Ecstasy Diagnoses?

[prominence]

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Under DSM-IV-TR diagnoses, if a pt is abusing or dependent on ecstasy, would that be considered under hallucinogen abuse vs dependence?

 

[digitlnoize]

Under DSM-IV-TR diagnoses, if a pt is abusing or dependent on ecstasy, would that be considered under hallucinogen abuse vs dependence?

Are they JUST using ecstasy alone? My guess is they're probably using other things too and might qualify for Polysubstance...

 

[Therapist4Chnge]

Polysubstance abuse is less useful than specifying each substance.

RE Ecstasy: I'd doubt someone would be able to reach dependance, so without compelling evidence, I'd classify a person's use as Abuse.

 

[TexasPhysician]

Polysubstance abuse is less useful than specifying each substance.

RE Ecstasy: I'd doubt someone would be able to reach dependance, so without compelling evidence, I'd classify a person's use as Abuse.

Polysubstance Abuse is not a DSM recognized diagnosis.

I agree that specifying the substance of abuse/dependence is important.

 

[digitlnoize]

Polysubstance Abuse is not a DSM recognized diagnosis.

I agree that specifying the substance of abuse/dependence is important.

It's not?!? Wow. I've just seen it used so much in practice...sorry, haven't memorized DSM yet...hahaha.

 

[heyjack70]

Polysubstance abuse is less useful than specifying each substance.

RE Ecstasy: I'd doubt someone would be able to reach dependance, so without compelling evidence, I'd classify a person's use as Abuse.

I believe this diagnosis does not exist, though polysubstance dependence does. I agree 100% that you should list every abuse diagnosis because it's the only right way to do it per dsmiv, because polysubstance abuse is not a diagnosis. Though it is used inaccurately by some physicians.

Polysubstance dependence is only used if the person does not meet criteria for dependence with one particular substance, but instead the use of multiple substances in combination are required to meet criteria for the diagnosis. So if someone meets dependence criteria for alcohol and cocaine, you list both dependence diagnoses. It would be incorrect to dx polysubstance dependence in this case. I someone met one dependence criterion for alcohol and two for cocaine, this is the situation where you diagnosis polysubstance dependence. Probably a fairly rare occurrence.

I think you can hit 3 criteria for a dependence diagnosis with ecstasy, though I don't think you would have tolerance/withdrawal, so it would be without physiologic dependence.

Regarding OP, yes ecstasy would fall under hallucinogen abuse/dependence.

 

[TexasPhysician]

It's not?!? Wow. I've just seen it used so much in practice...sorry, haven't memorized DSM yet...hahaha.

Nope.

There is also a distinct difference between:
1. Polysubstance Dependence
And
2. Alcohol Dependence, Opioid Dependence, Amphetamine Dependence

Most don't understand the difference.

 

[billypilgrim37]

The difference being that one is useless but helps you get your notes done 3 seconds faster :0)

 

[Addiction]

You should start becoming acquainted with the new addiction diagnoses in DSM-V which will eliminate 'abuse' and 'dependence' and have one disorder per drug called "substance use disorder". For example, Alcohol Abuse and Alcohol Dependence will no longer exist and there will be only "Alcohol Use Disorder" with 'moderate' or 'severe' specifiers.

 

[michaelrack]

Polysubstance Abuse is not a DSM recognized diagnosis.

.

It used to be.

 

[michaelrack]

I think what the OP was trying to ask is whether ectasy is considered an hallucinogen or a stimulant for DSM purposes (since it has properties of both).

----
looking back at the thread more closely, it appears that Heyjack70 answered the question

here is an article that addresses the question: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2891907/

 

[TexasPhysician]

It used to be.

So was homosexuality for that matter.

 

[Therapist4Chnge]

Polysubstance Abuse is not a DSM recognized diagnosis.

I believe it was from the DSM-III and/or DSM-III-R, though I don't have a copy in front of me to check (we use ICD-9 coding for everything, which I believe only allows for specific coding of each drug). It is still a popular Dx for some clinicians who trained prior to the DSM-IV. There are other codes that were relegated to V-codes, some more deserving than others.

 

[michaelrack]

So was homosexuality for that matter.

Removing homosexuality from DSM was a reasonable political decision for the APA to make.

If the APA ever held another vote on that matter, I would support that decision (well I would, if I was a member of the APA, which I am not).

 

[TexasPhysician]

Removing homosexuality from DSM was a reasonable political decision for the APA to make.

If the APA ever held another vote on that matter, I would support that decision (well I would, if I was a member of the APA, which I am not).

My point exactly, but I would do the same with Polysubstance Abuse. Neither are good diagnoses.

 

[OldPsychDoc]

I believe it was from the DSM-III and/or DSM-III-R, though I don't have a copy in front of me to check (we use ICD-9 coding for everything, which I believe only allows for specific coding of each drug). It is still a popular Dx for some clinicians who trained prior to the DSM-IV. There are other codes that were relegated to V-codes, some more deserving than others.

My pet peeve is that it is a popular dx for lazy residents who find greater than one positive on a urine drug screen. 🙄

 

[notdeadyet]

My pet peeve is that it is a popular dx for lazy residents who find greater than one positive on a urine drug screen. 🙄

My pet peeve as well. Beyond laziness, I get irritated with folks putting "_____ Abuse" anytime that particular drug comes up positive on a utox.

If a person tests hot on cocaine and marijuana, that doesn't mean they fit criteria for Marijuana Abuse or Cocaine Abuse. You need to do some actual psychiatrist stuff to determine how use of those drugs affects their lives and if they fit criteria.

Folks can actually use a drug and if it doesn't affect their work/school/home life in a major way, etc., they don't meet criteria. Slapping a diagnosis based on a lab test is bad psychiatry.

 

[digitlnoize]

It is still a popular Dx for some clinicians who trained prior to the DSM-IV.

That explains my encounters with it. Most of the attendings I've worked with have been on the more "seasoned" side of their careers.

 

[Therapist4Chnge]

My pet peeve is that it is a popular dx for lazy residents who find greater than one positive on a urine drug screen. 🙄

Agreed. It is pretty obvious when a note/intake is rushed, as the differential dx is weak, if not completely absent from the note. Tox screens out of context and without supportive information are useless, though for many it is the "proof" that the person obviously qualifies for "Abuse" or "Dependance".

 

[OldPsychDoc]

My pet peeve as well. Beyond laziness, I get irritated with folks putting "_____ Abuse" anytime that particular drug comes up positive on a utox.

If a person tests hot on cocaine and marijuana, that doesn't mean they fit criteria for Marijuana Abuse or Cocaine Abuse. You need to do some actual psychiatrist stuff to determine how use of those drugs affects their lives and if they fit criteria.

Folks can actually use a drug and if it doesn't affect their work/school/home life in a major way, etc., they don't meet criteria. Slapping a diagnosis based on a lab test is bad psychiatry.

The only thing I find more egregious is the ED docs slapping "Alcohol abuse" on a chart when the patient is here for his 12th detox in 6 months, has cirrhosis, Hep C, and pancreatitis, and was blowing 0.300 on arrival. Especially since it gets coded 305.00 and comes up on the EMR as "non-dependent alcohol abuse"...

 

[billypilgrim37]

Maybe I'm silly, but the substance diagnoses seem very unuseful no matter what you call them. All I want to know is

a) do they need gaba-ergic detox or not
b) do they need opiate detox or not
c) are they at risk for things that come with putting needles in your body
d) is their heart going to explode from something
e) am i going to recommend na, aa, or both.
f) is it worth talking about their nicotine yet or not
g) is their drug use putting them in other dangerous situations

After that, the treatment becomes so much more individualized that I'm not sure that the diagnostic labels inform very much. The labels don't tell you much about how their using the drug or what it's doing for them in what context. The more generalized DSM5 diagnoses seem like a good thing, because it seems most people use "abuse" vs "dependence" as more of a "volume knob" than anything.

 

[Apollyon]

The only thing I find more egregious is the ED docs slapping "Alcohol abuse" on a chart when the patient is here for his 12th detox in 6 months, has cirrhosis, Hep C, and pancreatitis, and was blowing 0.300 on arrival. Especially since it gets coded 305.00 and comes up on the EMR as "non-dependent alcohol abuse"...

Being an EM doc, explain to me what is the problem, namely, why ISN'T it "alcohol abuse"? I'm missing something here. Or are you saying that an alcohol addicted person can't abuse? I don't think you are, but I just don't get it (and that is not the idiotic "I have no idea what you are talking about", when someone - like, frequently, on SDN - is being pedantic and intentionally obtuse).

 

[TexasPhysician]

Being an EM doc, explain to me what is the problem, namely, why ISN'T it "alcohol abuse"? I'm missing something here. Or are you saying that an alcohol addicted person can't abuse? I don't think you are, but I just don't get it (and that is not the idiotic "I have no idea what you are talking about", when someone - like, frequently, on SDN - is being pedantic and intentionally obtuse).

I think the problem is labeling it "abuse" and not "dependence". Dependence includes likely withdrawal and more intensive medical care. Some docs will label a patient as having alcohol abuse when they are going through dt's, seizing, etc. Abuse does not adequately document the seriousness of the situation.

 

[OldPsychDoc]

Maybe I'm silly, but the substance diagnoses seem very unuseful no matter what you call them. All I want to know is

a) do they need gaba-ergic detox or not
b) do they need opiate detox or not
c) are they at risk for things that come with putting needles in your body
d) is their heart going to explode from something
e) am i going to recommend na, aa, or both.
f) is it worth talking about their nicotine yet or not
g) is their drug use putting them in other dangerous situations

After that, the treatment becomes so much more individualized that I'm not sure that the diagnostic labels inform very much. The labels don't tell you much about how their using the drug or what it's doing for them in what context. The more generalized DSM5 diagnoses seem like a good thing, because it seems most people use "abuse" vs "dependence" as more of a "volume knob" than anything.

Coding and billing, my young friend. It's all about the coding and billing.

 

[OldPsychDoc]

I think the problem is labeling it "abuse" and not "dependence". Dependence includes likely withdrawal and more intensive medical care. Some docs will label a patient as having alcohol abuse when they are going through dt's, seizing, etc. Abuse does not adequately document the seriousness of the situation.

That, and the DSM4 criteria to call it "abuse" clearly requires "never met criteria for dependence for this class of substance".

You can look it up... 😎

 

[TexasPhysician]

That, and the DSM4 criteria to call it "abuse" clearly requires "never met criteria for dependence for this class of substance".

You can look it up... 😎

How does this add to answering Apollyon's question?

 

[Apollyon]

I am not trying to sow dissent or cause a disruption; this now tells me more. In my current system, Cerner is from the devil, and I often turn out first starting by entering text for diagnoses, then, when they pop up, looking at the ICD-9 code, then entering the ICD-9 to get a better, more precise dx.

So, call it ETOH dependence. Right on! Thank you! I can tell you, at least for me, but probably extrapolatable, that I thought 305.00 was on a continuum, and didn't think that that flummoxed the whole works by using it.

 

[notdeadyet]

Being an EM doc, explain to me what is the problem, namely, why ISN'T it "alcohol abuse"? I'm missing something here. Or are you saying that an alcohol addicted person can't abuse? I don't think you are, but I just don't get it (and that is not the idiotic "I have no idea what you are talking about", when someone - like, frequently, on SDN - is being pedantic and intentionally obtuse).

While you can have Acute Kidney Failure on Chronic Kidney Failure, you can't have Alcohol Abuse on Alcohol Dependence. The DSM criteria for ETOH Abuse is that someone doesn't meet criteria for ETOH Dependence.

So in OPD's scenario of a patient with 12 detoxes in 6 months, cirrhosis, Hep C, pancreatitis and a BAL at dangerous levels, the patient meets criteria for ETOH Dependence. He's had unsuccessful efforts to quit, spent a great deal of time trying to recover from ETOH effects, and continues drinking despite physical problems being exacerbated by ETOH.

That's 3 of the 7 criteria you need to meet ETOH Dependence. From an ED perspective, those three are probably frequently seen and you can immediately chart a ETOH Dependence code.

Make sense?

 

[Apollyon]

While you can have Acute Kidney Failure on Chronic Kidney Failure, you can't have Alcohol Abuse on Alcohol Dependence. The DSM criteria for ETOH Abuse is that someone doesn't meet criteria for ETOH Dependence.

So in OPD's scenario of a patient with 12 detoxes in 6 months, cirrhosis, Hep C, pancreatitis and a BAL at dangerous levels, the patient meets criteria for ETOH Dependence. He's had unsuccessful efforts to quit, spent a great deal of time trying to recover from ETOH effects, and continues drinking despite physical problems being exacerbated by ETOH.

That's 3 of the 7 criteria you need to meet ETOH Dependence. From an ED perspective, those three are probably frequently seen and you can immediately chart a ETOH Dependence code.

Make sense?

That is SO MONEY, you don't even know it! Thank you!

 

[Encephalopathy]

Re: MDMA, I would consider it a stimulant, not a hallucinogen. It's an amphetamine derivative with the classic effects of euphoria, increased energy, insomnia, and anorexia. Perceptual disturbances can occur, but not to the extent seen with LSD, psilocybin, or mescaline.

 

[kugel]

Encephalopathy,
It is my understanding as well that Ecstasy gets properly identified as an "amphetamine-like" stimulant substance, whether you are coding the intoxication, abuse, or (theoretically) dependence.