Substance/Medication-Induced Psychotic Disorder

 

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Substance/Medication-Induced Psychotic Disorder

A. Presence of one or both of the following symptoms:
1. Delusions.
2. Hallucinations.
B. There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):
1. The symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication.
2. The involved substance/medication is capable of producing the symptoms in Criterion A.
C. The disturbance is not better explained by a psychotic disorder that is not substance/medication-induced.
Such evidence of an independent psychotic disorder could include the following:
The symptoms preceded the onset of the substance/medication use; the symptoms persist for a substantial
period of time (e.g., about 1 month) after the cessation of acute withdrawal or severe intoxication; or there is other
evidence of an independent non-substance/medication-induced psychotic disorder (e.g., a history of recurrent non-
substance/medication-related episodes).
D. The disturbance does not occur exclusively during the course of a delírium.
E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important
are as of functioning.
Note: This diagnosis should be made instead of a diagnosis of substance intoxication or substance withdrawal only when the symptoms in Criterion A predominate in the clinical picture and when they are sufficiently severe to warrant clincal attention.

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Coding note : The ICD-9-CM and ICD-10-CM

codes for the [specific substance/medication]-induced psychotic disorders are indicated in the the table below. Note that the ICD-20-CM vode depends on whether or not there is a comorbid substansce use disorder present for the same class of substance.
If a mild substance use disor xomorbidder is comorbid with the substance-induced psychotic disorder, the 4th position
character is “1," and the clinician should record "mild [substance] use disorder before the substance-induced psychotic
disorder (e.g., "mild cocaine use disorder with cocaine-induced psychotic disorder").
If a moderate or severe substance use disorder is comorbid with the substance-induced psychotic disorder, the 4th
position character is "2," and the clinician should record "moderate [substance] use disorder" or "severe [substance]
use disorder" depending on the severity of the comorbid substance use disorder. If there is no comorbid substance
use disorder (e.g., after a one-time heavy use of the substance), then the 4th position character is "9," and the
clinician should record only the substance-induced psychotic disorder.
 

 
Specify if (see Table 1 in the chapter "Substance-Related and Addictive Disorders" for diagnoses associated with substance class): With onset during intoxication: If the criteria are met for intoxication with the substance and the symptoms develop during intoxication.
With onset during withdrawal: If the criteria are met for withdrawal from the substance and the symptoms develop during, or shortly after, withdrawal.
Specify current severty:
Severity is rated by a quantitative assessment of the primary symptoms of psychosis, including delusions, hallucinations, abnormal psychomotor behavior, and negative symptoms. Each of these symptoms may be rated for its current severity (most severe in the last 7 days) on a 5-point scale ranging from 0 (not present) to 4 (present and severe). (See Clinician-Rated Dimensions of Psychosis Symptom Severity in the chapter "Assessment Measures" in Section Ill of DSM-5.)
Note: Diagnosis of substance/medication-induced psychotic disorder can be made without using this severity specifier.

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Recording Procedures

ICD-9-CM. The name of the substance/medication-induced psychotic disorder begins with the specific substance (e.g., cocaine, dexamethasone) that is presumed to be causing the delusions or hallucinations. The diagnostic code is selected from the table included in the criteria set, which is based on the drug class. For substances that do not fit into any of the classes (e.g., dexamethasone), the code for "other substance" should be used; and in cases in which a substance is judged to be an etiological factor but the specific class of substance is unknown, the category "unknown substance" should be used.
The name of the disorder is followed by the specification of onset (i.e., onset during intoxication, onset during withdrawal). Unlike the recording procedures for ICD-10-CM, which combine the substance-induced disorder and substance use disorder into a single code, for ICD-9-CM a separate diagnostic code is given for the substance use disorder. For example, in the case of delusions occurring during intoxication in a man with a severe cocaine use disorder, the diagnosis is 292.9 cocaine-induced psychotic disorder, with onset during intoxication. An additional diagnosis of 36.23 severe cocaine use disorder is also given. When more than one substance is judged to play a significant role in the development of psychotic symptoms, each should be listed separately (e.g., 292.9 cannabis-induced psychotic disorder with onset during intoxication, with severe cannabis use disorder; 292.9 phencyclidine-induced psychotic disorder, with onset during intoxication, with mild phencyclidine use disorder).
ICD-10-CM. The name of the substance/medication-induced psychotic disorder begins with the specific substance (e.g., cocaine, dexamethasone) that is presumed to be causing the delusions or hallucinations. The diagnostic code is selected from the table included in the criteria set, which is based on the drug class and presence or absence of a comorbid substance use disorder. For substances that do not fit into any of the classes (e.g., dexamethasone), the code for "other substance" with no comorbid substance use should be used; and in cases in which a substance is judged to be an etiological factor but the specific class of substance is unknown, the category "unknown substance" with no comorbid substance use should be used.
 
When recording the name of the disorder, the comorbid substance use disorder (if any) is listed first, followed by the word "with," followed by the name of the substance-induced psychotic disorder, followed by the specification of onset (i.e., onset during intoxication, onset during withdrawal). For example, in the case of delusions occurring during intoxication in a man with a severe cocaine use disor-
der, the diagnosis is F14.259 severe cocaine use disorder with cocaine-induced psychotic disorder, with onset during intoxication. A separate diagnosis of the comorbid severe cocaine use disorder is not given.
If the substance-induced psychotic disorder occurs without a comorbid substance use disorder (e.g., after a one-time heavy use of the substance), no accompanying substance use disorder is noted (e.g., F16.959 phencyclidine-induced psychotic disorder, with onset during intoxication). When more than one substance is judged to play a significant role in the development of psychotic symptoms, each should be listed separately (e.g., F12.259 severe cannabis use disorder with cannabis-induced psychotic disorder, with onset during intoxication; F16.159 mild phencyclidine use disorder with phencyclidine-induced psychotic disorder, with onset during intoxication).
 

DESK REFERENCE TO THE  DIAGNOSTIC CRITERIA  FROM DSM-5
 
 
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