242 - 6E64 Secondary obsessive compulsive or relate

6E64 Secondary obsessive-compulsive or related syndrome

665 Secondary mental or behavioural syndromes associated with disorders and diseases classified elsewhere Potentially explanatory medical conditions (examples) Brain disorders and general medical conditions that have been shown to be capable of producing anxiety syndromes include: • diseases of the nervous system (e.g. encephalitis, seizures); • diseases of the circulatory system (e.g. cardiac arrhythmia, congestive heart failure, hyperkinetic heart syndrome, mitral valve prolapse, pulmonary thromboembolis); • diseases of the ear or mastoid process (e.g. acute vestibular syndrome); • diseases of the respiratory system (e.g. asthma, chronic obstructive pulmonary disease); • endocrine, nutritional or metabolic diseases (e.g. hyperadrenalism, hypercalcaemia, hypermagnesaemia, hyperthyroidism, hypoglycaemia, hypoparathyroidism); • neoplasms (e.g. malignant phaeochromocytoma of adrenal gland, neoplasms of brain or meninges). Secondary obsessive-compulsive or related syndrome Essential (required) features • The presence of prominent symptoms that are characteristic of obsessive-compulsive and related disorders, such as obsessions, compulsions, skin picking, hair pulling or other body-focused repetitive behaviours, is required for diagnosis. • The symptoms are judged to be the direct pathophysiological consequence of a medical condition, based on evidence from 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 symptoms (e.g. onset, remission, response to treatment of the etiological medical condition) is consistent with causation by the medical condition. • The symptoms are not better accounted for by another mental disorder (e.g. an obsessivecompulsive or related disorder) or the effects of a medication or substance, including withdrawal effects. • The symptoms do not meet the diagnostic requirements for secondary tics, classified in the grouping of movement disorders in Chapter 8 on diseases of the nervous system. • The symptoms are sufficiently severe to be a specific focus of clinical attention. 6E64 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 obsessive-compulsive and related disorders Determining whether obsessive-compulsive or related 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 obsessive-compulsive or related symptoms and the temporal relationship between the medical condition and the primary obsessive-compulsive or related symptoms is critical in diagnosing secondary obsessive-compulsive or related syndrome. Secondary obsessivecompulsive or related syndrome is often characterized by clinical features that would be atypical for obsessive-compulsive and related disorders, such as late age of onset, sudden appearance of symptoms, or accompanying cognitive impairment or focal neurological signs. Boundary with obsessive-compulsive and related symptoms caused by substances or medications, including withdrawal effects When establishing a diagnosis of secondary obsessive-compulsive or related syndrome, it is important to rule out the possibility that a medication or substance is causing the obsessivecompulsive or related symptoms instead of – or in addition to – an underlying medical condition. This involves first considering whether any of the medications being used to treat the medical condition are known to cause obsessive-compulsive or related symptoms at the dose and duration at which it has been administered. Second, a temporal relationship between the medication use and the onset of the obsessive-compulsive or related symptoms should be established (i.e. the obsessive-compulsive or related symptoms began after administration of the medication and/ or remitted once the medication was discontinued). The same reasoning applies to individuals with a medical condition and obsessive-compulsive or related symptoms who are also using a psychoactive substance known to cause obsessive-compulsive or related symptoms in the context of either intoxication or withdrawal (e.g. cocaine-induced hair pulling, obsessions or compulsions due to amfetamine intoxication). In such cases, a diagnosis of a substance-induced obsessive-compulsive or related disorder should be assigned, applying the appropriate category corresponding to the substance involved. Potentially explanatory medical conditions (examples) Brain disorders and general medical conditions that have been shown to be capable of producing obsessive-compulsive or related syndromes include: • diseases of the nervous system (e.g. epilepsy, Huntington disease, myoclonic disorders, Parkinson disease, paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), secondary chorea – including chorea due to neuroacanthocytosis and McLeod syndrome, stroke); • certain infectious or parasitic diseases (e.g. rheumatic chorea (Sydenham chorea)); • endocrine, nutritional or metabolic diseases (e.g. iron overload diseases such as pantothenate-kinase-associated neurodegeneration); • injury, poisoning or certain other consequences of external causes (e.g. brain injury); • neoplasms (e.g. neoplasms of brain or meninges). Secondary mental or behavioural syndromes associated with disorders and diseases classified elsewhere