Substance intoxication
Substance Intoxication
Diagnostic Features
The essential feature of Substance Intoxication is the development of a reversible substance-specific syndrome due to the recent ingestion of (or exposure to) a substance (Criterion A). The clinically significant maladaptive behavioral or psychological changes associated with intoxication (e.g., belligerence, mood lability, cognitive impairment, impaired judgment, impaired social or occupational functioning) are due to the direct physiological effects of the substance on the central nervous system and develop during or shortly after use of the substance (Criterion B). The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder (Criterion C). Substance Intoxication is often associated with Substance Abuse or Dependence. This category does not apply to nicotine. Evidence for recent intake of the substance can be obtained from the history, physical examination (e.g., smell of alcohol on the breath), or toxicological analysis of body fluids (e.g., urine or blood).
The most common changes involve disturbances of perception, wakefulness, attention, thinking, judgment, psychomotor behavior, and interpersonal behavior. The specific clinical picture in Substance Intoxication varies dramatically among individuals and also depends on which substance is involved, the dose, the duration or chronicity of dosing, the person's tolerance for the substance, the period of time since the last dose, the expectations of the person as to the substance's effects, and the environment or setting in which the substance is taken. Short-term or "acute" intoxications may have different signs and symptoms from sustained or "chronic" intoxications. For example, moderate cocaine doses may initially produce gregariousness, but social withdrawal may develop if such doses are frequently repeated over days or weeks.
Different substances (sometimes even different substance classes) may produce identical symptoms. For example, Amphetamine and Cocaine Intoxication can both present with grandiosity and hyperactivity, accompanied by tachycardia, pupillary dilation, elevated blood pressure, and perspiration or chills. Also, alcohol and substances from the sedative, hypnotic, or anxiolytic class produce similar symptoms of intoxication.
When used in the physiological sense, the term intoxication is broader than Substance Intoxication as defined here. Many substances may produce physiological or psychological changes that are not necessarily maladaptive. For example, an individual with tachycardia from excessive caffeine use has a physiological intoxication, but if this is the only symptom in the absence of maladaptive behavior, the diagnosis of Caffeine Intoxication would not apply. The maladaptive nature of a substance-induced change in behavior depends on the social and environmental context. The maladaptive behavior generally places the individual at significant risk for adverse effects (e.g., accidents, general medical complications, disruption in social and family relationships, vocational or financial difficulties, legal problems). Signs and symptoms of intoxication may sometimes persist for hours or days beyond the time when the substance is detectable in body fluids. This may be due to continuing low concentrations of the substance in certain areas of the brain or to a "hit and run" effect in which the substance alters a physiological process, the recovery of which takes longer than the time for elimination of the substance. These longer-term effects of intoxication must be distinguished from withdrawal (i.e., symptoms initiated by a decline in blood or tissue concentrations of a substance).
Criteria for Substance Intoxication
- The development of a reversible substance-specific syndrome due to recent ingestion of (or exposure to) a substance.Note: Different substances may produce similar or identical syndromes.
- Clinically significant maladaptive behavioral or psychological changes that are due to the effect of the substance on the central nervous system (e.g., belligerence, mood lability, cognitive impairment, impaired judgment, impaired social or occupational functioning) and develop during or shortly after use of the substance.
- The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.