ICD-11 Criteria for Disorders Due to use of Synthetic Cathinones (6C47 )
Disorders due to use of synthetic cathinones are characterised by the pattern and consequences of synthetic cathinone use. Synthetic cathinones (also known as ‘bath salts’) are synthetic compounds with stimulant properties related to cathinone found in the khat plant, Catha edulis. The use of synthetic cathinones is common in young populations in many countries. They may produce a range of disorders including Synthetic Cathinone Intoxication, Synthetic Cathinone Dependence and Synthetic Cathinone Withdrawal. Several synthetic cathinone-induced mental disorders are recognised.
6C47.0 Episode of Harmful Use of Synthetic Cathinones
An episode of synthetic cathinone 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 synthetic cathinone 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 synthetic cathinone
use.
Exclusions:
·
Harmful pattern of use of
synthetic cathinones (6C47.1)
·
Synthetic cathinone dependence
(6C47.2)
6C47.1 Harmful Pattern of Use of Synthetic Cathinones
A pattern of use of synthetic cathinones 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 synthetic cathinone 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 synthetic cathinone intoxication on the
part of the person to whom the diagnosis of Harmful pattern of use of synthetic
cathinones applies.
Exclusions:
·
Episode of harmful use of
synthetic cathinones (6C47.0)
·
Synthetic cathinone
dependence (6C47.2)
6C47.10 Harmful Pattern Of Use Of Synthetic
Cathinones, Episodic
A pattern of episodic or intermittent use of synthetic cathinones 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
synthetic cathinone 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 synthetic
cathinone intoxication on the part of the person to whom the diagnosis of
Harmful pattern of use of synthetic cathinones applies.
Exclusions:
·
Episode of harmful use of
synthetic cathinones (6C47.0)
·
Synthetic cathinone
dependence (6C47.2)
6C47.11 Harmful Use of Synthetic Cathinones, Continuous
A pattern of continuous (daily or almost daily) use of synthetic
cathinones 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 synthetic cathinone 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 synthetic
cathinone intoxication on the part of the person to whom the diagnosis of
Harmful use of synthetic cathinones applies.
Exclusions:
·
Episode of harmful use of
synthetic cathinones (6C47.0)
·
Synthetic cathinone
dependence (6C47.2)
6C47.1Y Other specified harmful pattern of use of
synthetic cathinones
6C47.2 Synthetic Cathinone Dependence
Synthetic cathinone dependence is a disorder of regulation of synthetic
cathinone use arising from repeated or continuous use of synthetic cathinones.
The characteristic feature is a strong internal drive to use synthetic
cathinones, 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 synthetic cathinones. Physiological
features of dependence may also be present, including tolerance to the effects
of synthetic cathinones, withdrawal symptoms following cessation or reduction
in use of synthetic cathinone, or repeated use of synthetic cathinones 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 synthetic cathinone use is
continuous (daily or almost daily) for at least 3 months.
Exclusions:
·
Harmful pattern of use of
synthetic cathinones (6C47.1)
·
Episode of harmful use of
synthetic cathinones (6C47.0)
6C47.20 Synthetic Cathinone Dependence, Current
Use
Current synthetic cathinone dependence with use of synthetic cathinones
within the past month.
Exclusions:
·
Episode of harmful use of
synthetic cathinones (6C47.0)
·
Harmful pattern of use of
synthetic cathinones (6C47.1)
6C47.21 Synthetic cathinone dependence, early
full remission
After a diagnosis of synthetic cathinone dependence, and often following
a treatment episode or other intervention (including self-help intervention),
the individual has been abstinent from synthetic cathinone use during a period
lasting from between 1 and 12 months.
Exclusions:
·
Episode of harmful use of
synthetic cathinones (6C47.0)
·
Harmful pattern of use of
synthetic cathinones (6C47.1)
6C47.22 Synthetic Cathinone Dependence, Sustained
Partial Remission
After a diagnosis of synthetic cathinone dependence, and often following
a treatment episode or other intervention (including self-help intervention),
there is a significant reduction in synthetic cathinone consumption for more
than 12 months, such that even though synthetic cathinone use has occurred
during this period, the definitional requirements for dependence have not been
met.
Exclusions
·
Episode of harmful use of
synthetic cathinones (6C47.0)
·
Harmful pattern of use of
synthetic cathinones (6C47.1)
6C47.23 Synthetic Cathinone Dependence, Sustained
Full Remission
After a diagnosis of synthetic cathinone dependence, and often following
a treatment episode or other intervention (including self-intervention), the
person has been abstinent from synthetic cathinone use for 12 months or longer.
Exclusions
· Episode of harmful use of synthetic cathinones (6C47.0)· Harmful pattern of use of synthetic cathinones (6C47.1)
6C47.2Y Other Specified Synthetic Cathinone
Dependence
6C47.3 Synthetic Cathinone Intoxication
Synthetic cathinone intoxication is a clinically significant transient
condition that develops during or shortly after the consumption of synthetic
cathinones that is characterised by disturbances in consciousness, cognition,
perception, affect, behaviour, or coordination. These disturbances are caused
by the known pharmacological effects of synthetic cathinones and their
intensity is closely related to the amount of synthetic cathinones consumed.
They are time-limited and abate as the synthetic cathinone is cleared from the
body. Presenting features may include anxiety, anger, impaired attention,
hypervigilance, psychomotor agitation, paranoid ideation (possibly of
delusional intensity), transient auditory hallucinations, transitory confusion,
and changes in sociability. Perspiration or chills, nausea or vomiting, and
palpitations may be experienced. Physical signs may include tachycardia,
elevated blood pressure, pupillary dilatation, dyskinesias and dystonias, and
skin sores. In rare instances, usually in severe intoxication, use of synthetic
cathinones can result in seizures.
Coding Note: Code aslo the causing condition
6C47.4 Synthetic Cathinone Withdrawal
Synthetic cathinone withdrawal is a clinically significant cluster of
symptoms, behaviours and/or physiological features, varying in degree of
severity and duration, that occurs upon cessation or reduction of use of
synthetic cathinones in individuals who have developed Synthetic cathinone
dependence or have used synthetic cathinones for a prolonged period or in large
amounts. Presenting features of Synthetic cathinone withdrawal may include
dysphoric mood, irritability, fatigue, insomnia or (more commonly) hypersomnia,
vivid and unpleasant dreams, increased appetite, psychomotor agitation or
retardation, and craving for stimulants, including synthetic cathinones.
Coding Note: Code aslo the causing condition
6C47.5 Synthetic Cathinone-Induced
Delirium
Synthetic cathinone-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 withdrawal or during
the use of synthetic cathinones. The amount and duration of synthetic cathinone
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
6C47.6 Synthetic Cathinone-Induced
Psychotic Disorder
Synthetic cathinone-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 or withdrawal from synthetic cathinones. The intensity or duration of the
symptoms is substantially in excess of psychotic-like disturbances of
perception, cognition, or behaviour that are characteristic of Synthetic
cathinone intoxication or Synthetic cathinone withdrawal. The amount and
duration of synthetic cathinone 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 synthetic cathinone use,
if the symptoms persist for a substantial period of time after cessation of the
synthetic cathinone use or withdrawal, 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 synthetic cathinone use).
Coding Note: Code aslo the causing condition
6C47.60 Synthetic Cathinone-Induced Psychotic
Disorder with Hallucinations
Synthetic cathinone-induced psychotic disorder with hallucinations is characterised
by the presence of hallucinations that are judged to be the direct consequence
of synthetic cathinone use. Neither delusions nor other psychotic symptoms are
present. The symptoms do not occur exclusively during hypnogogic or hypnopompic
states, are not better accounted for by another mental and behavioural disorder
(e.g., schizophrenia), and are not due to another disorder or disease
classified elsewhere (e.g., epilepsies with visual symptoms).
Coding Note: Code aslo the causing condition
6C47.61 Synthetic Cathinone-Induced Psychotic
Disorder with Delusions
Synthetic cathinone psychotic disorder with delusions is characterised
by the presence of delusions that are judged to be the direct consequence of
synthetic cathinone use. Neither hallucinations nor other psychotic symptoms
are present. The symptoms do not occur exclusively during hypnogogic or
hypnopompic states, are not better accounted for by another mental and
behavioural disorder (e.g., schizophrenia), and are not due to another disorder
or disease classified elsewhere (e.g., epilepsies with visual symptoms).
Coding Note: Code aslo the causing condition
6c47.62 Synthetic Cathinone-Induced Psychotic
Disorder With Mixed Psychotic Symptoms
Synthetic cathinone-induced psychotic disorder with mixed psychotic
symptoms is characterised by the presence of multiple psychotic symptoms,
primarily hallucinations and delusions, when these are judged to be the direct
consequence of synthetic cathinone use. The symptoms do not occur exclusively
during hypnogogic or hypnopompic states, are not better accounted for by
another mental and behavioural disorder (e.g., Schizophrenia), and are not due
to another disorder or disease classified elsewhere (e.g., epilepsies with
visual symptoms).
Coding Note: Code aslo the causing condition
6c47.6z Synthetic Cathinone-Induced Psychotic Disorder, Unspecified
Coding Note: Code aslo the causing condition
6c47.7 Certain Specified Synthetic
Cathinone-Induced Mental or Behavioural Disorders
Coding Note: Code aslo the causing condition
6c47.70 Synthetic Cathinone-Induced Mood Disorder
Synthetic cathinone-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 or withdrawal from synthetic cathinones. The intensity
or duration of the symptoms is substantially in excess of mood disturbances
that are characteristic of Synthetic cathinone intoxication or Synthetic
cathinone withdrawal. The amount and duration of synthetic cathinone 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 synthetic cathinone use, if the symptoms persist for a
substantial period of time after cessation of the synthetic cathinone use or
withdrawal, 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 synthetic cathinone use).
Coding Note: Code aslo the causing condition
6C47.71 Synthetic Cathinone-Induced Anxiety
Disorder
Synthetic cathinone-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 or withdrawal from synthetic cathinones. The intensity
or duration of the symptoms is substantially over anxiety symptoms that are
characteristic of Synthetic cathinone intoxication or Synthetic cathinone
withdrawal. The amount and duration of synthetic cathinone 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 synthetic cathinone use, if the
symptoms persist for a substantial period of time after cessation of the
synthetic cathinone use or withdrawal, 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 synthetic cathinone use).
Coding Note: Code aslo the causing condition
6C47.72 Synthetic Cathinone-Induced
Obsessive-Compulsive or Related Syndrome
Synthetic cathinone-induced obsessive-compulsive or related disorder 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 synthetic cathinones. The
intensity or duration of the symptoms is substantially in excess of analogous
disturbances that are characteristic of Synthetic cathinone intoxication or
Synthetic cathinone withdrawal. The amount and duration of synthetic cathinone
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 synthetic cathinone use, if the symptoms
persist for a substantial period of time after cessation of the synthetic
cathinone 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 synthetic cathinone use).
Coding Note: Code aslo the causing condition
6C47.73 Synthetic Cathinone-Induced Impulse
Control Disorder
Synthetic cathinone-induced impulse control disorder 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 synthetic cathinones. The intensity
or duration of the symptoms is substantially in excess of disturbances of
impulse control that are characteristic of Synthetic cathinone intoxication or
Synthetic cathinone withdrawal. The amount and duration of synthetic cathinone
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 synthetic cathinone use,
if the symptoms persist for a substantial period of time after cessation of the
synthetic cathinone 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 synthetic cathinone use).
Coding Note: Code aslo the causing condition
6C47.Y Other specified disorders due to use of
synthetic cathinones
REFERENCE:
International Classification of Diseases Eleventh Revision (ICD-11). Geneva: World Health Organization; 2022. License: CC BY-ND 3.0 IGO.
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