ICD-11 Criteria for Disorders Due to Use of Multiple Specified Psychoactive Substances Including Medications (6C4F)
ICD-11 Criteria for Disorders Due to Use of Multiple Specified Psychoactive Substances Including Medications (6C4F)
Disorders due to use of multiple specified psychoactive substances, including medications are characterised by the pattern and consequences of multiple psychoactive substances. Although this grouping is provided for coding purposes, in most clinical situations it is recommended that multiple specific disorders due to substance use be assigned rather than using categories from this grouping.
6C4F.0 Episode of Harmful use of Multiple Specified Psychoactive Substances
An episode of use of multiple
specified psychoactive substances or medications that are not included in the
other substance classes specifically identified under Disorder Due to Substance
Use that has caused damage to a person’s physical or mental health or has
resulted in behaviour leading to harm to the health of others. Harm to health
of the individual occurs due to one or more of the following: (1) behaviour
related to multiple substance intoxication or psychoactive medication use (2)
direct or secondary toxic effects on body organs and systems; or (3) a harmful
route of administration. Harm to health of others includes any form of physical
harm, including trauma, or mental disorder that is directly attributable to
behaviour due to multiple substance intoxication or psychoactive medication use
on the part of the person to whom the diagnosis of single episode of harmful use
of multiple specified psychoactive substances applies. This diagnosis should
not be made if the harm is attributed to a known pattern of use of the multiple
psychoactive substances.
Exclusions:
- Harmful pattern of use of multiple specified psychoactive substances (6C4F.1)
- Multiple specified psychoactive substances dependence (6C4F.2)
6C4F.1 Harmful Pattern of use of Multiple Specified Psychoactive Substances
A pattern of use of a multiple
specified psychoactive substances or medications that are not included in the
other substance classes specifically identified under Disorders Due to
Substance Use that has caused damage to a person’s physical or mental health or
has resulted in behaviour leading to harm to the health of others. The pattern
of substance use is evident over a period of at least 12 months if use is
episodic or at least one month if use is continuous (i.e., daily or almost
daily). Harm to health of the individual occurs due to one or more of the
following: (1) behaviour related to multiple substance intoxication or
psychoactive medication use; (2) direct or secondary toxic effects on body
organs and systems; or (3) a harmful route of administration. Harm to health of
others includes any form of physical harm, including trauma, or mental disorder
that is directly attributable to behaviour related to multiple substance
intoxication or psychoactive medication use on the part of the person to whom
the diagnosis of Harmful pattern of use of multiple specified psychoactive
substances applies.
Exclusions:
- Episode of harmful use of multiple specified psychoactive substances (6C4F.0)
- Multiple specified psychoactive substances dependence (6C4F.2)
6C4F.10 Harmful Pattern of use of Multiple Specified Psychoactive Substances, Episodic
A pattern of episodic or
intermittent use of a specified psychoactive substance or medication that is
not included in the other substance classes specifically identified under
Disorders Due to Substance Use that has caused damage to a person’s physical or
mental health or has resulted in behaviour leading to harm to the health of
others. The pattern of episodic substance use is evident over a period of at
least 12 months. Harm to health of the individual occurs due to one or more of
the following: (1) behaviour related to intoxication; (2) direct or secondary
toxic effects on body organs and systems; or (3) a harmful route of
administration. Harm to health of others includes any form of physical harm,
including trauma, or mental disorder that is directly attributable to behaviour
related to intoxication due to the specified substance or medication on the
part of the person to whom the diagnosis of Harmful pattern of use of other
specified psychoactive substance applies.
Exclusions:
- Episode of harmful use of multiple specified psychoactive substances (6C4F.0)
- Multiple specified psychoactive substances dependence (6C4F.2)
6C4F.11 Harmful Pattern of use of Multiple Specified Psychoactive Substances, Continuous
A pattern of continuous (daily or
almost daily) use of a multiple specified psychoactive substance or medication
that is not included in the other substance classes specifically identified
under Disorders Due to Substance Use that has caused damage to a person’s
physical or mental health or has resulted in behaviour leading to harm to the
health of others. The pattern of continuous substance use is evident over a
period of at least one month. Harm to health of the individual occurs due to
one or more of the following: (1) behaviour related to multiple substance
intoxication or psychoactive medication use; (2) direct or secondary toxic
effects on body organs and systems; or (3) a harmful route of administration.
Harm to health of others includes any form of physical harm, including trauma,
or mental disorder that is directly attributable to behaviour related to
multiple substance intoxication or psychoactive medication use on the part of
the person to whom the diagnosis of Harmful pattern of multiple specified
psychoactive substances applies.
Exclusions:
- Episode of harmful use of multiple specified psychoactive substances (6C4F.0)
- Multiple specified psychoactive substances dependence (6C4F.2)
6C4F.1Z Harmful pattern of use of multiple specified psychoactive substances, unspecified
6C4F.2 Multiple Specified Psychoactive Substances Dependence
Multiple specified psychoactive
substance dependence is a disorder of regulation of use of multiple specified
substances arising from repeated or continuous use of the specified substances.
The characteristic feature is a strong internal drive to use the specified
substances, which is manifested by impaired ability to control use, increasing
priority given to use over other activities and persistence of use despite harm
or negative consequences. These experiences are often accompanied by a
subjective sensation of urge or craving to use the specified substances.
Physiological features of dependence may also be present, including tolerance
to the effects of the specified substances, withdrawal symptoms following
cessation or reduction in use of the specified substances, or repeated use of
the specified substances or pharmacologically similar substances to prevent or
alleviate withdrawal symptoms. The features of dependence are usually evident
over a period of at least 12 months but the diagnosis may be made if use of the
specified substances is continuous (daily or almost daily) for at least 3
months.
Exclusions:
- Episode of harmful use of multiple specified psychoactive substances (6C4F.0)
- Harmful pattern of use of multiple specified psychoactive substances (6C4F.1)
6C4F.20 Multiple Specified Psychoactive Substances Dependence, Current use
Exclusions:
- Episode of harmful use of multiple specified psychoactive substances (6C4F.0)
- Harmful pattern of use of multiple specified psychoactive substances (6C4F.1)
6C4F.21 Multiple Specified Psychoactive Substances Dependence, Early Full Remission
Exclusions:
- Episode of harmful use of multiple specified psychoactive substances (6C4F.0)
- Harmful pattern of use of multiple specified psychoactive substances (6C4F.1)
6C4F.22 Multiple Specified Psychoactive Substances Dependence, Sustained Partial Remission
Exclusions:
- Episode of harmful use of multiple specified psychoactive substances (6C4F.0)
- Harmful pattern of use of multiple specified psychoactive substances (6C4F.1)
6C4F.23 Multiple Specified Psychoactive Substances Dependence, Sustained full Remission
Exclusions:
- Episode of harmful use of multiple specified psychoactive substances (6C4F.0)
- Harmful pattern of use of multiple specified psychoactive substances (6C4F.1)
6C4F.2Z Multiple Specified Psychoactive Substances Dependence, Unspecified
6C4F.3 Intoxication due to Multiple Specified Psychoactive Substances
Intoxication due to multiple
specified psychoactive substances is a clinically significant transient
condition that develops during or shortly after the consumption of multiple
specified substances or medications that is characterised by disturbances in
consciousness, cognition, perception, affect, behaviour, or coordination. These
disturbances are caused by the known pharmacological effects of the multiple
specified psychoactive substances and their intensity is closely related to the
amount of the substances consumed. They are time-limited and abate as the
multiple specified substances are cleared from the body.
Coding Note: Code aslo the causing condition
6C4F.4 Multiple Specified Psychoactive Substances Withdrawal
Multiple specified psychoactive
substance withdrawal is a clinically significant cluster of symptoms,
behaviours and physiological features, varying in degree of severity and
duration, that occurs upon cessation or reduction of use of multiple specified
substances in individuals who have developed dependence or have used the
specified substances for a prolonged period or in large amounts. Multiple
specified psychoactive substance withdrawal can also occur when prescribed
psychoactive medications have been used in standard therapeutic doses. The
specific features of the withdrawal state depend on the pharmacological
properties of the specified substances and their interactions.
Coding Note: Code aslo the causing condition
6C4F.40 Multiple specified psychoactive substances withdrawal, uncomplicated
Coding Note: Code aslo the causing condition
6C4F.41 Multiple specified psychoactive substances withdrawal, with perceptual disturbances
Coding Note: Code aslo the causing condition
6C4F.42 Multiple specified psychoactive substances withdrawal, with seizures
Coding Note: Code aslo the causing condition
6C4F.43 Multiple specified psychoactive substances withdrawal, with perceptual disturbances and seizures
Coding Note: Code aslo the causing condition
6C4F.4Y Other specified multiple specified psychoactive substances withdrawal
Coding Note: Code aslo the causing condition
6C4F.4Z Multiple specified psychoactive substances withdrawal, unspecified
Coding Note: Code aslo the causing condition
6C4F.5 Delirium induced by multiple specified psychoactive substances including medications
Delirium induced by multiple
specified psychoactive substances is characterised by an acute state of
disturbed attention and awareness with specific features of delirium that
develops during or soon after substance intoxication or withdrawal or during
the use of multiple specified substances. The amount and duration of use of the
multiple specified substances must be capable of producing delirium. The
symptoms are not better explained by a primary mental disorder, by use of or
withdrawal from a substance other than those specified, or by another health condition
that is not classified under Mental, behavioural and neurodevelopmental
disorders. Note that this diagnosis applies only to those situations in which
delirium is present but it cannot be determined which of multiple psychoactive
substances is the cause of the delirium. In cases of multiple psychoactive
substance use in which more than one specific substance can be identified as a
cause of the delirium, the corresponding specific substance-induced delirium
diagnoses should be given instead.
Coding Note: Code aslo the causing condition
6C4F.6 Psychotic Disorder Induced by Multiple Specified Psychoactive Substances
Psychotic disorder induced by
multiple specified psychoactive substances is characterised by psychotic
symptoms (e.g., delusions, hallucinations, disorganised thinking, grossly
disorganised behaviour) that develop during or soon after intoxication with or
withdrawal from multiple specified psychoactive substances. The intensity or
duration of the symptoms is substantially in excess of psychotic-like
disturbances of perception, cognition, or behaviour that are characteristic of
intoxication with or withdrawal from multiple specified psychoactive
substances. The amount and duration of use of the multiple specified
psychoactive substances must be capable of producing psychotic symptoms. The
symptoms are not better explained by a primary mental disorder (e.g.,
Schizophrenia, a Mood disorder with psychotic symptoms), as might be the case
if the psychotic symptoms preceded the onset of the use of the multiple
specified psychoactive substances, if the symptoms persist for a substantial
period of time after cessation of the use of the multiple specified
psychoactive substances or withdrawal from the multiple specified psychoactive
substances, or if there is other evidence of a pre-existing primary mental
disorder with psychotic symptoms (e.g., a history of prior episodes not
associated with the use of the multiple specified psychoactive substances).
Coding Note: Code aslo the causing condition
6C4F.7 Certain multiple specified psychoactive substances-induced mental or behavioural disorders
Coding Note: Code aslo the causing condition
6C4F.70 Mood Disorder Induced by Multiple Specified Psychoactive Substances
Mood disorder induced by multiple
specified psychoactive substances is characterised by mood symptoms (e.g.,
depressed or elevated mood, decreased engagement in pleasurable activities,
increased or decreased energy levels) that develop during or soon after
intoxication with or withdrawal from multiple specified psychoactive
substances. The intensity or duration of the symptoms is substantially in
excess of mood disturbances that are characteristic of intoxication with or
withdrawal from multiple specified psychoactive substances. The amount and
duration of use of the multiple specified psychoactive substances must be
capable of producing mood symptoms. The symptoms are not better explained by a
primary mental disorder (e.g., a Depressive disorder, a Bipolar disorder,
Schizoaffective disorder), as might be the case if the mood symptoms preceded
the onset of the use of the multiple specified psychoactive substances, if the
symptoms persist for a substantial period of time after cessation of the use of
the multiple specified psychoactive substances or withdrawal from the multiple
specified psychoactive substances, or if there is other evidence of a
pre-existing primary mental disorder with mood symptoms (e.g., a history of
prior episodes not associated with the use of the multiple specified
psychoactive substances).
Coding Note: Code aslo the causing condition
6C4F.71 Anxiety Disorder Induced by Multiple Specified Psychoactive Substances
Anxiety disorder induced by
multiple specified psychoactive substances is characterised by anxiety symptoms
(e.g., apprehension or worry, fear, physiological symptoms of excessive
autonomic arousal, avoidance behaviour) that develop during or soon after
intoxication with or withdrawal from multiple specified psychoactive
substances. The intensity or duration of the symptoms is substantially in
excess of anxiety symptoms that are characteristic of intoxication with or
withdrawal from multiple specified psychoactive substances. The amount and
duration of use of the multiple specified psychoactive substances must be
capable of producing anxiety symptoms. The symptoms are not better explained by
a primary mental disorder (e.g., an Anxiety and fear-related disorder, a
Depressive disorder with prominent anxiety symptoms), as might be the case if
the anxiety symptoms preceded the onset of the use of the multiple specified
psychoactive substances, if the symptoms persist for a substantial period of
time after cessation of the use of the multiple specified psychoactive
substances or withdrawal from the multiple specified psychoactive substances,
or if there is other evidence of a pre-existing primary mental disorder with
anxiety symptoms (e.g., a history of prior episodes not associated with the use
of the multiple specified psychoactive substances).
Coding Note: Code aslo the causing condition
6C4F.72 Obsessive-Compulsive or Related Disorder Induced by Multiple Specified Psychoactive Substances
Obsessive-compulsive or related
disorder induced by multiple specified psychoactive substances is characterised
by either repetitive intrusive thoughts or preoccupations, normally associated
with anxiety and typically accompanied by repetitive behaviours performed in
response, or by recurrent and habitual actions directed at the integument
(e.g., hair pulling, skin picking) that develop during or soon after
intoxication with or withdrawal from multiple specified psychoactive
substances. The intensity or duration of the symptoms is substantially in
excess of analogous disturbances that are characteristic of intoxication with
or withdrawal from the multiple specified psychoactive substances. The amount
and duration of the multiple specified psychoactive substances use must be
capable of producing obsessive-compulsive or related symptoms. The symptoms are
not better explained by a primary mental disorder (in particular an
Obsessive-compulsive or related disorder), as might be the case if the symptoms
preceded the onset of the use of multiple specified psychoactive substances, if
the symptoms persist for a substantial period of time after cessation of the multiple
specified psychoactive substance use or withdrawal, or if there is other
evidence of a pre-existing primary mental disorder with obsessive-compulsive or
related symptoms (e.g., a history of prior episodes not associated with
multiple specified psychoactive substances use).
Coding Note: Code aslo the causing condition
6C4F.73 Impulse Control Syndrome Induced by Multiple Specified Psychoactive Substances
Impulse control disorder induced
by multiple specified psychoactive substances is characterised by persistently
repeated behaviours in which there is recurrent failure to resist an impulse,
drive, or urge to perform an act that is rewarding to the person, at least in
the short-term, despite longer-term harm either to the individual or to others
(e.g., fire setting or stealing without apparent motive, repetitive sexual
behaviour, aggressive outbursts) that develop during or soon after intoxication
with or withdrawal from multiple specified psychoactive substances. The
intensity or duration of the symptoms is substantially in excess of
disturbances of impulse control that are characteristic of intoxication with or
withdrawal from the multiple specified psychoactive substances. The amount and
duration of the multiple specified psychoactive substances use must be capable
of producing disturbances of impulse control. The symptoms are not better
explained by a primary mental disorder (e.g., an Impulse control disorder, a
Disorder due to addictive behaviours), as might be the case if the impulse
control disturbances preceded the onset of the use of multiple specified
psychoactive substances, if the symptoms persist for a substantial period of
time after cessation of the multiple specified psychoactive substance use or
withdrawal, or if there is other evidence of a pre-existing primary mental
disorder with impulse control symptoms (e.g., a history of prior episodes not
associated with multiple specified psychoactive substances use).
Coding Note: Code aslo the causing condition
6C4F.Y Other
specified disorders due to use of multiple specified psychoactive substances,
including medications
6C4F.Z Disorders
due to use of multiple specified psychoactive substances, including
medications, unspecified
REFERENCE:
International Classification of Diseases Eleventh Revision (ICD-11). Geneva: World Health Organization; 2022. License: CC BY-ND 3.0 IGO.
https://creativecommons.org/licenses/by-nc-nd/3.0/igo/
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