Disorders due to substance use or addictive behaviours Episode of harmful psychoactive substance use Harmful pattern of psychoactive substance usea Substance dependenceb Substance intoxication Substance withdrawalc Sedatives, hypnotics or anxiolytics 6C44.0 6C44.10 E 6C44.11 C 6C44.20 C 6C44.21 EF 6C44.22 SP 6C44.23 SF 6C44.3 6C44.40 U 6C44.41 PD 6C44.42 S 6C44.43 PD&S Cocaine 6C45.0 6C45.10 E 6C45.11 C 6C45.20 C 6C45.21 EF 6C45.22 SP 6C45.23 SF 6C45.3 6C45.4 Stimulants, including amfetamines, methamfetamine and methcathinone 6C46.0 6C46.10 E 6C46.11 C 6C46.20 C 6C46.21 EF 6C46.22 SP 6C46.23 SF 6C46.3 6C46.4 Synthetic cathinones 6C47.0 6C47.10 E 6C47.11 C 6C47.20 C 6C47.21 EF 6C47.22 SP 6C47.23 SF 6C47.3 6C47.4 Caffeine 6C48.0 6C48.10 E 6C48.11 C N/A 6C48.2 6C48.3 Hallucinogens 6C49.0 6C49.10 E 6C49.11 C 6C49.20 C 6C49.21 EF 6C49.22 SP 6C49.23 SF 6C49.3 N/A Table 6.13. contd Diagnostic categories that apply to the various classes of psychoactive substances

Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders Episode of harmful psychoactive substance use Harmful pattern of psychoactive substance usea Substance dependenceb Substance intoxication Substance withdrawalc Nicotine 6C4A.0 6C4A.10 E 6C4A.11 C 6C4A.20 C 6C4A.21 EF 6C4A.22 SP 6C4A.23 SF 6C4A.3 6C4A.4 Volatile inhalants 6C4B.0 6C4B.10 E 6C4B.11 C 6C4B.20 C 6C4B.21 EF 6C4B.22 SP 6C4B.23 SF 6C4B.3 6C4B.4 MDMA or related drugs, including MDA 6C4C.0 6C4C.10 E 6C4C.11 C 6C4C.20 C 6C4C.21 EF 6C4C.22 SP 6C4C.23 SF 6C4C.3 6C4C.4 Dissociative drugs, including ketamine and PCP 6C4D.0 6C4D.10 E 6C4D.11 C 6C4D.20 C 6C4D.21 EF 6C4D.22 SP 6C4D.23 SF 6C4D.3 N/A Other specified 6C4E.0 6C4E.10 E 6C4E.11 C 6C4E.20 C 6C4E.21 EF 6C4E.22 SP 6C4E.23 SF 6C4E.3 6C4E.40 U 6C4E.41 PD 6C4E.42 S 6C4E.43 PD&S Multiple specified 6C4F.0 6C4F.10 E 6C4F.11 C 6C4F.20 C 6C4F.21 EF 6C4F.22 SP 6C4F.23 SF 6C4F.3 6C4F.40 U 6C4F.41 PD 6C4F.42 S 6C4F.43 PD&S Table 6.13. contd Diagnostic categories that apply to the various classes of psychoactive substances

453 Disorders due to substance use or addictive behaviours Episode of harmful psychoactive substance use Harmful pattern of psychoactive substance usea Substance dependenceb Substance intoxication Substance withdrawalc Unknown or unspecified 6C4G.0 6C4G.10 E 6C4G.11 C 6C4G.20 C 6C4G.21 EF 6C4G.22 SP 6C4G.23 SF 6C4G.3 6C4G.40 U 6C4G.41 PD 6C4G.42 S 6C4G.43 PD&S Non-psychoactive 6C4H.0 6C4H.10 E 6C4H.11 C N/A N/A N/A a E = episodic; C = continuous b E = episodic; C = continuous; EF = early full remission; SP = sustained partial remission; SF = sustained full remission c U = uncomplicated; PD = with perceptual disturbances; S = with seizures; PD&S = with perceptual disturbances and seizures Table 6.13. contd Diagnostic categories that apply to the various classes of psychoactive substances

Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders Table 6.14. Applicable substance-induced mental disorders by substance class Delirium Psychotica Mood Anxiety Obsessivecompulsive Impulse control Amnestic Dementia Alcohol 6C40.5 6C40.60 H 6C40.61 D 6C40.62 M 6C40.70 6C40.71 N/A N/A 6D72.10 6D84.0 Cannabis 6C41.5 6C41.6 6C41.70 6C41.71 N/A N/A N/A N/A Synthetic cannabinoids 6C42.5 6C42.6 6C42.70 6C42.71 N/A N/A N/A N/A Opioids 6C43.5 6C43.6 6C43.70 6C43.71 N/A N/A N/A N/A Sedatives, hypnotics or anxiolytics 6C44.5 6C44.6 6C44.70 6C44.71 N/A N/A 6D72.11 6D84.1 Cocaine 6C45.5 6C45.60 H 6C45.61 D 6C45.62 M 6C45.70 6C45.71 6C45.72 6C45.73 N/A N/A Stimulants, including amfetamines, methamfetamine and methcathinone 6C46.5 6C46.60 H 6C46.61 D 6C46.62 M 6C46.70 6C46.71 6C46.72 6C46.73 N/A N/A Synthetic cathinones 6C47.5 6C47.60 H 6C47.61 D 6C47.62 M 6C47.70 6C47.71 6C47.72 6C47.73 N/A N/A Caffeine N/A N/A N/A 6C48.40 N/A N/A N/A N/A Hallucinogens 6C49.4 6C49.5 6C49.60 6C49.61 N/A N/A N/A N/A Nicotine N/A N/A N/A N/A N/A N/A N/A N/A Volatile inhalants 6C4B.5 6C4B.6 6C4B.70 6C4B.71 N/A N/A 6D72.13 6D84.2 MDMA or related drugs, including MDA 6C4C.5 6C4C.6 6C4C.70 6C4C.71 N/A N/A N/A N/A Dissociative drugs, including ketamine and PCP 6C4D.4 6C4D.5 6C4D.60 6C4D.61 N/A N/A N/A N/A Other specified 6C4E.5 6C4E.6 6C4E.70 6C4E.71 6C4E.72 6C4E.73 6D72.12 6D84.Y Multiple specified 6C4F.5 6C4F.6 6C4F.70 6C4F.71 6C4F.72 6C4F.73 N/A N/A Unknown or unspecified 6C4G.5 6C4G.6 6C4G.70 6C4G.71 6C4G.72 6C4G.73 N/A N/A Non-psychoactive N/A N/A N/A N/A N/A N/A N/A N/A a H = with hallucinations, D = with delusions, M = with mixed psychotic symptoms Diagnostic categories that apply to the various classes of psychoactive substances