Coding note: Include the name of the other medical condition in the name of the mental disorder (e.g., 293.81 [F06.2] psychotic disorder due to malignant lung neoplasm, with de— lusions). The other medical condition should be coded and listed separately immediately before the psychotic disorder due to the medical condition (e.g., 162.9 [C3490] malignant lung neoplasm; 293.81 [F06.2] psychotic disorder due to malignant lung neoplasm, with delusions).
Specify current severity:
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 chap-
Note: Diagnosis of psychotic disorder due to another medical condition can be made without using this severity specifier.
In addition to the symptom domain areas identified in the diagnostic criteria, the assess- ment of cognition, depression, and mania symptom domains is vital for making critically important distinctions between the various schizophrenia spectrum and other psychotic disorders.
The essential features of psychotic disorder due to another medical condition are promi- nent delusions or hallucinations that are judged to be attributable to the physiological ef— fects of another medical condition and are not better explained by another mental disorder (e.g., the symptoms are not a psychologically mediated response to a severe medical con- dition, in which case a diagnosis of brief psychotic disorder, with marked stressor, would be appropriate).
Hallucinations can occur in any sensory modality (i.e., visual, olfactory, gustatory, tac- tile, or auditory), but certain etiological factors are likely to evoke specific hallucinatory phenomena. Olfactory hallucinations are suggestive of temporal lobe epilepsy. Hallucina- tions may vary from simple and unformed to highly complex and organized, depending on etiological and environmental factors. Psychotic disorder due to another medical con- dition is generally not diagnosed if the individual maintains reality testing for the hallu- cinations and appreciates that they result from the medical condition. Delusions may have a variety of themes, including somatic, grandiose, religious, and, most commonly, perse- cutory. On the whole, however, associations between delusions and particular medical conditions appear to be less specific than is the case for hallucinations.
In determining whether the psychotic disturbance is attributable to another medical condition, the presence of a medical condition must be identified and considered to be the etiology of the psychosis through a physiological mechanism. Although there are no infallible guidelines for determining whether the relationship between the psychotic distur- bance and the medical condition is etiological, several considerations provide some guidance.
One consideration is the presence of a temporal association between the onset, exacerba- tion, or remission of the medical condition and that of the psychotic disturbance. A second consideration is the presence of features that are atypical for a psychotic disorder (e.g., atypical age at onset or presence of Visual or olfactory hallucinations). The disturbance must other mental disorder (e.g., an adjustment disorder).
The temporal association of the onset or exacerbation of the medical condition offers the greatest diagnostic certainty that the delusions or hallucinations are attributable to a med- ical condition. Additional factors may include concomitant treatments for the underlying medical condition that confer a risk for psychosis independently, such as steroid treatment for autoimmune disorders.
Prevalence rates for psychotic disorder due to another medical condition are difficult to es- timate given the wide variety of underlying medical etiologies. Lifetime prevalence has