Mental disorders and behavioral disorders caused by the use of psychoactive substances

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Mental disorders and behavioral disorders caused by the use of psychoactive substances (marked under codes F10 - F19 in the ICD-10) are a wide range of diseases and conditions of varying severity, duration and symptoms. Their common feature is that they are a direct consequence of the use of a psychoactive substance (whether legal or illegal drugs or pharmaceuticals).

Division
In this context, it is necessary to recall the way in which the 10th edition of the International Classification of Diseases (hereafter referred to as ICD-10) uses a four-character designation reflecting the current state of the patient, since the 3rd and 4th characters of the diagnosis are for further progress in psychiatry and addiction in addition to complete anamnesis very important data for further interventions (medication, institutional treatment, substitution treatment).

Generally, the diagnosis code is of the form XXX.X, where:
 * The first character is the letter indicating the chapter, i.e. the affected organ system, or process, injury, etc. (A-New growths, F-Psychiatric disorders, K-Diseases of the digestive system O-Pregnancy and related processes)


 * The second character is a number indicating the sub-chapter (section) where there is more detailed information; therefore, it reduces the chapter to parts with common characteristics - usually a certain type of disease, etiology, localization, etc. This part indicates, for example, a specific damaged organ or a group of diseases with similar characteristics, etc. (F2 - schizophrenia, schizotypal disorders and disorders with delusions)


 * The third character is a number, which already de facto indicates the diagnosis (e.g. F20 - Schizophrenia). For some diseases and processes, this may be the last sign, as the fourth sign would lose its meaning (e.g. P60 - Disseminated intravascular coagulation in a fetus or newborn (DIC))

The third character in the table below (replaced by the symbol "X" for generality) indicates the psychoactive substance or group of substances that the patient is/was using (see "related articles" at the end of the article). In psychiatry, in chapter F1, or section F10 - F19 we find the following breakdown in fourth place. The fourth place usually specifies the clinical condition.
 * The fourth - and last character (also a number) - is separated from the previous three by a dot. It specifies other important information as precisely as possible, possibly a clinical picture (e.g. F20.1 - Hebephrenic schizophrenia)

Note: Not every psychoactive substance (group of substances) can be diagnosed according to ICD-10 with the 4th sign - e.g. withdrawal from hallucinogens is very rare, and in practice there are no psychotic disorders caused by nicotine or withdrawal with delirium after caffeine use.

Clinical picture of acute intoxication, addiction syndrome and withdrawal state, or withdrawal state with delirium after the use of psychoactive substances are described in more detail in the articles on disorders caused by a specific substance (or group of substances).

Addictions of iatrogenic origin
A number of disorders resulting from the use of psychoactive substances are induced iatrogenically, i.e. by inadequate medication. A frequent case is the long-term administration of opioid analgesics to patients with chronic non-tumor pain, if there are other alternatives - e.g. new NSAIDs (often their combination with caffeine, spasmolytics or other synergistic agents), or tricyclic antidepressants or antiepileptics. For some types of long-term pain - usually superficial - capsaicin can be applied locally with success. For cancer pain, or in palliative medicine is emerging addiction, or increasing tolerance to opioid analgesics, a situation where even the use of high doses of opioids (including its negative consequences such as spastic constipation and medication depression) is still a greater benefit than treatment with less effective analgesics reducing the patient's quality of life.

The second - very common in practice - case is the long-term medication of anxiety disorders or insomnia using benzodiazepines. Benzodiazepine anxiolytics, or hypnotics can be - especially in predisposed patients - highly addictive and it is recommended to administer them only for a few weeks (max. 2 months), e.g. before the full effect of antidepressants becomes apparent. Insomnia can be temporarily treated with "Z" hypnotics (zolpidem, zopiclone, zaleplon), which also allosterically bind to GABAergic receptors, but exclusively on a specific subunit and carry a lower (although still high!) risk of addiction than diazepam, bromazepam and other classic benzodiazepines. In case of substance abuse (even if there is a history), it is better to avoid benzodiazepines completely (unless required by e.g. another comorbidity - typically epilepsy) and choose non-benzodiazepine anxiolytics/hypnotics in higher doses (hydroxyzine, guaifenesin), sedative antidepressants (trazodone, mirtazapine), low doses of atypical antipsychotics, or pregabalin.

Related Articles

 * Alcohol use disorders
 * Opioid use disorders
 * Disorders induced by the use of cannabinoids
 * Disorders caused by the use of sedatives or hypnotics
 * Cocaine use disorders
 * Disorders induced by the use of other stimulants (including caffeine)