Substance intoxication or substance withdrawal. Individuals intoxicated with stimu- lants, cannabis, the opioid meperidine, or phencyclidine, or those withdrawing from alco- hol or sedatives, may experience altered perceptions that they recognize as drug effects. If reality testing for these experiences remains intact (i.e., the individual recognizes that the perception is substance induced and neither believes in nor acts on it), the diagnosis is not substance/medication-induced psychotic disorder. Instead, substance intoxication or substance withdrawal, with perceptual disturbances, is diagnosed (e.g., cocaine intoxica- tion, with perceptual disturbances). ”Flashback” hallucinations that can occur long after the use of hallucinogens has stopped are diagnosed as hallucinogen persisting perception disorder. If substance/medication-induced psychotic symptoms occur exclusively during the course of a delirium, as in severe forms of alcohol withdrawal, the psychotic symptoms are considered to be an associated feature of the delirium and are not diagnosed sepa- rately. Delusions in the context of a major or mild neurocognitive disorder would be di- agnosed as major or mild neurocognitive disorder, with behavioral disturbance.
Psychotic Disorder Due to Another Medical Condition 115
Primary psychotic disorder. A substance/medication- induced psychotic disorder is distinguished from a primary psychotic disorder, such as schizophrenia, schizoaffective disorder, delusional disorder, brief psychotic disorder, other specified schizophrenia spectrum and other psychotic disorder, or unspecified schizophrenia spectrum and other psychotic disorder, by the fact that a substance is judged to be etiologically related to the symptoms.
Psychotic disorder due to another medical condition. A substance/medication—induced psychotic disorder due to a prescribed treatment for a mental or medical condition must have its onset while the individual is receiving the medication (or during withdrawal, if there is a withdrawal syndrome associated with the medication). Because individuals with medical conditions often take medications for those conditions, the clinician must con- sider the possibility that the psychotic symptoms are caused by the physiological conse- quences of the medical condition rather than the medication, in which case psychotic disorder due to another medical condition is diagnosed. The history often provides the primary basis for such a judgment. At times, a change in the treatment for the medical con- dition (e.g., medication substitution or discontinuation) may be needed to determine em- pirically for that individual whether the medication is the causative agent. If the clinician has ascertained that the disturbance is attributable to both a medical condition and sub- stance/medication use, both diagnoses (i.e., psychotic disorder due to another medical condition and substance/medication-induced psychotic disorder) may be given.
Due to Another Medical Condition
A. Prominent hallucinations or delusions.
B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condi- tion.
C. The disturbance is not better explained by another mental disorder.
D. The disturbance does not occur exclusively during the course of a delirium.
E. The disturbance causes clinically significant distress or impairment in social, occupa- tional. or other important areas of functioning.
Specify whether:
Code based on predominant symptom: 293.81 (F06.2) With delusions: If delusions are the predominant symptom.
293.82 (F06.0) With hallucinations: If hallucinations are the predominant symptom.