ICD-11 Criteria for Disorders due to use of Dissociative Drugs Including Ketamine and Phencyclidine [PCP] (6C4D)

Disorders due to use of dissociative drugs including ketamine and phencyclidine [PCP] are characterised by the pattern and consequences of dissociative drug use. Dissociative drugs include ketamine and phencyclidine (PCP) and their (comparatively rare) chemical analogues. Ketamine is an intravenous anaesthetic widely used in low- and middle-income countries, particularly in Africa, and in emergency situations. Ketamine is also undergoing evaluation for treatment of some mental disorders (e.g., treatment resistant Depressive Disorders). It is also a widespread drug of nonmedical use in many countries and may be taken by the oral or nasal routes or injected. It produces a sense of euphoria but depending on the dose, emergent hallucinations and dissociation are recognised as unpleasant side effects. Phencyclidine has a more restricted worldwide distribution and also has euphoric and dissociative effects. Its use may result in bizarre behaviour uncharacteristic for the individual, including self-harm. Dissociative Drug Dependence is described but a withdrawal syndrome is not recognized by most authorities. Several Dissociative Drug-Induced Mental Disorders are recognised.

Exclusions:             

• Hazardous use of dissociative drugs including ketamine or PCP (QE11.7)

6C4D.0        Episode of harmful use of dissociative drugs including ketamine or PCP

An episode of use of a dissociative drug, including Ketamine and PCP, 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 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 due to intoxication with a dissociative drug, including Ketamine and PCP, on the part of the person to whom the diagnosis of single episode of harmful use applies. This diagnosis should not be made if the harm is attributed to a known pattern of use of dissociative drugs, including Ketamine and PCP.

Exclusions: 

• Dissociative drug dependence including ketamine or PCP (6C4D.2)
• Harmful pattern of use of dissociative drugs, including ketamine or PCP (6C4D.1)

6C4D.1    Harmful pattern of use of dissociative drugs, including ketamine or PCP

A pattern of use of dissociative drugs, including ketamine and phencyclidine (PCP), 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 dissociative drug 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 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 dissociative drug intoxication on the part of the person to whom the diagnosis of Harmful pattern of use of dissociative drugs, including ketamine and PCP applies.

Exclusions:

• Dissociative drug dependence including ketamine or PCP (6C4D.2)
• Episode of harmful use of dissociative drugs including ketamine or PCP (6C4D.0)

6C4D.10     Harmful pattern of use of dissociative drugs including ketamine or PCP, episodic

A pattern of episodic or intermittent use of dissociative drugs, including ketamine and phencyclidine (PCP), 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 use of dissociative drugs 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 dissociative drug intoxication on the part of the person to whom the diagnosis of Harmful pattern of use of dissociative drugs, including ketamine and PCP applies.

Exclusions:

•  Episode of harmful use of dissociative drugs including ketamine or PCP (6C4D.0)
• Dissociative drug dependence including ketamine or PCP (6C4D.2)

6C4D.11    Harmful pattern of use of dissociative drugs including ketamine or PCP, continuous

A pattern of continuous (daily or almost daily) use of dissociative drugs, including ketamine and phencyclidine (PCP), 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 use of dissociative drugs 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 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 dissociative drug intoxication on the part of the person to whom the diagnosis of Harmful pattern of use of dissociative drugs, including ketamine and PCP applies.

Exclusions: 

• Episode of harmful use of dissociative drugs including ketamine or PCP (6C4D.0)
• Dissociative drug dependence including ketamine or PCP (6C4D.2)

6C4D.1Z     Harmful pattern of use of dissociative drugs, including ketamine or PCP, unspecified

6C4D.2    Dissociative drug dependence including ketamine or PCP

Dissociative drug dependence including ketamine or PCP is a disorder of regulation of dissociative drug use arising from repeated or continuous use of dissociative drugs. The characteristic feature is a strong internal drive to use dissociative drugs, 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 dissociative drugs. The features of dependence are usually evident over a period of at least 12 months but the diagnosis may be made if dissociative drugs use is continuous (daily or almost daily) for at least 3 months.

Exclusions:

• Episode of harmful use of dissociative drugs including ketamine or PCP (6C4D.0)
• Harmful pattern of use of dissociative drugs, including ketamine or PCP (6C4D.1)

6C4D.20    Dissociative drug dependence including Ketamine or PCP, current use

Dissociative drug dependence including Ketamine and PCP, current use refers to use of dissociative drugs within the past month.

Exclusions:

• Episode of harmful use of dissociative drugs including ketamine or PCP (6C4D.0)
• Harmful pattern of use of dissociative drugs, including ketamine or PCP (6C4D.1)

6C4D.21    Dissociative drug dependence including Ketamine or PCP, early full remission

After a diagnosis of Dissociative drug dependence including Ketamine and PCP, and often following a treatment episode or other intervention (including self-help intervention), the individual has been abstinent from dissociative drugs during a period lasting from between 1 and 12 months.

Exclusions:

• Episode of harmful use of dissociative drugs including ketamine or PCP (6C4D.0)
• Harmful pattern of use of dissociative drugs, including ketamine or PCP (6C4D.1)

6C4D.22    Dissociative drug dependence including Ketamine or PCP, sustained partial remission

After a diagnosis of Dissociative drug dependence including Ketamine and PCP, and often following a treatment episode or other intervention (including self-help intervention), there is a significant reduction in dissociative drug consumption for more than 12 months, such that even though intermittent or continuing dissociative drug use has occurred during this period, the definitional requirements for dependence have not been met.

Exclusions:             

• Episode of harmful use of dissociative drugs including ketamine or PCP (6C4D.0)
• Harmful pattern of use of dissociative drugs, including ketamine or PCP (6C4D.1)

 

6C4D.23    Dissociative drug dependence including Ketamine or PCP, sustained full remission

After a diagnosis of Dissociative drug dependence including Ketamine and PCP, and often following a treatment episode or other intervention (including self-intervention), the person has been abstinent from dissociative drugs for 12 months or longer.

Exclusions: 

• Episode of harmful use of dissociative drugs including ketamine or PCP (6C4D.0)
• Harmful pattern of use of dissociative drugs, including ketamine or PCP (6C4D.1)

6C4D.2Z Dissociative drug dependence including ketamine or PCP, unspecified

6C4D.3      Dissociative drug intoxication including Ketamine or PCP

Dissociative drug intoxication including Ketamine and PCP is a clinically significant transient condition that develops during or shortly after the consumption of a dissociative drug that is characterised by disturbances in consciousness, cognition, perception, affect, behaviour, or coordination. These disturbances are caused by the known pharmacological effects of a dissociative drug and their intensity is closely related to the amount of the dissociative drug consumed. They are time-limited and abate as the dissociative drug is cleared from the body. Presenting features may include aggression, impulsiveness, unpredictability, anxiety, psychomotor agitation, impaired judgment, numbness or diminished responsiveness to pain, slurred speech, and dystonia. Physical signs include nystagmus (repetitive, uncontrolled eye movements), tachycardia, elevated blood pressure, numbness, ataxia, dysarthria, and muscle rigidity. In rare instances, use of dissociative drugs including Ketamine and PCP can result in seizures.

Coding Note:     Code aslo the causing condition

6C4D.4     Dissociative drug-induced delirium including ketamine or PCP

Dissociative drug-induced delirium including Ketamine or PCP 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 during the use of dissociative drugs. The amount and duration of dissociative drug use must be capable of producing delirium. The symptoms are not better explained by a primary mental disorder, by use of or withdrawal from a different substance, or by another health condition that is not classified under Mental, behavioural and neurodevelopmental disorders.

Coding Note:     Code aslo the causing condition

6C4D.5    Dissociative drug-induced psychotic disorder including Ketamine or PCP

Dissociative drug-induced psychotic disorder including Ketamine or PCP is characterised by psychotic symptoms (e.g., delusions, hallucinations, disorganised thinking, grossly disorganised behaviour) that develop during or soon after intoxication with dissociative drugs. The intensity or duration of the symptoms is substantially in excess of psychotic-like disturbances of perception, cognition, or behaviour that are characteristic of Dissociative drug intoxication. The amount and duration of Dissociative drug use 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 dissociative drug use, if the symptoms persist for a substantial period of time after cessation of the dissociative drug use, 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 dissociative drug use).

Coding Note:     Code aslo the causing condition

6C4D.6     Certain specified dissociative drugs -induced mental or behavioural disorders, including ketamine and phencyclidine [PCP]

Coding Note:     Code aslo the causing condition

6C4D.60    Dissociative drug-induced mood disorder including Ketamine or PCP

Dissociative drug-induced mood disorder including Ketamine or PCP 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 dissociative drugs. The intensity or duration of the symptoms is substantially in excess of mood disturbances that are characteristic of Dissociative drug intoxication. The amount and duration of Dissociative drug use 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 dissociative drug use, if the symptoms persist for a substantial period of time after cessation of the dissociative drug use, 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 dissociative drug use).

Coding Note:     Code aslo the causing condition

6C4D.61      Dissociative drug-induced anxiety disorder including Ketamine or PCP

Dissociative drug-induced anxiety disorder including Ketamine or PCP 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 dissociative drugs. The intensity or duration of the symptoms is substantially in excess of anxiety symptoms that are characteristic of Dissociative drug intoxication. The amount and duration of Dissociative drug use 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 dissociative drug use, if the symptoms persist for a substantial period of time after cessation of the dissociative drug use, 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 dissociative drug use).

Coding Note:     Code aslo the causing condition

6C4D.Y     Other specified disorders due to use of dissociative drugs including ketamine and phencyclidine [PCP]
6C4D.Z     Disorders due to use of dissociative drugs including ketamine and phencyclidine [PCP], 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/