ICD-11 Criteria for Disorders due to use of Sedatives, Hypnotics or Anxiolytics (6C44)

Disorders due to use of sedatives, hypnotics or anxiolytics are characterised by the pattern and consequences of use of these substances. Sedatives, hypnotics, and anxiolytics are typically prescribed for the short-term treatment of anxiety or insomnia and are also employed to provide sedation for medical procedures. They include the benzodiazepines and the non-benzodiazepine positive allosteric modulators of GABA receptors (i.e., ‘Z-drugs’) as well as many other compounds. Sedatives, hypnotics, and anxiolytics include barbiturates, which are available much less commonly now than in previous decades. Sedatives, hypnotics, and anxiolytics have dependence-inducing properties that are related to the dose and duration of their use. They may cause intoxication, dependence and withdrawal. Several other mental disorders induced by sedatives, hypnotics, or anxiolytics are recognized.

Exclusions:             

• Hazardous use of Sedatives, Hypnotics or Anxiolytics (QE11.2)

6C44.0    Episode of Harmful use of Sedatives, Hypnotics or Anxiolytics

An episode of use of a sedative, hypnotic or anxiolytic 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 sedative, hypnotic or anxiolytic 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 sedative, hypnotic or anxiolytic use.

Exclusions:             

• Sedative, hypnotic or anxiolytic dependence (6C44.2)
• Harmful pattern of use of sedatives, hypnotics or anxiolytics (6C44.1)

6C44.1   Harmful pattern of use of sedatives, hypnotics or anxiolytics

A pattern of sedative, hypnotic, or anxiolytic use that has caused clinically significant harm to a person’s physical or mental health or in which behaviour induced by sedatives, hypnotics or anxiolytics has caused clinically significant harm to the health of other people. The pattern of sedative, hypnotic, or anxiolytic use is evident over a period of at least 12 months if use is episodic and at least one month if use is continuous (i.e., daily or almost daily). Harm may be caused by the intoxicating effects of sedatives, hypnotics or anxiolytics, the direct or secondary toxic effects on body organs and systems, or a harmful route of administration.

Exclusions:             

• Sedative, hypnotic or anxiolytic dependence (6C44.2)
• Episode of harmful use of sedatives, hypnotics or anxiolytics (6C44.0)

6C44.10    Harmful pattern of use of sedatives, hypnotics or anxiolytics, episodic

A pattern of episodic or intermittent use of sedatives, hypnotics or anxiolytics that has caused clinically significant harm to a person’s physical or mental health or in which behaviour induced by sedatives, hypnotics or anxiolytics has caused clinically significant harm to the health of other people. The pattern of episodic or intermittent use of sedatives, hypnotics or anxiolytics is evident over a period of at least 12 months. Harm may be caused by the intoxicating effects of sedatives, hypnotics or anxiolytics, the direct or secondary toxic effects on body organs and systems, or a harmful route of administration.

Exclusions:             

• Episode of harmful use of sedatives, hypnotics or anxiolytics (6C44.0)
• Sedative, hypnotic or anxiolytic dependence (6C44.2)

6C44.11    Harmful Pattern of use of Sedatives, Hypnotics or Anxiolytics, Continuous

A pattern of continuous use of sedatives, hypnotics or anxiolytics (daily or almost daily) that has caused clinically significant harm to a person’s physical or mental health or in which behaviour induced by sedatives, hypnotics or anxiolytics has caused clinically significant harm to the health of other people. The pattern of continuous use of sedatives, hypnotics or anxiolytics is evident over a period of at least one month. The intoxicating effects of sedatives, hypnotics or anxiolytics, the direct or secondary toxic effects on body organs and systems, or a harmful route of administration may cause harm.

Exclusions:             

• Episode of harmful use of sedatives, hypnotics or anxiolytics (6C44.0)
• Sedative, hypnotic or anxiolytic dependence (6C44.2)

6C44.1Z    Harmful Pattern of use of Sedatives, Hypnotics or Anxiolytics, Unspecified

6C44.2    Sedative, Hypnotic or Anxiolytic Dependence

Sedative, hypnotic or anxiolytic dependence is a disorder of regulation of sedative use arising from repeated or continuous use of these substances. The characteristic feature is a strong internal drive to use sedatives, hypnotics, or anxiolytics, 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 these substances. Physiological features of dependence may also be present, including tolerance to the effects of sedatives, hypnotics or anxiolytics, withdrawal symptoms following cessation or reduction in use, or repeated use of sedatives 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 sedative use is continuous (daily or almost daily) for at least 3 months.

Exclusions:             

• Episode of harmful use of sedatives, hypnotics or anxiolytics (6C44.0)
• Harmful pattern of use of sedatives, hypnotics or anxiolytics (6C44.1)

6C44.20    Sedative, Hypnotic or Anxiolytic Dependence, Current Use

Current Sedative, hypnotic or anxiolytic dependence with use of a sedative, hypnotic or anxiolytic drug within the past month.

Exclusions:             

Episode of harmful use of sedatives, hypnotics or anxiolytics (6C44.0)

Harmful pattern of use of sedatives, hypnotics or anxiolytics (6C44.1)

6C44.21    Sedative, Hypnotic or Anxiolytic Dependence, Early full Remission

After a diagnosis of Sedative, hypnotic or anxiolytic dependence, and often following a treatment episode or other intervention (including self-help intervention), the individual has been abstinent from sedatives, hypnotics or anxiolytics during a period lasting from between 1 and 12 months.

Exclusions:             

• Episode of harmful use of sedatives, hypnotics or anxiolytics (6C44.0)
• Harmful pattern of use of sedatives, hypnotics or anxiolytics (6C44.1)

6C44.22    Sedative, hypnotic or anxiolytic dependence, sustained partial remission

After a diagnosis of Sedative, hypnotic or anxiolytic dependence, and often following a treatment episode or other intervention (including self-help intervention), there is a significant reduction in sedative, hypnotic or anxiolytic consumption for more than 12 months, such that even though sedative, hypnotic or anxiolytic use has occurred during this period, the definitional requirements for dependence have not been met.

Exclusions:             

• Episode of harmful use of sedatives, hypnotics or anxiolytics (6C44.0)
• Harmful pattern of use of sedatives, hypnotics or anxiolytics (6C44.1)

6C44.23    Sedative, Hypnotic or Anxiolytic Dependence, Sustained Full Remission

After a diagnosis of Sedative, hypnotic or anxiolytic dependence, and often following a treatment episode or other intervention (including self-intervention), the person has been abstinent from alcohol for 12 months or longer.

Exclusions:             

• Episode of harmful use of sedatives, hypnotics or anxiolytics (6C44.0)
• Harmful pattern of use of sedatives, hypnotics or anxiolytics (6C44.1)

6C44.2Z    Sedative, Hypnotic or Anxiolytic Dependence, Unspecified

6C44.3    Sedative, Hypnotic or Anxiolytic Intoxication

Sedative, hypnotic or anxiolytic intoxication is a clinically significant transient condition that develops during or shortly after the consumption of sedatives, hypnotics or anxiolytics that is characterised by disturbances in consciousness, cognition, perception, affect, behaviour, or coordination. These disturbances are caused by the known pharmacological effects of sedatives, hypnotics or anxiolytics and their intensity is closely related to the amount of sedatives, hypnotics or anxiolytics consumed. They are time-limited and abate as sedatives, hypnotics or anxiolytics are cleared from the body. Presenting features may include somnolence, impaired judgment, inappropriate behavior (including sexual behavior or aggression), slurred speech, impaired motor coordination, unsteady gait, mood changes, as well as impaired memory, attention and concentration. Nystagmus (repetitive, uncontrolled eye movements) is a common physical sign. In severe cases stupor or coma may occur.

Coding Note:     Code aslo the causing condition

Inclusions:              

• "Bad trips" due to sedatives, hypnotics or anxiolytics

Exclusions:             

• Sedative, hypnotic drugs and other CNS depressants poisoning (NE60)
• Possession trance disorder (6B63)

6C44.4    Sedative, Hypnotic or Anxiolytic Withdrawal

Sedative, hypnotic or anxiolytic 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 sedatives, hypnotics or anxiolytics in individuals who have developed dependence or have used sedatives, hypnotics or anxiolytics for a prolonged period or in large amounts. Sedative, hypnotic or anxiolytic withdrawal can also occur when prescribed sedatives, hypnotics or anxiolytics have been used in standard therapeutic doses. Presenting features of Sedative, hypnotic or anxiolytic withdrawal may include anxiety, psychomotor agitation, insomnia, increased hand tremor, nausea or vomiting, and transient visual, tactile or auditory illusions or hallucinations. There may be signs of autonomic hyperactivity (e.g., tachycardia, hypertension, sweating), or postural hypotension. The withdrawal state may be complicated by seizures. Less commonly, there may be progression to a more severe withdrawal state characterised by confusion and disorientation, delusions, and more prolonged visual, tactile or auditory hallucinations. In such cases, a separate diagnosis of Sedative, hypnotic, or anxiolytic-induced delirium should be assigned.

Coding Note:     Code aslo the causing condition

6C44.40    Sedative, Hypnotic or Anxiolytic Withdrawal, Uncomplicated

All diagnostic requirements for Sedative, hypnotic or anxiolytic Withdrawal are met and the withdrawal state is not accompanied by perceptual disturbances or seizures.

Coding Note:     Code aslo the causing condition

6C44.41    Sedative, Hypnotic or Anxiolytic Withdrawal, with Perceptual Disturbances

All diagnostic requirements for Sedative, hypnotic or anxiolytic withdrawal are met and the withdrawal state is accompanied by perceptual disturbances (e.g., visual or tactile hallucinations or illusions) with intact reality testing. There is no evidence of confusion and other diagnostic requirements for Delirium are not met. The withdrawal state is not accompanied by seizures.

Coding Note:     Code aslo the causing condition

6C44.42    Sedative, Hypnotic or Anxiolytic Withdrawal, with Seizures

All diagnostic requirements for Sedative, hypnotic or anxiolytic withdrawal are met and the withdrawal state is accompanied by seizures (i.e., generalised tonic-clonic seizures) but not by perceptual disturbances.

Coding Note:     Code aslo the causing condition

6C44.43    Sedative, Hypnotic or Anxiolytic Withdrawal, with Perceptual Disturbances and Seizures

All diagnostic requirements for Sedative, hypnotic or anxiolytic withdrawal are met and the withdrawal state is accompanied by both seizures (i.e., generalised tonic-clonic seizures) and perceptual disturbances (e.g., visual or tactile hallucinations or illusions) with intact reality testing. Diagnostic requirements for Delirium are not met.

Coding Note:     Code aslo the causing condition

6C44.4Z    Sedative, Hypnotic or Anxiolytic Withdrawal, Unspecified

Coding Note:     Code aslo the causing condition

6C44.5     Sedative, Hypnotic or Anxiolytic-Induced Delirium

Sedative, hypnotic or anxiolytic-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 sedatives, hypnotics, or anxiolytics. Specific features of Sedative, hypnotic or anxiolytic-induced delirium may include confusion and disorientation, paranoid delusions, and recurrent visual, tactile or auditory hallucinations. The amount and duration of sedative, hypnotic, or anxiolytic 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

Inclusions:              

• Delirium induced by sedative, hypnotic or anxiolytic withdrawal

6C44.6    Sedative, Hypnotic or Anxiolytic-Induced Psychotic Disorder

Sedative, hypnotic or anxiolytic-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 sedatives, hypnotics or anxiolytics. The intensity or duration of the symptoms is substantially in excess of psychotic-like disturbances of perception, cognition, or behaviour that are characteristic of intoxication or withdrawal due to sedatives, hypnotics or anxiolytics. The amount and duration of sedative, hypnotic or anxiolytic 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 sedative, hypnotic or anxiolytic use, if the symptoms persist for a substantial period of time after cessation of the sedative, hypnotic or anxiolytic 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 sedative, hypnotic or anxiolytic use).

Coding Note:     Code aslo the causing condition

6C44.7    Certain Specified Sedatives, Hypnotics or Anxiolytic-Induced Mental or Behavioural Disorders

Coding Note:     Code aslo the causing condition

Coded Elsewhere:  Amnestic disorder due to use of sedatives, hypnotics or anxiolytics (6D72.11)

Dementia due to use of sedatives, hypnotics or anxiolytics (6D84.1)

6C44.70    Sedative, Hypnotic or Anxiolytic-induced Mood Disorder

Sedative, hypnotic or anxiolytic-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 sedatives, hypnotics or anxiolytics. The intensity or duration of the symptoms is substantially in excess of mood disturbances that are characteristic of intoxication or withdrawal due to sedatives, hypnotics or anxiolytics. The amount and duration of sedative, hypnotic or anxiolytic 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 sedative, hypnotic or anxiolytic use, if the symptoms persist for a substantial period of time after cessation of the sedative, hypnotic or anxiolytic 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 sedative, hypnotic or anxiolytic use).

Coding Note:     Code aslo the causing condition

6C44.71    Sedative, Hypnotic or Anxiolytic-Induced Anxiety Disorder

Sedative, hypnotic or anxiolytic-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 sedatives, hypnotics or anxiolytics. The intensity or duration of the symptoms is substantially in excess of anxiety symptoms that are characteristic of intoxication or withdrawal due to sedatives, hypnotics or anxiolytics. The amount and duration of sedative, hypnotic or anxiolytic 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 sedative, hypnotic or anxiolytic use, if the symptoms persist for a substantial period of time after cessation of the sedative, hypnotic or anxiolytic 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 sedative, hypnotic or anxiolytic use).

Coding Note:     Code aslo the causing condition

6C44.Y    Other specified disorders due to use of sedatives, hypnotics or anxiolytics
6C44.Z    Disorders due to use of sedatives, hypnotics or anxiolytics, 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/