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
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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