Friday, 27 May 2022

ICD-11 Criteria for Disorders due to use of Stimulants Including Amphetamines, Methamphetamine or Methcathinone (6C46)

ICD-11 Criteria for Disorders due to use of Stimulants Including Amphetamines, Methamphetamine or Methcathinone (6C46)

Disorders due to use of stimulants including amphetamines, methamphetamine or methcathinone are characterised by the pattern and consequences of use of these substances. There is a wide array of naturally occurring and synthetically produced psychostimulants other than cocaine. The most numerous of this group are the amphetamine-type substances, including methamphetamine. Prescribed stimulants including dexamphetamine are indicated for a limited number of conditions such as for Attention Deficit Hyperactivity Disorder. Methcathinone, known in many countries as ephedrone, is a synthetic potent stimulant that is a structural analogue of methamphetamine and is related to cathinone. All these drugs have primarily psychostimulant properties and are also vasoconstrictors to a varying degree. They induce euphoria and hyperactivity as may be seen in Stimulant Intoxication. They have potent dependence-producing properties, which may lead to the diagnosis of Stimulant Dependence and Stimulant Withdrawal following the cessation of use. Several Stimulant-Induced Mental Disorders are described.

Exclusions:             

  • Disorders due to use of synthetic cathinones (6C47)
  • Disorders due to use of caffeine (6C48)
  • Disorders due to use of cocaine (6C45)
  • Hazardous use of stimulants including amphetamines or methamphetamine (QE11.4)

6C46.0        Episode of Harmful Use of Stimulants Including Amphetamines, Methamphetamine or Methcathinone

An episode of use of a stimulant including amphetamines, methamphetamine and methcathinone 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 stimulant 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 stimulant including amphetamines, methamphetamine and methcathinone use.

Exclusions:             

  • Harmful pattern of use of stimulants including amphetamines, methamphetamine or methcathinone (6C46.1)
  • Stimulant dependence including amphetamines, methamphetamine or methcathinone (6C46.2)

6C46.1        Harmful Pattern of Use of Stimulants Including Amphetamines, Methamphetamine or Methcathinone

A pattern of use of stimulants including amphetamines, methamphetamine and methcathinone but excluding caffeine, cocaine and 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 stimulant 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. 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 stimulant intoxication on the part of the person to whom the diagnosis of Harmful pattern of use of stimulants including amphetamines, methamphetamine and methcathinone applies.

Exclusions:             

  • Harmful pattern of use of caffeine (6C48.1)
  • Harmful pattern of use of cocaine (6C45.1)
  • Harmful pattern of use of synthetic cathinones (6C47.1)
  • Episode of harmful use of stimulants including amphetamines, methamphetamine or methcathinone (6C46.0)
  • Stimulant dependence including amphetamines, methamphetamine or methcathinone (6C46.2)

6C46.10      Harmful Pattern of Use of Stimulants Including Amphetamines, Methamphetamine or Methcathinone, Episodic

A pattern of episodic or intermittent use of stimulants including amphetamines, methamphetamine and methcathinone but excluding caffeine, cocaine and 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 stimulant 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 stimulant intoxication on the part of the person to whom the diagnosis of Harmful pattern of use of stimulants including amphetamines, methamphetamine and methcathinone applies.

Exclusions:            

  • Episode of harmful use of stimulants including amphetamines, methamphetamine or methcathinone (6C46.0)
  • Stimulant dependence including amphetamines, methamphetamine or methcathinone (6C46.2)

6C46.11      Harmful Pattern of Use of Stimulants Including Amphetamines, Methamphetamine or Methcathinone, Continuous

A pattern of use of stimulants including amphetamines, methamphetamine and methcathinone but excluding caffeine, cocaine and 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 stimulant 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 stimulant intoxication on the part of the person to whom the diagnosis of Harmful pattern of use of stimulants including amphetamines, methamphetamine and methcathinone applies.

Exclusions:            

  • Episode of harmful use of stimulants including amphetamines, methamphetamine or methcathinone (6C46.0)
  • Stimulant dependence including amphetamines, methamphetamine or methcathinone (6C46.2)

6C46.1Z      Harmful Pattern of Use of Stimulants Including Amphetamines, Methamphetamine And Methcathinone, Unspecified

6C46.2        Stimulant Dependence Including Amphetamines, Methamphetamine or Methcathinone

Stimulant dependence including amphetamines, methamphetamine or methcathinone is a disorder of regulation of stimulant use arising from repeated or continuous use of stimulants. The characteristic feature is a strong internal drive to use stimulants, 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 stimulants. Physiological features of dependence may also be present, including tolerance to the effects of stimulants, withdrawal symptoms following cessation or reduction in use of stimulants, or repeated use of stimulants 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 stimulant use is continuous (daily or almost daily) for at least 3 months.

Exclusions:             

  • Cocaine dependence (6C45.2)
  • Synthetic cathinone dependence (6C47.2)
  • Episode of harmful use of stimulants including amphetamines, methamphetamine or methcathinone (6C46.0)
  • Harmful pattern of use of stimulants including amphetamines, methamphetamine or methcathinone (6C46.1)

6C46.20      Stimulant Dependence Including Amphetamines, Methamphetamine or Methcathinone, Current Use

Stimulant dependence including amphetamines, methamphetamine and methcathinone but excluding caffeine, cocaine and synthetic cathinones refers to amphetamine or other stimulant use within the past month.

Exclusions:             

  • Harmful pattern of use of stimulants including amphetamines, methamphetamine or methcathinone (6C46.1)
  • Episode of harmful use of stimulants including amphetamines, methamphetamine or methcathinone (6C46.0)

6C46.21      Stimulant Dependence Including Amphetamines, Methamphetamine or Methcathinone, Early Full Remission

After a diagnosis of Stimulant dependence including amphetamines, methamphetamine and methcathinone but excluding caffeine, cocaine and synthetic cathinones, and often following a treatment episode or other intervention (including self-help intervention), the individual has been abstinent from stimulants during a period lasting from between 1 and 12 months.

Exclusions:            

  • Episode of harmful use of stimulants including amphetamines, methamphetamine or methcathinone (6C46.0)
  • Harmful pattern of use of stimulants including amphetamines, methamphetamine or methcathinone (6C46.1)

6C46.22      Stimulant Dependence Including Amphetamines, Methamphetamine or Methcathinone, Sustained Partial Remission

After a diagnosis of Stimulant dependence including amphetamines, methamphetamine and methcathinone but excluding caffeine, cocaine and synthetic cathinones, and often following a treatment episode or other intervention (including self-help intervention), there is a significant reduction in amphetamine or other stimulant consumption for more than 12 months, such that even though amphetamine or other stimulant use has occurred during this period, the definitional requirements for dependence have not been met.

Exclusions:             

  • Episode of harmful use of stimulants including amphetamines, methamphetamine or methcathinone (6C46.0)
  • Harmful pattern of use of stimulants including amphetamines, methamphetamine or methcathinone (6C46.1)

6C46.23      Stimulant Dependence Including Amphetamines, Methamphetamine or Methcathinone, Sustained Full Remission

After a diagnosis of Stimulant dependence including amphetamines, methamphetamine and methcathinone but excluding caffeine, cocaine and synthetic cathinones, and often following a treatment episode or other intervention (including self-intervention), the person has been abstinent from amphetamine or other stimulants for 12 months or longer.

Exclusions:             

  • Episode of harmful use of stimulants including amphetamines, methamphetamine or methcathinone (6C46.0)
  • Harmful pattern of use of stimulants including amphetamines, methamphetamine or methcathinone (6C46.1)

6C46.2Z      Stimulant Dependence Including Amphetamines, Methamphetamine or Methcathinone, Unspecified

6C46.3        Stimulant Intoxication Including Amphetamines, Methamphetamine or Methcathinone

Stimulant intoxication including amphetamines, methamphetamine and methcathinone but excluding caffeine, cocaine and synthetic cathinones is a clinically significant transient condition that develops during or shortly after the consumption of amphetamine or other stimulants that is characterised by disturbances in consciousness, cognition, perception, affect, behaviour, or coordination. These disturbances are caused by the known pharmacological effects of amphetamine or other stimulants and their intensity is closely related to the amount of amphetamine or other stimulant consumed. They are time-limited and abate as amphetamine or another stimulant 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 stimulants including amphetamines, methamphetamine and methcathinone can result in seizures.

Coding Note:     Code aslo the causing condition

Exclusions:             

  • Amphetamine poisoning (NE60)
  • Caffeine intoxication (6C48.2)
  • Cocaine intoxication (6C45.3)
  • Synthetic cathinone intoxication (6C47.3)
  • Possession trance disorder (6B63)

6C46.4        Stimulant Withdrawal Including Amphetamines, Methamphetamine or Methcathinone

Stimulant withdrawal including amphetamines, methamphetamine and methcathinone 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 stimulants in individuals who have developed Stimulant dependence or have used stimulants for a prolonged period or in large amounts. Stimulant withdrawal can also occur when prescribed stimulants have been used in standard therapeutic doses. Presenting features of stimulant 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 amphetamine or related stimulants.

Coding Note:     Code aslo the causing condition

Exclusions:            

  • Cocaine withdrawal (6C45.4)
  • Caffeine withdrawal (6C48.3)
  • Synthetic cathinone withdrawal (6C47.4)

6C46.5        Stimulant-Induced Delirium Including Amphetamines, Methamphetamine or Methcathinone

Stimulant-induced delirium including amphetamines, methamphetamine and methcathinone 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 stimulants. The amount and duration of stimulant 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

Exclusions:             

  • Cocaine-induced delirium (6C45.5)
  • Synthetic cathinone-induced delirium (6C47.5)
  • Disorders due to use of caffeine (6C48)

6C46.6        Stimulant-Induced Psychotic Disorder Including Amphetamines, Methamphetamine or Methcathinone

Stimulant-induced psychotic disorder including amphetamines, methamphetamine and methcathinone is characterised by psychotic symptoms (e.g., delusions, hallucinations, disorganised thinking, grossly disorganised behaviour) that develop during or soon after intoxication or withdrawal due to stimulants. The intensity or duration of the symptoms is substantially in excess of psychotic-like disturbances of perception, cognition, or behaviour that are characteristic of Stimulant intoxication or Stimulant withdrawal. The amount and duration of stimulant 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 stimulant use, if the symptoms persist for a substantial period of time after cessation of the stimulant 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 use of stimulants).

Coding Note: Code aslo the causing condition

Exclusions:

  • Cocaine-induced psychotic disorder (6C45.6)
  • Synthetic cathinone-induced psychotic disorder (6C47.6)
  • Disorders due to use of caffeine (6C48)

6C46.60      Stimulant-Induced Psychotic Disorder Including Amphetamines, Methamphetamine or Methcathinone with Hallucinations

Stimulant-induced psychotic disorder with hallucinations is characterised by the presence of hallucinations that are judged to be the direct consequence of stimulant 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

Exclusions:

  • Cocaine-induced psychotic disorder with hallucinations (6C45.60)
  • Disorders due to use of caffeine (6C48)
  • Synthetic cathinone-induced psychotic disorder with hallucinations (6C47.60)

6C46.61      Stimulant-Induced Psychotic Disorder Including Amphetamines, Methamphetamine or Methcathinone With Delusions

Stimulant-induced psychotic disorder including amphetamines, methamphetamine and methcathinone is characterised by psychotic symptoms (e.g., delusions, hallucinations, disorganised thinking, grossly disorganised behaviour) that develop during or soon after intoxication or withdrawal due to stimulants. The intensity or duration of the symptoms is substantially in excess of psychotic-like disturbances of perception, cognition, or behaviour that are characteristic of Stimulant intoxication or Stimulant withdrawal. The amount and duration of stimulant 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 stimulant use, if the symptoms persist for a substantial period of time after cessation of the stimulant 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 use of stimulants).

Coding Note:     Code aslo the causing condition

Exclusions:

  • Disorders due to use of caffeine (6C48)
  • Cocaine-induced psychotic disorder with delusions (6C45.61)
  • Synthetic cathinone-induced psychotic disorder with delusions (6C47.61)

6C46.62      Stimulant-Induced Psychotic Disorder Including Amphetamines But Excluding Caffeine Or Cocaine With Mixed Psychotic Symptoms

Stimulant-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 stimulant 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

Exclusions:

  • Disorders due to use of caffeine (6C48)
  • Cocaine-induced psychotic disorder with mixed psychotic symptoms (6C45.62)
  • Synthetic Cathinone-Induced Psychotic Disorder With Mixed Psychotic Symptoms (6C47.62)

6C46.6Z      Stimulant-Induced Psychotic Disorder Including Amphetamines, Methamphetamine or Methcathinone, Unspecified

Coding Note:     Code aslo the causing condition

6C46.7        Certain Specified Stimulant-Induced Mental or Behavioural Disorders Including Amphetamines, Methamphetamine or Methcathinone

Coding Note:     Code aslo the causing condition

6C46.70      Stimulant-Induced Mood Disorder Including Amphetamines, Methamphetamine or Methcathinone

Stimulant-induced mood disorder including amphetamines, methamphetamine and methcathinone 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 or withdrawal due to stimulants. The intensity or duration of the symptoms is substantially in excess of mood disturbances that are characteristic of Stimulant intoxication or Stimulant withdrawal. The amount and duration of stimulant 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 stimulant use, if the symptoms persist for a substantial period of time after cessation of the stimulant 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 use of stimulants).

Coding Note:     Code aslo the causing condition

Exclusions:

  • Synthetic cathinone-induced mood disorder (6C47.70)
  • Cocaine-induced mood disorder (6C45.70)
  • Disorders due to use of caffeine (6C48)

6C46.71       Stimulant-Induced Anxiety Disorder Including Amphetamines, Methamphetamine or Methcathinone

Stimulant-induced anxiety disorder including amphetamines, methamphetamine and methcathinone 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 or withdrawal due to stimulants. The intensity or duration of the symptoms is substantially in excess of anxiety symptoms that are characteristic of Stimulant intoxication or Stimulant withdrawal. The amount and duration of stimulant 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 stimulant use, if the symptoms persist for a substantial period of time after cessation of the stimulant 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 use of stimulants).

Coding Note:     Code aslo the causing condition

Exclusions:             

  • Cocaine-induced anxiety disorder (6C45.71)
  • Caffeine-induced anxiety disorder (6C48.40)
  • Synthetic cathinone-induced anxiety disorder (6C47.71)

6C46.72   Stimulant-Induced Obsessive-Compulsive or Related Disorder Including Amphetamines, Methamphetamine or Methcathinone

Stimulant-induced obsessive-compulsive or related disorder including amphetamines, methamphetamine and methcathinone 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 stimulants. The intensity or duration of the symptoms is substantially in excess of analogous disturbances that are characteristic of Stimulant intoxication or Stimulant withdrawal. The amount and duration of stimulant 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 stimulant use, if the symptoms persist for a substantial period of time after cessation of the stimulant 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 stimulant use).

Coding Note:     Code aslo the causing condition

Exclusions: 

  • Cocaine-induced obsessive-compulsive or related disorder (6C45.72)
  • Synthetic cathinone-induced obsessive-compulsive or related syndrome (6C47.72)
  • Disorders due to use of caffeine (6C48)

6c46.73      Stimulant-Induced Impulse Control Disorder Including Amphetamines, Methamphetamine or Methcathinone

Stimulant-induced impulse control disorder including amphetamines, methamphetamine and methcathinone 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 stimulants. The intensity or duration of the symptoms is substantially in excess of disturbances of impulse control that are characteristic of Stimulant intoxication or Stimulant withdrawal. The amount and duration of stimulant 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 stimulant use, if the symptoms persist for a substantial period of time after cessation of the stimulant 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 stimulant use).

Coding Note:     Code aslo the causing condition

6C46.Y        Other Specified Disorders Due to Use Of Stimulants Including Amphetamines, Methamphetamine Or Methcathinone

6C46.Z         Disorders Due to Use Of Stimulants Including Amphetamines, Methamphetamine Or Methcathinone, 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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