Friday, 27 May 2022

ICD-11 Criteria for Disorders Due to use of Synthetic Cathinones (6C47 )

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
6C47.1Z      Harmful Pattern of Use of Synthetic Cathinones, Unspecified

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
6C47.2Z      Synthetic Cathinone Dependence, Unspecified

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
6C47.Z       Disorders due to use of synthetic cathinones, 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/

No comments:

Post a Comment

Your Thoughts?

Featured Post

ICD-11 Criteria for Gambling Disorder (6C50)

ICD-11 Criteria for Gambling Disorder (6C50) Foundation URI : http://id.who.int/icd/entity/1041487064 6C50 Gambling disorder Description G...