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 intoxi- cation in a man with a severe cocaine use disorder, 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 sub- (e.g., after a one-time heavy use of the substance), no accompanying substance use disor- der is noted (e.g., F16.959 phencyclidine-induced psychotic disorder, with onset during in- toxication). 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 intox- ication; F16.159 mild phencyclidine use disorder with phencyclidine-induced psychotic disorder, with onset during intoxication).
The essential features of substance /medication-induced psychotic disorder are prominent delusions and/ or hallucinations (Criterion A) that are judged to be due to the physiolog- ical effects of a substance/medication (i.e., a drug of abuse, a medication, or a toxin expo- sure) (Criterion B). Hallucinations that the individual realizes are substance/medication- induced are not included here and instead would be diagnosed as substance intoxication or substance withdrawal with the accompanying specifier "with perceptual disturbances” (applies to alcohol withdrawal; cannabis intoxication; sedative, hypnotic, or anxiolytic withdrawal; and stimulant intoxication).
A substance/medication-induced psychotic disorder is distinguished from a primary psychotic disorder by considering the onset, course, and other factors. For drugs of abuse, there must be evidence from the history, physical examination, or laboratory findings of substance use, intoxication, or withdrawal. Substance/ medication-induced psychotic disorders arise during or soon after exposure to a medication or after substance intoxica- tion or withdrawal but can persist for weeks, whereas primary psychotic disorders may precede the onset of substance/medication use or may occur during times of sustained ab- stinence. Once initiated, the psychotic symptoms may continue as long as the substance/ medication use continues. Another consideration is the presence of features that are atyp- ical of a primary psychotic disorder (e.g., atypical age at onset or course). For example, the appearance of delusions de novo in a person older than 35 years without a known history of a primary psychotic disorder should suggest the possibility of a substance/medication- induced psychotic disorder. Even a prior history of a primary psychotic disorder does not rule out the possibility of a substance /medication-induced psychotic disorder. In contrast, factors that suggest that the psychotic symptoms are better accounted for by a primary psychotic disorder include persistence of psychotic symptoms for a substantial period of time (i.e., a month or more) after the end of substance intoxication or acute substance with- drawal or after cessation of medication use; or a history of prior recurrent primary psy— chotic disorders. Other causes of psychotic symptoms must be considered even in an individual with substance intoxication or withdrawal, because substance use problems are not uncommon among individuals with non-substance/medication-induced psychotic disorders.