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