239 - 6E61 Secondary psychotic syndrome

6E61 Secondary psychotic syndrome

Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders Potentially explanatory medical conditions (examples) Brain disorders and general medical conditions that have been shown to be capable of producing long-lasting intellectual impairment, poor social functioning, learning difficulties and disruptions in attentional processes include: • diseases of the nervous system (e.g. acquired epileptic aphasia (Landau-Kleffner syndrome), autoimmune encephalitis, encephalopathy); • developmental anomalies (e.g. Rett syndrome); • diseases of the visual system (e.g. congenital blindness, vision impairment); • endocrine, nutritional or metabolic diseases (e.g. diabetes mellitus, hyper- or hypothyroidism, Lesch-Nyhan syndrome, lysosomal diseases such as neuronal ceroid, lipofuscinosis or sphingolipidosis, mucolipidosis, phenylketonuria); • injury, poisoning or certain other consequences of external causes (e.g. brain injury, concussion, traumatic haemorrhage); • neoplasms (e.g. neoplasms of brain or meninges). Brain disorders and general medical conditions that have been shown to be capable of producing long-lasting movement dysfunction or motor impairment include: • diseases of the nervous system (e.g. cerebral palsy, Huntington disease, muscular dystrophy, Parkinson disease, tardive dyskinesia); • developmental anomalies (e.g. Ehlers-Danlos syndrome, Rett syndrome); • endocrine, nutritional or metabolic diseases (e.g. Lesch-Nyhan syndrome). Secondary neurodevelopmental syndrome, unspecified Secondary psychotic syndrome Essential (required) features • The presence of prominent hallucinations and/or delusions is required for diagnosis. • The symptoms are judged to be the direct pathophysiological consequence of a medical condition, based on evidence from the history, physical examination or laboratory findings. This judgement depends on establishing the following. • The medical condition is known to be capable of producing the symptoms. • The course of the hallucinations and/or delusions (e.g. onset, remission, response of the psychotic symptoms to treatment of the etiological medical condition) is consistent with causation by the medical condition. 6E60.Z 6E61 Secondary mental or behavioural syndromes associated with disorders and diseases classified elsewhere

657 Secondary mental or behavioural syndromes associated with disorders and diseases classified elsewhere • The symptoms are not better accounted for by delirium, dementia, another mental disorder (e.g. schizophrenia or another primary psychotic disorder, a mood disorder) or the effects of a medication or substance, including withdrawal effects. • The symptoms are sufficiently severe to be a specific focus of clinical attention. Secondary psychotic syndrome, with hallucinations Essential (required) features • All diagnostic requirements for secondary psychotic syndrome are met. • The presentation is characterized by prominent hallucinations without prominent delusions. Secondary psychotic syndrome, with delusions Essential (required) features • All diagnostic requirements for secondary psychotic syndrome are met. • The presentation is characterized by prominent delusions without prominent hallucinations. Secondary psychotic syndrome, with hallucinations and delusions Essential (required) features • All diagnostic requirements for secondary psychotic syndrome are met. • The presentation is characterized by both prominent hallucinations and prominent delusions. Secondary psychotic syndrome, with unspecified symptoms 6E61.0 6E61.1 6E61.2 6E61.3 Secondary mental or behavioural syndromes associated with disorders and diseases classified elsewhere

Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders Boundaries with other disorders and conditions (differential diagnosis) Boundary with schizophrenia and other primary psychotic disorders Determining whether psychotic symptoms are due to a medical condition as opposed to manifestations of a primary mental disorder is often difficult because the clinical presentations may be similar. Establishing the presence of a potentially explanatory medical condition that can cause hallucinations or delusions and the temporal relationship between the medical condition and the psychotic symptoms is critical in diagnosing secondary psychotic syndrome. A list of medical conditions that have been reported to cause psychotic symptoms is included below (p. 659), but the strength of the association varies according to the medical condition. Secondary psychotic syndrome is often characterized by clinical features that would be atypical for a primary psychotic disorder such as later age of onset, rapid occurrence of clouding of consciousness, and accompanying cognitive, neurological or medical symptoms. In secondary psychotic syndrome, disorganized thinking (formal thought disorder) is not typically present, delusions are more often simple and fragmented, and hallucinations are more often visual, tactile, olfactory or gustatory rather than auditory. Boundary with psychotic symptoms that are precipitated by the stress of being diagnosed with a medical condition Depending on the nature of the medical condition (e.g. a life-threatening type of cancer, a potentially fatal infection) or its onset (e.g. a heart attack, a stroke, a severe injury), being diagnosed with a severe medical condition can be experienced as a traumatic event, which could trigger the development of psychotic symptoms (e.g. hallucinations and delusions) in susceptible individuals (e.g. individuals with a pre-existing psychotic disorder, a dissociative disorder or a personality disorder). If the psychotic symptoms are part of the presentation of a diagnosable mental disorder that is judged to be precipitated or exacerbated by the stress of being diagnosed or coping with a medical condition, the appropriate mental disorder (e.g. acute and transient psychotic disorder, post-traumatic stress disorder, recurrent depressive disorder) should be diagnosed rather than secondary psychotic syndrome. Boundary with delirium due to disease classified elsewhere Hallucinations or delusions can occur in the context of delirium due to disease classified elsewhere. Delirium is characterized by disturbed attention (i.e. reduced ability to direct, focus, sustain and shift attention) and awareness (i.e. reduced orientation to the environment) that develops over a short period of time and tends to fluctuate during the course of a day, accompanied by other cognitive impairments such as memory deficit, disorientation or impairment in language, visuospatial ability or perception. Disturbed attention and awareness and severe cognitive impairment are not features of secondary psychotic syndrome. If the psychotic symptoms are judged to be better explained by delirium due to disease classified elsewhere, an additional diagnosis of secondary psychotic syndrome is not warranted. Boundary with dementia Hallucinations or delusions can occur in the context of dementia, which is characterized by a decline from a previous level of cognitive functioning with impairment in two or more cognitive domains (e.g. memory, executive functions, attention, language, social cognition and judgement, psychomotor speed, visuoperceptual or visuospatial abilities). In contrast, secondary psychotic syndrome is not accompanied by marked cognitive impairment. The presence of hallucinations or delusions in the context of dementia can be recorded using the psychotic symptoms in dementia specifier. If the psychotic symptoms are judged to be due to the same medical condition as is causing the dementia, an additional diagnosis of secondary psychotic syndrome is not warranted. Secondary mental or behavioural syndromes associated with disorders and diseases classified elsewhere