ICD-11 Criteria for Disorders Due to Use of Cocaine (6C45)
Disorders due to use of cocaine
are characterised by the pattern and consequences of cocaine use. Cocaine is a
compound found in the leaves of the coca plant, Erythroxylum coca, which is
indigenous to countries in northern regions of South America. Cocaine has a
limited place in medical treatment as an anaesthetic and vasoconstrictive
agent. It is commonly used illicitly and widely available across the world,
where it is found in two main forms: cocaine hydrochloride and cocaine freebase
(also known as ‘crack’). Cocaine is a central nervous system stimulant, and
Cocaine Intoxication typically includes a state of euphoria and hyperactivity.
Cocaine has potent dependence-producing properties and Cocaine Dependence is a
common cause of morbidity and of clinical presentations. Cocaine Withdrawal has
a characteristic course that includes lethargy and depressed mood. A range of
Cocaine-Induced Mental Disorders is described.
Exclusions:
- Disorders due to use of stimulants including amphetamines, methamphetamine or methcathinone (6C46)
- Hazardous use of cocaine (QE11.3)
6C45.0 Episode of Harmful Use of Cocaine
An episode of use of cocaine 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 cocaine 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 cocaine use.
Exclusions:
- Cocaine dependence (6C45.2)
- Harmful pattern of use of cocaine (6C45.1)
6C45.1 Harmful pattern of use of cocaine
A pattern of use of cocaine 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 cocaine 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 cocaine
intoxication on the part of the person to whom the diagnosis of Harmful pattern
of use of cocaine applies.
Exclusions:
- Cocaine dependence (6C45.2)
- Episode of harmful use of cocaine (6C45.0)
6C45.10 Harmful Pattern of Use of Cocaine, Episodic
A pattern of episodic or
intermittent cocaine 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. The pattern of episodic cocaine 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 cocaine intoxication on the part of the person to whom the diagnosis
of Harmful pattern of use of cocaine applies.
Exclusions:
- Episode of harmful use of cocaine (6C45.0)
- Cocaine dependence (6C45.2)
6C45.11 Harmful Pattern of Use of Cocaine, Continuous
A pattern of continuous (daily or
almost daily) cocaine 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.
The pattern of continuous cocaine 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 because of behaviour related to
cocaine intoxication on the part of the person to whom the diagnosis of Harmful
pattern of use of cocaine applies.
Exclusions:
- Episode of harmful use of cocaine (6C45.0)
- Cocaine dependence (6C45.2)
6C45.1Z Harmful Pattern of use of Cocaine, Unspecified
6C45.2 Cocaine Dependence
Cocaine dependence is a disorder
of regulation of cocaine use arising from repeated or continuous use of
cocaine. The characteristic feature is a strong internal drive to use cocaine,
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 cocaine. Physiological features of
dependence may also be present, including tolerance to the effects of cocaine,
withdrawal symptoms following cessation or reduction in use of cocaine, or
repeated use of cocaine 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 cocaine
use is continuous (daily or almost daily) for at least 3 months.
Exclusions:
- Episode of harmful use of cocaine (6C45.0)
- Harmful pattern of use of cocaine (6C45.1)
6C45.20 Cocaine Dependence, Current Use
Current cocaine dependence with
cocaine use within the past month.
Exclusions:
- Episode of harmful use of cocaine (6C45.0)
- Harmful pattern of use of cocaine (6C45.1)
6C45.21 Cocaine Dependence, Early Full Remission
After a diagnosis of Cocaine
dependence, and often following a treatment episode or other intervention
(including self-help intervention), the individual has been abstinent from
cocaine during a period lasting from between 1 and 12 months.
Exclusions:
- Episode of harmful use of cocaine (6C45.0)
- Harmful pattern of use of cocaine (6C45.1)
6C45.22 Cocaine Dependence, Sustained Partial Remission
After a diagnosis of Cocaine
dependence, and often following a treatment episode or other intervention
(including self-help intervention), there is a significant reduction in cocaine
consumption for more than 12 months, such that even though cocaine use has
occurred during this period, the definitional requirements for dependence have
not been met.
Exclusions:
- Episode of harmful use of cocaine (6C45.0)
- Harmful pattern of use of cocaine (6C45.1)
6C45.23 Cocaine Dependence, Sustained Full Remission
After a diagnosis of cocaine
dependence, and often following a treatment episode or other intervention
(including self-intervention), the person has been abstinent from cocaine for
12 months or longer.
Exclusions:
- Episode of harmful use of cocaine (6C45.0)
- Harmful pattern of use of cocaine (6C45.1)
6C45.2Z Cocaine Dependence, Unspecified
6C45.3 Cocaine Intoxication
Cocaine intoxication is a
clinically significant transient condition that develops during or shortly
after the consumption of cocaine that is characterised by disturbances in
consciousness, cognition, perception, affect, behaviour, or coordination. These
disturbances are caused by the known pharmacological effects of cocaine and
their intensity is closely related to the amount of cocaine consumed. They are
time-limited and abate as cocaine is cleared from the body. Presenting features
may include inappropriate euphoria, anxiety, anger, impaired attention,
hypervigilance, psychomotor agitation, paranoid ideation (sometimes of
delusional intensity), auditory hallucinations, confusion, and changes in
sociability. Perspiration or chills, nausea or vomiting, and palpitations and
chest pain may be experienced. Physical signs may include tachycardia, elevated
blood pressure, and pupillary dilatation. In rare instances, usually in severe
intoxication, cocaine use can result in seizures, muscle weakness, dyskinesia,
or dystonia.
Coding
Note: Code
aslo the causing condition
Exclusions:
- Cocaine poisoning (NE60)
- Possession trance disorder (6B63)
6C45.4 Cocaine withdrawal
Cocaine 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 cocaine in individuals who have developed Cocaine
dependence or have used cocaine for a prolonged period or in large amounts.
Presenting features of Cocaine withdrawal may include dysphoric mood,
irritability, fatigue, psychomotor retardation, vivid unpleasant dreams,
insomnia or hypersomnia, increased appetite, anxiety, psychomotor agitation or
retardation, and craving for cocaine.
Coding Note: Code aslo the causing condition
6C45.5 Cocaine-Induced Delirium
Cocaine-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 cocaine. The amount and duration
of cocaine 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
6C45.6 Cocaine-Induced Psychotic Disorder
Cocaine-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 cocaine. The intensity or
duration of the symptoms is substantially in excess of psychotic-like
disturbances of perception, cognition, or behaviour that are characteristic of
Cocaine intoxication or Cocaine withdrawal. The amount and duration of cocaine
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 cocaine use, if the symptoms persist for a
substantial period of time after cessation of the cocaine 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
cocaine use).
Coding Note: Code aslo the causing condition
6C45.60 Cocaine-Induced Psychotic Disorder with Hallucinations
Cocaine-induced psychotic disorder
with hallucinations is characterised by the by the presence of hallucinations
that are judged to be the direct consequence of cocaine 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
6C45.61 Cocaine-Induced Psychotic Disorder with Delusions
Cocaine-induced psychotic disorder
with delusions is characterised by the by the presence of delusions that are
judged to be the direct consequence of cocaine 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
6C45.62 Cocaine-Induced Psychotic Disorder with Mixed Psychotic Symptoms
Cocaine-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 cocaine 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
6C45.6Z Cocaine-Induced Psychotic Disorder, Unspecified
Coding Note: Code aslo the causing condition
6C45.7 Certain Specified Cocaine-Induced Mental or Behavioural disorders
Coding Note: Code aslo the causing condition
6C45.70 Cocaine-Induced Mood Disorder
Cocaine-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 cocaine.
The intensity or duration of the symptoms is substantially in excess of mood
disturbances that are characteristic of Cocaine intoxication or Cocaine
withdrawal. The amount and duration of cocaine 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
cocaine use, if the symptoms persist for a substantial period of time after
cessation of the cocaine 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 cocaine use).
Coding Note: Code aslo the causing condition
6C45.71 Cocaine-Induced Anxiety Disorder
Cocaine-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 cocaine.
The intensity or duration of the symptoms is substantially in excess of anxiety
symptoms that are characteristic of Cocaine intoxication or Cocaine withdrawal.
The amount and duration of cocaine 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 cocaine use, if the symptoms persist for a
substantial period of time after cessation of the cocaine 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 cocaine
use).
Coding Note: Code aslo the causing condition
6C45.72 Cocaine-Induced Obsessive-Compulsive or Related Disorder
Cocaine-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 cocaine. The intensity or duration of the symptoms is substantially in
excess of analogous disturbances that are characteristic of Cocaine
intoxication or Cocaine withdrawal. The amount and duration of cocaine 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 cocaine use, if the symptoms persist for a
substantial period of time after cessation of the cocaine 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 cocaine use).
Coding Note: Code aslo the causing condition
6C45.73 Cocaine-Induced Impulse Control Disorder
Cocaine-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 cocaine.
The intensity or duration of the symptoms is substantially in excess of
disturbances of impulse control that are characteristic of Cocaine intoxication
or Cocaine withdrawal. The amount and duration of cocaine 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 cocaine use, if the symptoms
persist for a substantial period of time after cessation of the cocaine 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 cocaine use).
Coding Note: Code aslo the causing condition
6C45.Y Other Specified Disorders Due to Use of Cocaine
6C45.Z Disorders Due to Use of Cocaine, 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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