Substance-Related and Addictive Disorders

Question 1

Overall Breakdown of Substance Use Related Disorders

Answer 1

Divided into:

Substance use disorder

Substance-induced disorders
- Intoxication
- Withdrawal
- Substance/Medical-induced mental disorders

Question 2

Which substance doesn’t have a use disorder

Answer 2

Caffeine

Question 3

Which substance doesn’t have an intoxication disorder

Answer 3

Tobacco

Question 4

Overall: Substance Use Disorder

Answer 4

Cognitive, behavioral and psychological symptoms, continued use despite significant substance-related problems – typically 11 symptoms, in 12 months

Meet 2 to be mild!!

Categories include:

(Symptom 1-4) Impaired control over substance use

(Symptom 5-7) Social impairment

(Symptom 8-9) Risky use of the substance

(Symptom 10) Tolerance

(Symptom 11) Withdrawal

tolerance and withdrawal vary across symptoms

Question 5

Impaired control over substance use – SYMPTOMS

Answer 5

taken in larger amounts/over longer period than intended

Can’t cut down on use (with desire/effort)

Good amount of time spent getting, using, recovery

Cravings to use

Question 6

Social impairment – SYMPTOMS

Answer 6

failure to fulfill major role obligations

continued use despite interpersonal problems from substance use

Social/recreational activies given up because of substance use

Question 7

Risky use of the substance – SYMPTOMS

Answer 7

Substance use in physically hazardous situations

Continued use despite knowing its causing or worsening physical and psychological problems

Question 8

Tolerance and Withdrawl SYMPTOMS

Answer 8

TOLERANCE

Defined by either; need more to achieve intoxication, same amount of use has diminished effect

WITHDRAWAL

Defined by either: criteria from withdrawal diagnosis, or use of current substance/medical aid to avoid withdrawl symptoms

Question 9

Substance Use Disorder GENERAL SPECIFIERS

Answer 9

In early remission (at least 3 months no criteria met except for craving)

Sustained remission (12 months with no criteria met except for craving)

In a controlled environment (don’t have access)

Question 10

Substance Use Disorder CODING

Answer 10

IF NO COMORBIDITY WHAT I DON”T KNOW

DM5 TR: single combined code for substance use and substance induced aspects of the clinical picture (integrated!) MAJOR CHANGE FROM DSM5 TO MATCH ICD

mild
mild, in early remission
mild, in sustained remission
(REPEAT FOR MODERATE, SEVERE)

Question 11

Overall: Substance Intoxication

Answer 11

Recent ingestion

Clinically significant behavior or psychological changes caused by physiological effects of substance after use of substance

Changes are associated with substance-specific symptoms (list of symptoms)

Symptoms not attributable to another medical condition or disorder

Question 12

Overall: Substance Withdrawal

Answer 12

Cessation/reduction in prolonged heavy substance use

Development of substance-specific behavioral, physiological, and cognitive symptoms (list of symptoms, substance specific)

Clinically significant distress/impairment

not attributable to another medical condition or mental disorder

Question 13

Overall: Substance/medication-induced mental disorders

Answer 13

IN DIFFERENT SECTIONS

Clinically significant symptoms predominates clinical picture

Evidence (history, labs, etc.) that both: symptoms in A developed after medication use (intoxication, withdrawal), AND medication can produce symptoms A

Not better explained by independent mental disorder

Disturbance not just during delirium

Clinically significant impairment

Question 14

Gambling Disorder

Answer 14

A: persistent and recurrent problematic gambling behavior leading to clinically significant impairments or distress, 4/9 symptoms, 12-month period

B: not a manic episode (they are very similar)

Specifiers:
- Episodic/persistent
- Remission (not met for at least 3 months = remission, sustained Is 12-month period)
- Specify if severe

Question 15

Remission for substance use

Answer 15

typically 3 months