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So patients cannot be involuntarily signed into our psych EC (or our inpatient unit) if their absolute only problem is drug intoxication. Same is true if their only problem is known to be antisocial personality d/o. Today I tried to dodge a consult in the ER which was for "agitation and paranoia" that was clearly due to drugs and nothing else. It did not seem like something you would call "primary psych."
However, substance abuse is in the DSM in a wide multitude of permutations. Primary psych or not, I would have no trouble labeling this patient with an Axis I disorder. The same is true for ASPD. Even malingering is a V code, I believe, and you could interpret it in such a way as to qualify as an antisocial trait and thus be a psychiatric symptom. Then there are smaller things like nicotine and caffeine dependence and jet lag. All these are in the DSM yet I doubt anyone would call them "primary psych" disorders. I bet almost no one would commit a patient to an inpatient unit just on the basis of nicotine dependence, for example.
So my question is, why are things like schizophrenia and depression considered "primary psychiatric" but many other things, including drug use, are not? At least not for the purposes of many consults, admissions and commitment laws. The distinction seems really arbitrary to me!
However, substance abuse is in the DSM in a wide multitude of permutations. Primary psych or not, I would have no trouble labeling this patient with an Axis I disorder. The same is true for ASPD. Even malingering is a V code, I believe, and you could interpret it in such a way as to qualify as an antisocial trait and thus be a psychiatric symptom. Then there are smaller things like nicotine and caffeine dependence and jet lag. All these are in the DSM yet I doubt anyone would call them "primary psych" disorders. I bet almost no one would commit a patient to an inpatient unit just on the basis of nicotine dependence, for example.
So my question is, why are things like schizophrenia and depression considered "primary psychiatric" but many other things, including drug use, are not? At least not for the purposes of many consults, admissions and commitment laws. The distinction seems really arbitrary to me!