Cocaine intoxication
292.89 Cocaine Intoxication
Refer, in addition, to the text and criteria for Substance Intoxication (see p. 199). The essential feature of Cocaine Intoxication is the presence of clinically significant maladaptive behavioral or psychological changes that develop during, or shortly after, use of cocaine (Criteria A and B). Cocaine Intoxication usually begins with a "high" feeling and includes one or more of the following: euphoria with enhanced vigor, gregariousness, hyperactivity, restlessness, hypervigilance, interpersonal sensitivity, talkativeness, anxiety, tension, alertness, grandiosity, stereotyped and repetitive behavior, anger, and impaired judgment, and in the case of chronic intoxication, affective blunting with fatigue or sadness and social withdrawal. These behavioral and psychological changes are accompanied by two or more of the following signs and symptoms that develop during or shortly after cocaine use: tachycardia or bradycardia; pupillary dilation; elevated or lowered blood pressure; perspiration or chills; nausea or vomiting; evidence of weight loss; psychomotor agitation or retardation; muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias; and confusion, seizures, dyskinesias, dystonias, or coma (Criterion C). Intoxication, either acute or chronic, is often associated with impaired social or occupational functioning. Severe intoxication can lead to convulsions, cardiac arrhythmias, hyperpyrexia, and death. To make a diagnosis of Cocaine Intoxication, the symptoms must not be due to a general medical condition and are not better accounted for by another mental disorder (Criterion D).
The magnitude and direction of the behavioral and physiological changes depend on many variables, including the dose used and the individual characteristics of the person using the substance (e.g., tolerance, rate of absorption, chronicity of use, context in which it is taken). Stimulant effects such as euphoria, increased pulse and blood pressure, and psychomotor activity are most commonly seen. Depressant effects such as sadness, bradycardia, decreased blood pressure, and decreased psychomotor activity are less common and generally emerge only with chronic high-dose use.
Specifier
The following specifier may be applied to a diagnosis of Cocaine Intoxication:
With Perceptual Disturbances. This specifier may be noted when hallucinations with intact reality testing or auditory, visual, or tactile illusions occur in the absence of a delirium. Intact reality testing means that the person knows that the hallucinations are induced by the substance and do not represent external reality. When hallucinations occur in the absence of intact reality testing, a diagnosis of Substance-Induced Psychotic Disorder, With Hallucinations, should be considered.
Diagnostic criteria for 292.89 Cocaine Intoxication
- Recent use of cocaine.
- Clinically significant maladaptive behavioral or psychological changes (e.g., euphoria or affective blunting; changes in sociability; hypervigilance; interpersonal sensitivity; anxiety, tension, or anger; stereotyped behaviors; impaired judgment; or impaired social or occupational functioning) that developed during, or shortly after, use of cocaine.
- Two (or more) of the following, developing during, or shortly after, cocaine use:
- tachycardia or bradycardia
- pupillary dilation
- elevated or lowered blood pressure
- perspiration or chills
- nausea or vomiting
- evidence of weight loss
- psychomotor agitation or retardation
- muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias
- confusion, seizures, dyskinesias, dystonias, or coma
- The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.
Specify if:
With Perceptual Disturbances