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)
6C46.2 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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