Anxiety and depressive disorders. Discontinuation symptoms often resemble symptoms of a persistent anxiety disorder or a return of somatic symptoms of depression for which the medication was initially given.
Substance use disorders. Antidepressant discontinuation syndrome differs from sub- fects. The medication dosage has usually not been increased without the clinician’s permission, and the individual generally does not engage in drug-seeking behavior to ob- tain additional medication. Criteria for a substance use disorder are not met.
Tolerance to medications. Tolerance and discontinuation symptoms can occur as a normal physiological response to stopping medication after a substantial duration of exposure. Most cases of medication tolerance can be managed through carefully con- trolled tapering.
Typically, the individual was initially started on the medication for a major depressive dis- order; the original symptoms may return during the discontinuation syndrome.
Other Adverse Effect of Medication 995.20 (T 50.905A) Initial encounter 995.20 (T 50.905D) Subsequent encounter 995.20 (T 50.9058) Sequelae
This category is available for optional use by clinicians to code side effects of medication (other than movement symptoms) when these adverse effects become a main focus of clin- ical attention. Examples include severe hypotension, cardiac arrhythmias, and priapism.
a Focus of Cllnical Attention
This d iscussion covers other conditions and problems that may be a focus of clini- cal attention or that may otherwise affect the diagnosis, course, prognosis, or treatment of a patient’s mental disorder. These conditions are presented with their corresponding codes from ICD-9-CM (usually V codes) and ICD-10-CM (usually Z codes). A condition or problem in this chapter may be coded if it is a reason for the current visit or helps to explain the need for a test, procedure, or treatment. Conditions and problems in this chap- ter may also be included in the medical record as useful information on circumstances that may affect the patient’s care, regardless of their relevance to the current visit.
The conditions and problems listed in this chapter are not mental disorders. Their in- clusion in DSM-5 is meant to draw attention to the scope of additional issues that may be encountered in routine clinical practice and to provide a systematic listing that may be useful to clinicians in documenting these issues.
Key relationships, especially intimate adult partner relationships and parent/caregiver- child relationships, have a significant impact on the health of the individuals in these re- lationships. These relationships can be health promoting and protective, neutral, or detri- mental to health outcomes. In the extreme, these close relationships can be associated with maltreatment or neglect, which has significant medical and psychological consequences for the affected individual. A relational problem may come to clinical attention either as the reason that the individual seeks health care or as a problem that affects the course, prognosis, or treatment of the individual’s mental or other medical disorder.
Problems Related to Family Upbringing
V61.20 (Z62.820) Parent-Child Relational Problem
For this category, the term parent is used to refer to one of the child’s primary caregivers, who may be a biological, adoptive, or foster parent or may be another relative (such as a grandparent) who fulfills a parental role for the child. This category should be used when the main focus of clinical attention is to address the quality of the parent-child relationship or when the quality of the parent—child relationship is affecting the course, prognosis, or treatment of a mental or other medical disorder. Typically, the parent-child relational problem is associated with impaired functioning in behavioral, cognitive, 0r affective do- mains. Examples of behavioral problems include inadequate parental control, supervision, and involvement with the child; parental overprotection; excessive parental pressure; ar- guments that escalate to threats of physical violence; and avoidance without resolution of problems. Cognitive problems may include negative attributions of the other’s intentions, hostility toward or scapegoating of the other, and unwarranted feelings of estrangement.