Friday, 27 May 2022

ICD-11 Criteria for Disorders Due to Use of Hallucinogens (6C49)

ICD-11 Criteria for Disorders Due to Use of Hallucinogens (6C49)

Disorders due to use of hallucinogens are characterised by the pattern and consequences of hallucinogen use. Several thousand compounds have hallucinogenic properties, many of which are found in plants (e.g., mescaline) and fungi (e.g., psilocybin) or are chemically synthesized (e.g., lysergic acid diethylamide [LSD]). These compounds have primarily hallucinogenic properties, but some may also be stimulants. Much of the morbidity associated with these compounds arises from the acute effects related to Hallucinogen Intoxication. Hallucinogen Dependence is rare and Hallucinogen Withdrawal is not described. Among the mental disorders related to hallucinogen use, Hallucinogen-Induced Psychotic Disorder is the most frequently seen, although worldwide it is still fairly uncommon.

6C49.0     Episode of Harmful Use of Hallucinogens

An episode of hallucinogen 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 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 hallucinogen intoxication 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 hallucinogen use.

Exclusions:

  • Hallucinogen dependence (6C49.2)
  • Harmful pattern of use of hallucinogens (6C49.1)

6C49.1     Harmful Pattern Of Use Of Hallucinogens

A pattern of use of hallucinogens 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 hallucinogen use is evident over a period of at least 12 months if substance 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 hallucinogen intoxication on the part of the person to whom the diagnosis of Harmful pattern of use of hallucinogens applies.

Exclusions:

  • Hallucinogen dependence (6C49.2)
  • Episode of harmful use of hallucinogens (6C49.0) 

6C49.10     Harmful Pattern of Use Of Hallucinogens, Episodic

A pattern of episodic or intermittent use of hallucinogens 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 hallucinogen 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 hallucinogen intoxication on the part of the person to whom the diagnosis of Harmful pattern of use of hallucinogens applies.

Exclusions:

  • Episode of harmful use of hallucinogens (6C49.0)
  • Hallucinogen dependence (6C49.2)

6C49.11     Harmful Pattern of Use of Hallucinogens, Continuous

A pattern of continuous (daily or almost daily) use of hallucinogens 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 hallucinogen 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 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 hallucinogen intoxication on the part of the person to whom the diagnosis of Harmful use of hallucinogens applies.

Exclusions:

  • Episode of harmful use of hallucinogens (6C49.0)
  • Hallucinogen dependence (6C49.2)

6C49.1Z     Harmful pattern of use of hallucinogens, unspecified

6C49.2     Hallucinogen Dependence

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

Exclusions:

  • Episode of harmful use of hallucinogens (6C49.0)
  • Harmful pattern of use of hallucinogens (6C49.1) 

6C49.20     Hallucinogen Dependence, Current Use

Current hallucinogen dependence with hallucinogen use within the past month.

Exclusions:

  • Episode of harmful use of hallucinogens (6C49.0)
  • Harmful pattern of use of hallucinogens (6C49.1)

6C49.21     Hallucinogen Dependence, Early Full Remission

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

Exclusions:

  • Episode of harmful use of hallucinogens (6C49.0)
  • Harmful pattern of use of hallucinogens (6C49.1)

6C49.22     Hallucinogen Dependence, Sustained Partial Remission

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

Exclusions:

  • Episode of harmful use of hallucinogens (6C49.0)
  • Harmful pattern of use of hallucinogens (6C49.1)

6C49.23     Hallucinogen Dependence, Sustained Full Remission

After a diagnosis of Hallucinogen dependence, and often following a treatment episode or other intervention (including self-intervention), the person has been abstinent from hallucinogens for 12 months or longer.

Exclusions:

  • Episode of harmful use of hallucinogens (6C49.0)
  • Harmful pattern of use of hallucinogens (6C49.1)

6C49.2Z     Hallucinogen Dependence, Unspecified

6C49.3     Hallucinogen Intoxication

Hallucinogen intoxication is a clinically significant transient condition that develops during or shortly after the consumption of hallucinogens that is characterised by disturbances in consciousness, cognition, perception, affect, behaviour, or coordination. These disturbances are caused by the known pharmacological effects of hallucinogens and their intensity is closely related to the amount of hallucinogen consumed. They are time-limited and abate as the hallucinogen is cleared from the body. Presenting features may include hallucinations, illusions, perceptual changes such as depersonalisation, derealization, or synesthesias (blending of senses, such as a visual stimulus evoking a smell), anxiety, depressed or dysphoric mood, ideas of reference, paranoid ideation, impaired judgment, palpitations, sweating, blurred vision, tremors and incoordination. Physical signs may include tachycardia, elevated blood pressure, and pupillary dilatation. In rare instances, hallucinogen intoxication may facilitate suicidal ideation and behaviour.

Coding Note:     Code aslo the causing condition

Exclusions:

  • Hallucinogens poisoning (NE60)
  • Possession trance disorder (6B63)

6C49.4     Hallucinogen-Induced Delirium

Hallucinogen-induced delirium 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 hallucinogens. The amount and duration of hallucinogen 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

6C49.5     Hallucinogen-Induced Psychotic Disorder

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

Coding Note:     Code aslo the causing condition

Exclusions:

  • Psychotic disorder induced by other specified psychoactive substance (6C4E.6)
  • Alcohol-induced psychotic disorder (6C40.6)

6C49.6     Certain specified hallucinogen-induced mental or behavioural disorders

Coding Note:     Code aslo the causing condition

6C49.60     Hallucinogen-Induced Mood Disorder

Hallucinogen-induced mood disorder 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 hallucinogens. The intensity or duration of the symptoms is substantially in excess of mood disturbances that are characteristic of hallucinogen intoxication. The amount and duration of hallucinogen 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 hallucinogen use, if the symptoms persist for a substantial period of time after cessation of the hallucinogen 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 hallucinogen use).

Coding Note:     Code aslo the causing condition

6C49.61     Hallucinogen-Induced Anxiety Disorder

Hallucinogen-induced anxiety disorder 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 hallucinogens. The intensity or duration of the symptoms is substantially in excess of anxiety symptoms that are characteristic of hallucinogen intoxication. The amount and duration of hallucinogen 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 hallucinogen use, if the symptoms persist for a substantial period of time after cessation of the hallucinogen 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 hallucinogen use).

Coding Note:     Code aslo the causing condition

6C49.Y     Other specified disorders due to use of hallucinogens
6C49.Z     Disorders due to use of hallucinogens, 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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