Laboratory testing may be useful, as phencyclidine is detectable in urine for up to 8 days following use, although the levels are only weakly associated with an individual’s clinical presentation and may therefore not be useful for case management. Creatine phosphoki- nase and aspartate aminotransferase levels may be elevated.
Functional Consequences of Phencyclidine Intoxication
Phencyclidine intoxication produces extensive cardiovascular and neurological (e.g., sei- zures, dystonias, dyskinesias, catalepsy, hypothermia or hyperthermia) toxicity.
In particular, in the absence of intact reality testing (i.e., without insight into any percep- tual abnormalities), an additional diagnosis of phencyclidine-induced psychotic disorder should be considered.
Other substance intoxication. Phencyclidine intoxication should be differentiated from intoxication due to other substances, including other hallucinogens; amphetamine, co- caine, or other stimulants; and anticholinergics, as well as withdrawal from benzodiaze- pines. Nystagmus and bizarre and violent behavior may distinguish intoxication due to phencyclidine from that due to other substances. Toxicological tests may be useful in mak- ing this distinction, since phencyclidine is detectable in urine for up to 8 days after use.
However, there is a weak correlation between quantitative toxicology levels of phencycli- dine and clinical presentation that diminishes the utility of the laboratory findings for pa- tient management.
Other conditions. Other conditions to be considered include schizophrenia, depression, withdrawal from other drugs (e.g., sedatives, alcohol), certain metabolic disorders like hy- poglycemia and hyponatremia, central nervous system tumors, seizure disorders, sepsis, neuroleptic malignant syndrome, and vascular insults.
A. Recent use of a hallucinogen (other than phencyclidine).
B. Clinically significant problematic behavioral or psychological changes (e.g., marked anxiety or depression, ideas of reference, fear of “losing one's mind," paranoid ide- ation, impaired judgment) that developed during, or shortly after, hallucinogen use.
C. Perceptual changes occurring in a state of full wakefulness and alertness (e.g., sub- jective intensification of perceptions, depersonalization, derealization, illusions, hallu- cinations, synesthesias) that developed during, or shortly after, hallucinogen use.
D. Two (or more) of the following signs developing during, or shortly after, hallucinogen use:
Pupillary dilation.
Tachycardia.
Sweating.
Palpitations.
Blurring of vision.
Tremors.
7. Incoordination.
E. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another sub- stance.
Coding note: The |CD-9-CM code is 292.89. The lCD-10-CM code depends on whether there is a comorbid hallucinogen use disorder. It a mild hallucinogen use disorder is co- morbid, the |CD-10-CM code is F16.129, and if a moderate or severe hallucinogen use disorder is comorbid, the |CD-10-CM code is F16.229. If there is no comorbid hallucinogen use disorder, then the |CD-10-CM code is F16.929.
Note: For information on Associated Features Supporting Diagnosis and Culture-Related
Diagnostic Issues, see the corresponding sections in other hallucinogen use disorder.