245 - 6E67 Secondary neurocognitive syndrome

6E67 Secondary neurocognitive syndrome

Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders context of either intoxication or withdrawal (e.g. compulsive sexual behaviour due to cocaine intoxication, aggressive outburst due to methamfetamine intoxication). In such cases, substanceinduced impulse control disorder is the appropriate diagnosis, 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 impulse control syndromes include: • diseases of the nervous system (e.g. encephalitis, seizures, stroke, Klüver–Bucy syndrome); • developmental anomalies (e.g. male with double or multiple Y [xyy syndrome]); • endocrine diseases; • injury, poisoning or certain other consequences of external causes (e.g. intracranial injury); • neoplasms (e.g. neoplasms of brain). Secondary neurocognitive syndrome Essential (required) features • The presence of deficits in neurocognitive functioning that do not meet the diagnostic requirements for delirium, mild neurocognitive disorder, amnestic disorder or dementia, and do not have their onset during the developmental period, is required for diagnosis. • The neurocognitive symptoms are judged to be the direct pathophysiological consequence of a medical condition, based on evidence from the history, physical examination or laboratory findings (as opposed to being a psychological reaction to having the medical condition). This judgement depends on establishing the following. • The medical condition is known to be capable of producing the symptoms. • The course of the deficits in neurocognitive functioning (e.g. onset, remission, response to treatment of the etiological medical condition) is consistent with causation by the medical condition. • The symptoms are not judged to be better explained by disturbance of consciousness or altered mental status (e.g. due to seizure, traumatic brain injury, stroke or the effects of medication), a neurodevelopmental disorder, another mental disorder (e.g. schizophrenia or another primary psychotic disorder, a mood disorder, post-traumatic stress disorder, a dissociative disorder) or the effects of a medication or substance, including withdrawal effects. • The symptoms are of short duration (e.g. less than 1 month), and it is expected that the neurocognitive symptoms will remit with treatment of the etiological medical condition. • The symptoms are sufficiently severe to be a specific focus of clinical attention. 6E67 Secondary mental or behavioural syndromes associated with disorders and diseases classified elsewhere

671 Secondary mental or behavioural syndromes associated with disorders and diseases classified elsewhere Boundaries with other disorders and conditions (differential diagnosis) Boundary with neurocognitive disorders Delirium, mild neurocognitive disorder, amnestic disorder and dementia can all be caused by medical conditions classified elsewhere. If the presentation meets the diagnostic requirements for any of these neurocognitive disorders, that diagnosis should be assigned rather than secondary neurocognitive syndrome. If the presence of a specific etiological medical condition has not been established, a diagnosis of other specified neurocognitive disorder should be assigned. Boundary with disorders of intellectual development Presentations that meet the diagnostic requirements for disorder of intellectual development and are judged to be the direct pathophysiological consequence of a medical condition are not diagnosed as secondary neurocognitive syndrome because, by convention, disorders of intellectual development are diagnosed regardless of etiology. In these cases, disorder of intellectual development and the underlying medical condition should be diagnosed, and a diagnosis of secondary neurocognitive syndrome is not assigned. Boundary with secondary neurodevelopmental syndrome Secondary neurodevelopmental syndrome may also be characterized by cognitive impairment that is judged to be due to a medical condition. If the cognitive impairment has its onset during the developmental period, the appropriate diagnosis is secondary neurodevelopmental syndrome rather than secondary neurocognitive syndrome. Boundary with other mental disorders that may be associated with cognitive impairment Deficits in cognitive functioning may be a presenting or associated feature of a variety of mental disorders (e.g. developmental speech or language disorders, developmental learning disorders, schizophrenia or other primary psychotic disorders, mood disorders). Secondary neurocognitive syndrome should be diagnosed only if a medical condition has been identified that is judged to be the direct physiological cause of the neurocognitive impairment. Boundary with deficits in cognitive functioning caused by substances or medications, including withdrawal effects When establishing a diagnosis of secondary neurocognitive syndrome, it is important to rule out the possibility that a medication or substance is causing the deficits in neurocognitive functioning 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 deficits in cognitive functioning at the dose and duration at which it has been administered. Second, a temporal relationship between the medication use and the onset of the deficits in neurocognitive functioning should be established (i.e. deficits in neurocognitive functioning began after administration of the medication and/or remitted once the medication was discontinued). The same reasoning applies to individuals with a medical condition who are using a psychoactive substance known to cause deficits in neurocognitive functioning (e.g. memory loss due to sedative intoxication, disturbed attention/concentration and orientation due to alcohol intoxication). In such cases, delirium, amnestic disorder or dementia due to psychoactive substances (including medications) or mild neurocognitive disorder is the appropriate diagnosis, applying the appropriate category corresponding to the substance involved. Secondary mental or behavioural syndromes associated with disorders and diseases classified elsewhere