Mkb narcology. Types of psychoactive substances (surfactants). F1x.05x Acute intoxication with coma

Alcohol addiction is a strong craving for alcohol, its regular use. A person suffering from alcohol addiction has an irresistible, uncontrollable desire to drink, which becomes more important than almost everything else in his life. It is this craving, the difficulty to limit the amount of alcohol you drink, and the withdrawal symptoms that occur after you stop drinking alcohol that distinguishes alcohol dependence from alcohol abuse (regular drinking in excess).

Risk factors

It is most common in men between the ages of 20 and 40. Sometimes it is inherited. People who are fearful, anxious, and depressed may try to reduce their anxiety with large doses of alcohol. These people are at increased risk of addiction if they work in bars or other places where alcohol is consumed.

Alcohol dependence is often the result of a combination of various factors. Sometimes the predisposition to abuse is laid down in the family, incl. when raising a child surrounded by heavy drinkers.

Symptoms

Symptoms may include:

• a strong, uncontrollable desire to drink and loss of control over the amount of alcohol consumed;
• increasing resistance to the effects of alcohol, which leads to an increase in alcohol consumption in order to achieve the desired effect;
• Withdrawal symptoms such as nausea, sweating, and tremors that occur several hours after the last drink of alcohol.

Complications

In severe cases, withdrawal syndrome may occur after the complete cessation of alcohol consumption. After a few days of absolute sobriety, delirium tremens may develop, accompanied by symptoms such as fever, trembling, seizures, disorientation, and hallucinations. The condition can last 3-4 days. In extreme cases, shock can develop, which sometimes leads to the death of the patient.

Alcohol has a direct effect on the human body and brain, it can cause the development of many diseases. Long-term alcohol dependence is the most common cause of serious liver disease, and alcohol can also affect digestive system human, resulting in stomach ulcers.

People who drink a lot are often malnourished, which can lead to a deficiency in the body (thiamine) and, as a result, the development of dementia. In rare cases, chronic thiamine deficiency causes Wernicke-Korsakoff syndrome, a severe brain disease accompanied by impaired consciousness and memory loss, which can lead to the development of coma. If excessive consumption of alcoholic beverages has continued long enough, the resulting damage to the internal organs can threaten the patient's life.

In addition to the damage caused by alcohol to the liver and brain, regular excessive alcohol consumption can destroy families, relationships with other people and careers.

Gradual reduction of alcohol doses or limiting its use to acceptable levels is rarely possible. Instead, the patient will be asked to stop drinking altogether. In cases of mild or moderate abstinence syndrome, the process of its removal can be carried out at home, where the patient is provided with all possible support. For a short time, drugs such as benzodiazepines may be prescribed to reduce anxiety and other physiological manifestations of withdrawal symptoms.

In cases where there is a strong drinking man suddenly and immediately refuses alcohol, the patient may develop a strong withdrawal syndrome, accompanied by seizures and delirium tremens. The symptoms of delirium tremens carry a potential threat to a person's life, which requires the patient to be admitted to a hospital or a specialized detoxification center.

Withdrawal symptoms are usually relieved with anxiolytics.

Treatment of somatic disorders resulting from long-term alcohol dependence includes the use of antiulcer drugs (in cases of developed stomach ulcers), injections of vitamin B 1 to correct thiamine deficiency, and other therapeutic measures.

After the symptoms of withdrawal syndrome disappear, the doctor may prescribe medications that reduce the patient's craving for alcohol or cause him discomfort when drinking alcohol. Sessions of individual counseling psychotherapy or group psychotherapy can help people cope with problems that contribute to the development and maintenance of alcohol dependence.

The Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) defines addiction syndrome as a complex of physiological, behavioral and cognitive phenomena in which the use of a psychoactive substance or class of psychoactive substances begins to take a higher place in the person's value system, than other behaviors that were previously more important to him. The main descriptive characteristic of the addiction syndrome is the desire (often strong, sometimes overwhelming) to use psychoactive drugs (which may or may not be prescribed by a doctor), alcohol, or tobacco. There is evidence that a return to substance use after a period of abstinence leads to more rapid onset of other signs of the syndrome than in individuals who do not have the addiction syndrome.

In 1964, the WHO Expert Committee introduced the term "addiction", replacing the terms "addiction" and "addiction". The term can be used broadly to refer to a range of psychoactive drugs (substance dependence, chemical dependence, substance dependence) or to a specific substance or class of substances (e.g., alcohol dependence, opioid dependence). The ICD-10 describes addiction in terms that apply to different classes of psychoactive drugs, but the characteristic symptoms of dependence differ between psychoactive drugs.

In its unconditional form, addiction encompasses both physical and psychological elements. Psychological or psychiatric dependence refers to the impairment of the ability to control the use of alcohol or a psychoactive drug, while physiological or physical dependence refers to symptoms of tolerance and withdrawal. In discussions with a biological focus, addiction is often viewed only as a physical addiction.

Dependence or physical dependence is also used in a psychopharmacological context in a narrower sense, only in relation to the development of withdrawal symptoms after cessation of the use of a psychoactive drug. In this limited sense, cross-dependence appears to be in addition to cross-tolerance, and both terms refer only to physical symptoms (neuroadaptation).

ICD-10 - Clinical Description

A set of physiological, behavioral, and cognitive phenomena in which the use of a psychoactive substance or class of psychoactive substances becomes more important in a person's value system than other behaviors that were previously more important to him. The main descriptive characteristic of the addiction syndrome is the desire (often strong, sometimes overwhelming) to use psychoactive drugs (which may or may not be prescribed by a doctor), alcohol, or tobacco. There is evidence that a return to substance use after a period of abstinence leads to more rapid onset of other signs of the syndrome than in individuals who do not have the addiction syndrome.

ICD-10 - Diagnostic guidelines

A definitive diagnosis of addiction can only be made if three or more of the following symptoms are present at the same time for a certain period of time during the previous year:

• Difficulties in controlling behavior associated with taking a psychoactive substance: its onset, end or levels of consumption;
• A physiological withdrawal state that occurs when the use of a psychoactive substance is discontinued or reduced, as evidenced by the following disorders: a withdrawal syndrome characteristic of that substance; or use of the same (or similar) psychoactive substance for the purpose of alleviating or preventing withdrawal symptoms;
• Signs of tolerance, manifested in the need to increase the doses of the psychoactive substance to achieve the effects initially achieved with the use of lower doses (obvious examples of this are people with alcohol or opiate dependence, whose daily doses can completely disable or lead to death of intolerant users);
• Progressive neglect of alternative pleasures or interests due to substance use, increased time required to acquire or take the substance and to recover from its effects;
• Continued use of a psychoactive substance despite clear signs of obvious harmful effects, such as liver damage from excessive alcohol consumption or substance-related cognitive impairment; efforts should be made to determine whether the consumer actually knew - or could be expected to know - the nature and extent of the harm.

ICD-10 - Research Diagnostic Criteria

Three or more of the following, which must have been present simultaneously for at least one month or, if present for periods of less than one month, must have occurred repeatedly simultaneously within a 12-month period:

• A strong desire or feeling of an irresistible craving to take a psychoactive substance;
• Impaired ability to control substance-related behavior: its onset, ending, or levels of use, as evidenced by frequent use of the substance in large amounts or for longer than intended periods of time, or persistent desire or unsuccessful attempts to reduce or control substance use;
• A physiological withdrawal state that occurs when the use of a psychoactive substance is reduced or stopped, as evidenced by the substance's characteristic withdrawal syndrome or use of the same (or similar) psychoactive substance to relieve or prevent withdrawal symptoms;
• Signs of tolerance to the effects of a psychoactive substance, manifested in the need for a significant increase in the amount of the substance to achieve intoxication or the desired effect, or in a clearly reduced effect with continued use of the same amount of the substance;
• Preoccupation with substance use, in which the person foregoes all or part of important alternative pleasures and interests in order to take the substance, or spends a great deal of time in the activities necessary to acquire and take the substance and to recover from its effects .
• Persistent use of a psychoactive substance in spite of clear signs of harmful effects observed with continued use, when the person actually knows - or can be expected to know - the nature and extent of the harm.

Classification of surfactants (according to ICD-10)

Types of psychoactive substances (surfactants)

1. By origin, psychoactive substances and drugs are divided into:

A. vegetable;

b. semi-synthetic (synthesized on the basis of vegetable raw materials);

V. synthetic, also divided according to the method of action on the body.

Not all psychoactive substances are drugs, but all drugs are psychoactive substances.

Combined classifications of surfactants.

Psychoactive substances (according to A. Dubrov)

CNS stimulants

¦ + Psychomotor

¦ ¦ + Purines

¦ ¦ ¦ + Caffeine

¦ ¦ ¦ + Theophylline

¦ ¦ ¦ LTheobromine

¦ ¦ + Phenisopropylamines

¦ ¦ ¦ + Amphetamine

¦ ¦ ¦ +Methamphetamine

¦ ¦ ¦ LSydnocarb

¦ ¦ + Cocaine

¦ ¦ LNicotine

¦ + Antidepressants

¦ L Nootropics]

Hyperstimulants (psychedelics)

¦ + Empathogens

¦ + Phenethylamines

¦ LIndole

¦ + Beta-carbolines

¦ ¦ + Garmin

¦ ¦ LHarmaline

¦ + Tryptamines

¦ ¦ +DMT (dimethyltryptamine)

¦ ¦ +5-MeO-DMT (5-methoxy-dimethyltryptamine)

¦ ¦ LPsilocybin

¦ Llysergic

Cannabis (marijuana)

Depressants

+ Sleeping pills

¦ ¦ + Barbiturates

¦ ¦ L Benzodiazepines

¦ + Means for inhalation anesthesia

¦ ¦ L Thinner and glue

¦ + Sedative drugs

¦ + Tranquilizers

¦ ethyl alcohol

Dissociatives

¦ + Anesthetics

¦ ¦ + Ketamine

¦ ¦ LDXM (dextromethorphan)

¦ Lanticholinergics

¦ + Datura

¦ + Cyclodol

Semi-synthetic

¦ LHeroin

organic

¦ + Codeine

¦ L Morphine

lSynthetic

Fentanyl

Lpromedol

2. By strength.

The smaller the amount of a substance that needs to be taken in order to fully experience its effect, the more powerful, the more psychoactive it is. For LSD, for example, the canonical dose is 100 micrograms, while for ethanol, the dose is measured in tens of grams. Depending on the characteristics of the individual's metabolism, the substance may have little effect on him or act much more strongly (hypersensitivity). It is also customary to measure the dose in grams of a substance per kilogram of body weight.

The division according to the strength of dependence is ambiguous. The leaders in this indicator among the substances are: heroin, cocaine and sometimes nicotine, as well as alcohol. Of the classes of substances, opiates and stimulants are distinguished as highly addictive, and barbiturates can also be highly addictive, although the reactions of individual people to various drugs can be very individual.

Coffee and tea containing purines have a slight stimulating effect. "Soft drugs" usually refers to marijuana and sometimes some psychedelics.

3. Mechanism of action.

Psychoactive substances have a diverse effect on the CNS at any level of CNS functioning: molecular, cellular, systemic, synaptic. In general, any such influence is accompanied by a change in metabolism at the level at which this influence occurs.

4. Ways of hitting.

Psychoactive substances can enter the body in a variety of ways, common ways:

orally, through the digestive system,

injection intramuscularly or intravenously,

through mucous membranes, including intranasally (through the nasopharynx by inhalation of a crushed substance)

through the lungs, by smoking or inhaling vapors

A psychoactive substance goes through a complex path in the body, depending on the way it is taken, it can be processed by the body into derivatives, and, passing through the blood-brain barrier, affects the balance of neurotransmitters in the brain, thus changing the setting of the nervous system.

5. Tolerance.

The higher the tolerance of the user to the substance, the larger doses it needs to obtain the expected effect. Usually, tolerance is developed when taking a substance and eventually goes into decline. Tolerance is quickly formed in caffeine and opiates. The more often and more the substance is used, the faster the tolerance grows.

Classical psychedelics (LSD, psilocybin, mescaline) have a kind of tolerance - when one of these substances is taken, tolerance increases very quickly, literally a few hours after the onset of action, but completely subsides in about a week. Moreover, psychedelics are characterized by cross-tolerance; for example, taking psilocybin the day after taking LSD, depending on the individual's susceptibility and amount of the substance, will either have no effect at all, or the effect will be greatly reduced and short-lived. Cross-tolerance to psychedelics also disappears completely in about one week.

It is noted that some substances, such as salvinorin, a natural dissociative found in the Mexican sage Salvia divinorum, may exhibit reverse tolerance, meaning the phenomenon that with prolonged use, a smaller amount of a substance is required to achieve the same effect.

6. Formation of addiction and withdrawal syndrome.

Usually, the formation of dependence is associated with the abuse of PAS, its systematic use. Although the effect of substances on a person is very individual, it can be said that addiction is most quickly formed when taking heroin and the stimulant Pervitin, psychostimulants cocaine and methamphetamine can also be distinguished.

There is an opinion that psychological dependence is caused by substances that affect the circulation of endogenous neurotransmitters in the body (the number of which is limited, the balance is restored gradually), and physical - directly affecting nervous system(for the use of such substances for pleasure, a constant increase in the dose is characteristic). The nature of the impact in both cases has a neurochemical basis that affects the human psyche.

Physiological dependence is formed when the body gets used to the regular exogenous intake of substances involved in metabolism in the body and reduces their endogenous production, thus, when the intake of a substance in the body stops, a need for this substance arises due to physiological processes. This may be due to both the substance itself and its metabolites, for example, heroin is metabolized by removing acetyl groups into morphine, which acts on opioid receptors. Alcohol acts on the nervous system by directly connecting to GABA receptors. Nicotine acts on nicotinic cholinergic receptors, stimulating the release of adrenaline.

Psychological dependence is associated mainly with pleasant sensations from substances that stimulate a person to repeat them. Under the influence opiates a person may not honor pain and anxiety, one of the options for the action of stimulants is to increase self-esteem and energy.

Alcohol addiction- strong craving for alcohol, its regular use, causing withdrawal symptoms if alcohol ceases to enter the body. It is most common in men between the ages of 20 and 40. Sometimes it is inherited. Risk factors - stress and work in places associated with the use of alcoholic beverages.

Man suffering alcohol addiction, has an irresistible, uncontrollable desire to drink, which becomes more important than almost everything else in his life. It is this craving, the difficulty to limit the amount of alcohol consumed, as well as the withdrawal syndrome that occurs after the cessation of alcohol consumption, that distinguishes alcohol addiction from alcohol abuse, a term used to refer to the regular consumption of alcohol in excessive amounts. In addition to the damage caused by alcohol to the liver and brain, regular excessive alcohol consumption can destroy families, relationships with other people and careers.

Alcohol addiction often the result of a combination of various factors. Sometimes the predisposition to abuse is laid down in the family, incl. when raising a child surrounded by heavy drinkers.

People who are fearful, anxious, and depressed may try to reduce their anxiety with large doses of alcohol. These people are at increased risk of addiction if they work in bars or other places where alcohol is consumed.

Among the symptoms alcohol addiction may include:

- a strong, uncontrollable desire to drink and loss of control over the amount of alcohol consumed;

- increasing resistance to the effects of alcohol, which leads to an increase in alcohol consumption in order to achieve the desired effect;

- Withdrawal symptoms such as nausea, sweating and tremor that occur several hours after the last dose of alcohol drunk.

In severe cases alcohol addiction Withdrawal syndrome may occur after the complete cessation of alcohol consumption. After a few days of absolute sobriety, delirium tremens may develop, accompanied by symptoms such as fever, trembling, seizures, disorientation and hallucinations, the condition can last 3-4 days. In extreme cases, shock can develop, which sometimes leads to the death of the patient.

Alcohol has a direct effect on the human body and brain, it can cause the development of many diseases. long alcohol addiction - the most common cause of serious liver disease, alcohol can also affect the human digestive system, leading to stomach ulcers.

People who drink a lot are often malnourished, which can lead to a lack of vitamin B 1 (thiamine) in the body and, as a result, to the development of dementia. In rare cases, chronic thiamine deficiency causes Wernicke-Korsakoff syndrome, a severe brain disease accompanied by impaired consciousness and memory loss, which can lead to the development of coma. If excessive consumption of alcoholic beverages has continued long enough, the resulting damage to the internal organs can threaten the patient's life.

Gradual reduction of alcohol doses or limiting its use to acceptable levels is rarely possible. Instead, the patient will be asked to stop drinking altogether. In cases of mild or moderate abstinence syndrome, the process of its removal can be carried out at home, where the patient is provided with all possible support. Anxiolytics, such as benzodiazepines, may be given for a short time to reduce anxiety and other physiological manifestations of withdrawal symptoms.

In cases where a heavy drinker suddenly and immediately refuses alcohol, the patient may develop a strong withdrawal syndrome, accompanied by seizures and delirium tremens. The symptoms of delirium tremens carry a potential threat to a person's life, which requires the patient to be admitted to a hospital or to a specialized detoxification center.

Withdrawal symptoms are usually relieved with anxiolytics.

Treatment of somatic disorders resulting from long-term alcohol addiction, includes the use of anti-ulcer drugs (in cases of developed stomach ulcers), injections of vitamin B 1 to correct thiamine deficiency, and other therapeutic measures.

After the symptoms of withdrawal syndrome disappear, the doctor may prescribe medications that reduce the patient's craving for alcohol or cause him discomfort when drinking alcohol. Sessions of individual counseling psychotherapy or group psychotherapy can help people cope with problems that contribute to the development and maintenance of their alcohol addiction.

Alcohol addiction mcb

/F1/ Mental and behavioral disorders,

associated with (caused by) the use of psychoactive substances

This section includes a wide variety of disorders that range in severity (from uncomplicated drunkenness and harmful use to severe psychotic disorders and dementia), but all of which can be explained by the use of one or more psychoactive substances, which may or may not be prescribed by a physician. .

This substance is indicated by the 2nd and 3rd characters (i.e. the first two digits after the letter F), and the 4th, 5th and 6th characters indicate the clinical condition. To save space, all psychoactive substances are listed first, followed by the 4th and subsequent characters; they should be used as needed for each analyte, however, it should be borne in mind that not all 4th and subsequent characters are applicable to all substances.

Some classes of psychoactive substances include both drugs and drugs that are not officially classified as drugs. In cases of dependence on sedatives or hypnotics (F13), stimulants (F15), hallucinogens (F16), volatile solvents (F18), use of several psychoactive substances (F19), the diagnosis of drug addiction is made if it is possible to determine dependence on psychoactive substances included to the official "List of narcotic drugs, psychotropic substances and their precursors, subject to control in Russian Federation(Lists I, II, III) ”(Decree of the Government of the Russian Federation of June 30, 1998 N 681). In these cases, after the main 4th, 5th or 6th sign, the Russian letter "H" is placed. If the identified psychoactive substance is not included in the above "List", then the Russian letter "T" is put.

Dependence formed as a result of the abuse of a psychoactive substance classified as a narcotic drug is assessed

like an addiction. Addictions include dependence on opioids

(F11), cannabinoids (F12), cocaine (F14). In this case, the letter "H" in

the end of the code is not affixed.

For alcohol dependence and alcoholism (F10), as well as tobacco dependence and nicotinism (F17), the letter "T" is not affixed.

Identification of the used psychoactive substances is carried out on the basis of the statement of the patient himself, an objective analysis of urine, blood, etc. or other data (presence of drugs in the patient, clinical signs and symptoms, reports from informed third-party sources). It is always desirable to obtain similar data from more than one source.

Objective (laboratory) analyzes provide the most clear evidence of current or recent substance use, although this method is limited in relation to past or present levels of use.

Many patients use more than one type of psychoactive substance, but the diagnosis of the disorder must be made in relation to the individual psychoactive substance or type of substance that led to the existing disorder. When in doubt, the disorder is coded for the substance or type most commonly abused, especially in cases of chronic or daily use.

Only in cases where the system of drug use is chaotic and uncertain, or if the consequences of using different psychoactive substances are inseparably mixed, should the code

F19.- (mental and behavioral disorders caused by the simultaneous use of several drugs and the use of other psychoactive substances).

Abuse of non-psychoactive substances, e.g. laxatives, aspirin and others, should be coded F55.- (abuse

non-addictive substances) with a 4th character indicating the type of substance.

Cases in which psychiatric disorders (particularly delirium in the elderly) are caused by psychoactive substances, but without signs of the disorders described in this section (eg, harmful use or dependence syndrome), should be coded in F00-F09. If delirium occurs in the background of one of the listed disorders, it should be coded in F1x.4xx.

The degree of association with alcohol can be determined by an additional code from ICD-10 Class XX: Y90 (proof of the presence of alcohol by blood test) or Y91 (proof of the presence of alcohol, determined by the level of intoxication).

- abuse of non-addictive substances (F55.-).

/F1х.0/ Acute intoxication

A transient state following the use of a psychoactive substance, consisting in disorders of consciousness, cognitive functions, perception, emotions, behavior or other psychophysiological functions and reactions, statics, coordination of movements, vegetative and other functions.

Diagnosis should be the main one only in cases where intoxication is not accompanied by more persistent disorders associated with the use of alcohol or other psychoactive substances. In the latter case, preference should be given to the diagnosis of harmful use (F1x.1x), dependence syndrome (F1x.2xx) or psychotic disorders (F1x.5xx).

Acute intoxication is in direct proportion to dose levels (see ICD-10 Class XX). Exceptions may be patients with

some organic diseases (for example, renal or hepatic insufficiency), when small doses of a substance can have a disproportionately acute intoxication effect. Disinhibition due to social circumstances (eg behavioral disinhibition at holidays, carnivals, etc.) must also be taken into account. Acute intoxication is a transient phenomenon. Its intensity decreases with time, and in the absence of further use of the substance, its action ceases. Recovery, therefore, is complete unless there is tissue damage or other complication.

The symptoms of intoxication do not always reflect the primary effect of the substance, for example, CNS depressants can cause symptoms of revitalization or hyperactivity, and stimulants can cause withdrawal and introverted behavior. The effects of substances such as cannabis and hallucinogens are almost unpredictable. Moreover, many psychoactive substances also produce different effects at different dose levels. For example, alcohol at low doses has a stimulant effect, with increasing doses it causes agitation and hyperactivity, and at very large doses it has a purely sedative effect.

The presence of head injuries and hypoglycemia, coma of other origins, as well as the possibility of intoxication as a result of the use of several substances should be borne in mind.

The following diagnostic criteria are distinguished:

G1. Evidence of recent use of a psychoactive substance (or substances) in high enough doses to cause intoxication.

G2. The symptoms and signs of intoxication must be consistent with the known effects of the particular substance(s) as defined below, and must be of sufficient severity to result in clinically significant impairments in levels of consciousness, cognition, perception, affect or behavior.

G3. The symptoms or signs present cannot be explained by a non-substance related illness or other mental or behavioral disorder.

Acute intoxication often occurs in individuals who additionally have problems with alcohol or drug use. If such problems exist, such as harmful use (use with harmful consequences) (F1x.1x), dependence syndromes (F1x.2xx) or psychotic disorder (F1x.5xx), they should also be noted.

- acute intoxication (intoxication) with alcoholism;

- acute intoxication (intoxication) with drug addiction;

- acute intoxication (intoxication) with substance abuse;

- acute alcohol intoxication;

- disorders in the form of trance during intoxication caused by psychoactive substances;

- disorder in the form of a state or trance with intoxication caused by psychoactive substances;

- acute intoxication (intoxication) when taking hallucinogens;

- acute intoxication (intoxication) NOS.

F1x.00x Acute intoxication, uncomplicated

Symptoms of varying severity, dose dependent.

F1x.01x Acute intoxication

with injury or other bodily injury

F1x.02x Acute intoxication with other medical complications

- acute intoxication with psychoactive substances, complicated by vomiting with blood;

- acute intoxication with psychoactive substances, complicated by aspiration of vomit.

F1x.03x Acute intoxication with delirium

F1x.04x Acute intoxication with impaired perception

- acute intoxication with psychoactive substances with delirium (F1x.03x).

F1x.05x Acute intoxication with coma

F1x.06x Acute intoxication with convulsions

F1x.07x Pathological intoxication

Applicable only in case of drinking alcohol (F10.07).

F1x.08x Acute intoxication with other complications

F1x.09x Acute intoxication with unspecified complications

- acute intoxication with psychoactive substances with a complication of NOS.

/F1х.0хх/ Private forms of acute intoxication,

caused by substance use

/F10.0х/ Acute intoxication,

alcohol-induced

The general criteria for acute intoxication (F1x.0) must be met.

You can check the level of alcohol in the blood using the ICD-10 codes Y90.0 - Y90.8.

F10.0x1 Mild intoxication (acute alcohol intoxication)

It is expressed mainly by changes in well-being and behavioral disorders, among which may be: euphoria; disinhibition; propensity to argue; aggressiveness; mood lability; attention disorders; impaired judgment; violation of personal functioning; nystagmus; hyperemia of the face; injection of conjunctiva and sclera.

F10.0х2 Moderate intoxication (acute alcohol intoxication)

In addition to the symptoms indicated with a mild degree of intoxication (F10.0x1), neurological disorders are also observed, among which may be: unsteady gait; violations of statics and coordination of movements; blurred speech; nystagmus; hyperemia of the face; injection of conjunctiva and sclera.

F10.0x3 Severe intoxication (acute alcohol intoxication)

It is expressed by oppression of consciousness and vegetative functions, in particular: deep stupefaction, doubtfulness; stupor or coma; pallor and cyanosis of the skin and mucous membranes; arterial hypotension; hypothermia.

F10.07 Pathological intoxication (alcoholic)

This is a rare short-term acute psychotic disorder that develops in connection with the intake of alcohol even at low doses and proceeds, in the absence of clinical signs of ordinary alcohol intoxication, with impaired consciousness, agitation and aggression, and, as a rule, subsequent amnesia.

F11.0x Acute intoxication due to opioid use

There are signs of a change in mental state from among the following: apathy and sedation; disinhibition; psychomotor retardation; attention disorders; impaired judgment; disruption of social functioning.

drowsiness; slurred speech; constriction of the pupils (with the exception of conditions of anoxia from severe overdose, when the pupils dilate); oppression of consciousness (for example, stupor, coma).

In severe acute opioid intoxication, respiratory depression (and hypoxia), hypotension, and hypothermia may occur.

F12.0x Acute intoxication due to the use of cannabinoids

There are signs of a change in mental state from among the following: euphoria and disinhibition; anxiety or agitation; suspicion (paranoid mood); feeling of time slowing down and/or experiencing a fast flow of thoughts; impaired judgment; attention disorders; change in the rate of reactions; auditory, visual or tactile illusions; hallucinations with preservation of orientation; depersonalization; derealization; disruption of social functioning.

Signs may be present, from among the following: increased appetite; dry mouth; injection of the sclera; tachycardia.

F13.0xx Acute intoxication,

caused by the use of sedatives or hypnotics

When using this code, the following diagnostic principles apply:

There are signs of a change in mental state from among the following: euphoria and disinhibition; apathy and sedation; rudeness or aggressiveness; mood lability; attention disorders; anterograde amnesia; disruption of social functioning.

Some of the following may be present: unsteady gait; violations of statics and coordination of movements; slurred speech;

nystagmus; depression of consciousness (for example, stupor, coma); erythematous

or bullous eruptions on the skin.

In severe cases, acute intoxication with sedatives or hypnotics may be accompanied by hypotension, hypothermia, and inhibition of the swallowing reflex.

F14.0x Acute intoxication due to cocaine use

There are signs of a change in mental state from among the following: euphoria and a feeling of increased energy (energy); increase in the level of wakefulness ("over-wakefulness"); reassessment of one's own personality; rudeness or aggressiveness; propensity to argue; mood lability; stereotypical actions; auditory, visual or tactile illusions; hallucinations, usually with the preservation of orientation; paranoid mood; psychomotor agitation (sometimes lethargy); violations of social functioning from excessive sociability to social isolation.

Some of the following may be present: tachycardia (sometimes bradycardia); cardiac arrhythmia; arterial hypertension (sometimes hypotension); sweating and chills; nausea or vomiting; pupil dilation; muscle weakness; chest pain; convulsions.

F15.0xx Acute intoxication,

caused by the use of other stimulants (including caffeine)

There are signs of a change in mental state from among the following: euphoria and a feeling of a surge of energy; increase in the level of wakefulness ("over-wakefulness"); reassessment of one's own personality; rudeness or aggressiveness; propensity to argue; psychomotor agitation (sometimes lethargy); mood lability; stereotypical actions; auditory, visual or tactile illusions; hallucinations, usually with the preservation of orientation; paranoid mood; violations of social functioning from excessive sociability to social isolation.

Some of the following may be present: tachycardia (sometimes bradycardia); cardiac arrhythmia; arterial hypertension (sometimes hypotension); sweating and chills; nausea or vomiting; possible weight loss; pupil dilation; muscle weakness; chest pain; convulsions.

F16.0xx Acute intoxication due to the use of hallucinogens

There are signs of a change in mental state from among the following: anxiety and timidity; auditory, visual or tactile

nye illusions and / or hallucinations that occur in the waking state; depersonalization; derealization; paranoid mood; relationship ideas; mood lability; impulsive actions; hyperactivity; attention disorders; disruption of social functioning.

Signs from among the following may be present: tachycardia; heartbeat; sweating and chills; tremor; pupil dilation; violations of coordination; decrease in visual acuity.

F17.0x Acute intoxication due to tobacco use

(acute nicotine intoxication)

There are signs of a change in mental state from among the following: mood lability; sleep disorders.

Signs from among the following may be present: nausea or vomiting; dizziness; sweating; tachycardia; cardiac arrhythmia.

F18.0xx Acute intoxication due to ingestion of volatile solvents

General criteria for acute intoxication (F1x.0) are identified.

There are signs of a change in mental state from among the following: apathy and deep, close to lethargic, sleep; rudeness or aggressiveness; mood lability; impaired judgment; impaired attention and memory; psychomotor retardation; disruption of social functioning.

Some of the following may be present: unsteady gait; violations of statics and coordination of movements; slurred speech; nystagmus; depression of consciousness (for example, stupor, coma); muscle weakness; blurred vision or diplopia.

Acute intoxication from inhalation of substances other than solvents should also be coded here.

In severe cases, acute intoxication with volatile solvents may be accompanied by hypotension, hypothermia, and inhibition of the swallowing reflex.

F19.0xx Acute intoxication,

caused by the simultaneous use of several drugs

drugs and the use of other psychoactive substances

This category should be used when there is evidence of intoxication due to recent use of other psychoactive substances (eg, phencyclidine) or multiple psychoactive substances, where it is not clear which substance is the main one.

/F1х.1/ Harmful (with harmful consequences)

A pattern of substance use causing harm to health. The harm can be physical (eg, in the case of hepatitis as a result of self-administration of injecting drugs) or mental (eg, in the case of secondary depressive disorders after heavy alcohol use).

This category diagnoses repeated substance use with clear medical consequences for the substance abuser, without evidence of dependence syndrome as defined in F1x.2xxx.

When making this diagnosis, it is necessary to have direct damage caused to the psyche or physical condition of the consumer. Substance use is often criticized by others and is associated with various negative social consequences. The fact that the use of a certain substance causes disapproval from another person or society at large, or may lead to social negative consequences such as arrest or divorce is not yet evidence of harmful use.

A. There must be clear evidence that the use of the substance has caused or significantly contributed to physical or psychological harmful changes, including impaired judgment or dysfunctional behavior.

B. The nature of the harmful changes must be identifiable and described.

C. The pattern of use persisted or recurred periodically in the previous 12 months.

This category does not include acute intoxication (see F1x.0xx), dependence syndrome (F1x.2xxx), psychotic disorders (F1x.5xx) or other specific forms of alcohol or drug use disorder.

- Substance abuse.

/F1х.2/ Dependency syndrome

A combination of somatic, behavioral and cognitive phenomena in which the use of a substance or class of substances begins to take first place in the individual's value system. The main characteristic of the addiction syndrome is the need (often intense, sometimes overwhelming) to take a psychoactive substance (which may or may not be prescribed by a doctor), alcohol, or tobacco. There is evidence that a return to the use of psychoactive drugs after a period of abstinence leads to a more rapid onset of signs of this syndrome than in individuals who did not previously have a dependence syndrome.

An addiction diagnosis can be made if 3 or more of the following occur over a period of time during the year:

a) A strong desire or feeling of intractable craving to take the substance.

b) Decreased ability to control substance use: onset, end, or dose, as evidenced by the use of the substance in large quantities and for a period of time longer than intended, unsuccessful attempts, or a persistent desire to reduce or control the use of the substance.

c) A state of withdrawal or withdrawal syndrome (see F1x.3xx and F1x.4xx) that occurs when the use of a substance is reduced or discontinued, as evidenced by a complex of disorders characteristic of that substance or by the use of the same (or similar substance) to relieve or prevention of withdrawal symptoms.

d) Increasing tolerance to the effects of a substance, consisting in the need to increase the dose to achieve intoxication or the desired effects, or in the fact that chronic use of the same dose of the substance leads to a clearly reduced effect.

e) Preoccupation with substance use, which manifests itself in the complete or partial abandonment of other important alternative forms of enjoyment and interests in order to use the substance, or in the fact that a lot of time is spent on activities related to the acquisition and use of the substance and on its recovery effects.

f) Continued use of the substance despite clear evidence of harmful effects, as evidenced by chronic use of the substance with actual or perceived understanding of the nature and extent of the harm.

Narrowing the repertoire of substance use is also considered hallmark(for example, the tendency to consume alcohol equally on weekdays and weekends despite social disincentives). An essential characteristic of the addiction syndrome is the use of a certain type of substance or the desire to use it. Subjective awareness of craving for psychoactive substances most often occurs when trying to stop or limit their use. Such a diagnostic requirement excludes, for example, surgical patients who are given opiates for pain relief and who may show signs of withdrawal when opiates are stopped, but have no desire to continue taking the drug. The dependence syndrome may be in relation to a particular substance (such as tobacco or diazepam), a class of substances (such as opioid drugs), or more a wide range various substances (presence in some individuals of the need to regularly take any available drugs with the appearance of anxiety, agitation and / or physical signs of withdrawal during abstinence).

The diagnosis of dependence syndrome should be clarified by the following five-digit codes:

/F1x.20/ Currently abstinence (remission);

/F1x.21/ Currently abstinence, but under conditions precluding use (under protective conditions);

/F1x.22/ Currently on a maintenance regimen of clinical observation or substitution therapy (controlled dependence);

/F1x.23/ Currently abstinence, but on the background of treatment

aversive (disgusting) means, or

drugs that block the action of drugs and

/F1x.24/ Current substance use (active

/F1х.25/ Systematic (permanent) use;

/F1x.26/ Periodic use;

/F1х.29/ Periodic use NOS.

To code the stage of dependence in the use of psychoactive substances, the sixth character must be used:

F1x.2x1x Initial (first) stage of dependence;

F1x.2x2x Middle (second) stage of dependence;

F1х.2х3х Final (third) stage of dependence;

F1x.2x9x Dependency stage unknown.

Dependence on psychoactive substances is understood as a painful process, naturally passing through successive stages, having its own beginning and end. However, not all stages can be found in the dynamics of dependence on individual psychoactive substances (hallucinogens, tobacco, and others).

F1х.2х1х Initial (first) stage of dependence

The following diagnostic criteria are distinguished (see Criteria

a), b), d) and f) "Diagnostic instructions" to the F1x.2 dependence syndrome), indicating the formation initial stage Dependences (two criteria are enough to make a diagnosis):

a strong desire or feeling of an overwhelming craving to take a substance;

reduced ability to control substance use: onset, end, or dose, as evidenced by using the substance in large amounts and for a period of time longer than intended, unsuccessful attempts, or a persistent desire to reduce or control the use of the substance;

increasing tolerance to the effects of a substance, consisting in the need for a significant increase in dose to achieve intoxication or the desired effects, or in the fact that chronic use of the same dose of the substance leads to a clearly weakened effect; continued use of the substance despite clear evidence of harmful effects, as evidenced by chronic use of the substance with actual or perceived understanding of the nature and extent of the harm.

F1x.2x2x Middle (second) stage of dependence

In addition to those signs of dependence, which are indicated in F1x.2x1x, at least one of the two remaining criteria c) and e) of the dependence syndrome is additionally present (see F1x.2-):

withdrawal state or withdrawal syndrome (see F1x.3xx and

F1x.4xx) occurring when the use of a substance is reduced or discontinued as evidenced by the complex of disorders characteristic of that substance or the use of the same (or a similar substance) to alleviate or prevent withdrawal symptoms;

preoccupation with substance use, which manifests itself in that other important alternative forms of enjoyment and interests are forfeited in whole or in part in order to take the substance, or that a great deal of time is spent in activities related to acquiring and taking the substance and recovering from its effects.

F1x.2x3x Final (third) stage of dependence

In addition to the signs of the dependence syndrome indicated in F1x.2x1x and in F1x.2x2x, signs of residual mental disorders and mental disorders with a late onset are determined (see F1x.7xx); an increase in tolerance to a psychoactive substance may be replaced by a tendency to decrease it.

In the final stage of dependence, as a rule, persistent somato-neurological disorders are determined (in particular, polyneuropathy, cerebellar disorders, characteristic lesions of the heart, liver and other organs and systems).

F1x.2x9x Dependency stage unknown

/F1x.3/ Withdrawal state (withdrawal syndrome)

A group of symptoms of varying combination and severity that occur when a substance is completely discontinued or its dose is reduced after repeated, usually prolonged and/or high doses of the substance. The onset and course of the withdrawal syndrome is limited in time and corresponds to the type of substance and dose immediately preceding abstinence. The withdrawal syndrome can be complicated by convulsions.

The state (syndrome) of withdrawal is one of the manifestations of the dependence syndrome (see F1x.2xx), and this latter diagnosis also needs to be established.

The diagnosis of dependence syndrome should be coded as primary if it is sufficiently pronounced and is the immediate reason for the referral to a specialist doctor.

Physical impairments may vary depending on the substance used. Psychiatric disorders (eg, anxiety, depression, sleep disorders) are also characteristic of withdrawal syndrome. Usually the patient indicates that the withdrawal syndrome is alleviated by subsequent use of the substance.

It must be remembered that the syndrome (state) of withdrawal can be caused by a conditioned reflex stimulus in the absence of immediately preceding use. In such cases, the diagnosis of withdrawal syndrome is made only if it is justified by the sufficient severity of the manifestations.

Many of the symptoms present in the structure of the withdrawal syndrome (state) can also be caused by other mental disorders, such as anxiety, depressive disorders, and others. A simple post-intoxication state (“hangover”) or tremor caused by other causes should not be confused with withdrawal symptoms.

G1. There must be clear evidence of recent discontinuation or dose reduction of the substance after using the substance, usually for a long time and/or at high doses.

G2. Symptoms and signs match known characteristics withdrawal states of a particular substance or substances (see below under the relevant subheadings).

G3. The symptoms and signs are not due to a medical disorder unrelated to the use of the substance and cannot be better explained by another mental or behavioral disorder.

The diagnosis of the cancellation condition must be clarified by the appropriate five-digit codes.

F1x.30x Withdrawal state (withdrawal syndrome), uncomplicated

F1x.31x Withdrawal state (withdrawal syndrome) with convulsive seizures

For some groups of psychoactive substances with anticonvulsant activity, such as barbiturates, for example, seizures are one of the typical manifestations of the state of withdrawal.

F1х.39х Withdrawal state

(withdrawal syndrome) NOS

F1x.3xx Particular forms of withdrawal symptoms

This subsection uses the diagnostic features specific to each of the psychoactive substances listed below.

F10.3x Alcohol withdrawal syndrome

(alcohol withdrawal state)

Some of the following may be present: desire to drink alcohol; tremor of the tongue, eyelids, or outstretched arms; sweating; nausea or vomiting; tachycardia or arterial hypertension; psychomotor agitation; headache; insomnia; feeling unwell or weak; episodic visual, tactile, auditory hallucinations or illusions; grand mal seizures; depressive and dysphoric disorders.

If delirium is present, the diagnosis should be "alcohol withdrawal with delirium" (F10.4x).

F11.3x Opioid withdrawal syndrome

When using this code, the following diagnostics apply:

Must meet the general criteria for a withdrawal state (F1x.3) (Note that opioid withdrawal can also be induced by opioid antagonists after a short period of opioid use.).

Symptoms from the following may be present: strong desire

not taking opioids; rhinorrhea or sneezing; lacrimation; muscle pain or cramps; abdominal cramps; nausea or vomiting; diarrhea; pupil dilation; the formation of "goosebumps", periodic chills; tachycardia or arterial hypertension; yawn; restless sleep; dysphoria.

F12.3x Cannabinoid withdrawal syndrome

It is an ill-defined syndrome for which specific diagnostic criteria cannot currently be established.

It develops after the cessation of long-term use of cannabis in high doses.

Its symptoms include asthenia, apathy, hypobulia, decreased mood, anxiety, irritability, tremors, and muscle pain.

F13.3xx Sedative or hypnotic withdrawal syndrome

Symptoms from the following may be present: tongue tremor,

eyelids or outstretched arms; nausea or vomiting; tachycardia; postural

hypotension; psychomotor agitation; headache; insomnia;

feeling unwell or weak; episodic visual, tactile, auditory hallucinations or illusions; paranoid mood; grand mal seizures; dysphoria; desire to take sleeping pills or sedatives.

If delirium is present, the diagnosis should be Sedative or Hypnotic Withdrawal Condition with Delirium (F13.4xx).

F14.3x Cocaine withdrawal syndrome

There is a disturbed mood (eg, depression and/or anhedonia).

Symptoms from the following may be present: apathy and asthenia; psychomotor retardation or agitation; strong desire to take cocaine; deep, close to lethargic, sleep; increased appetite; insomnia or hypersomnia; bizarre or unpleasant dreams.

F15.3xx Syndrome of withdrawal of other stimulants

There is a disturbed mood (eg, depression and/or anhedonia).

Symptoms from the following may be present: apathy and asthenia; psychomotor retardation or agitation; a strong desire to take stimulants; increased appetite; insomnia or hypersomnia; bizarre or unpleasant dreams; deep, close to lethargic sleep.

F16.3xx Hallucinogen withdrawal syndrome

There are currently no defined diagnostic criteria for this condition.

F17.3x Tobacco withdrawal syndrome

When using this code, the following diagnostic rules apply:

Must meet the general criteria for abort condition (F1x.3).

Symptoms from the following may be present: strong desire

not using tobacco (or other nicotine containing products); feeling unwell or weak; dysphoria; irritability or anxiety; insomnia; increased appetite; coughing; difficulty concentrating.

F18.3xx Volatile solvent withdrawal syndrome

F19.3xx Multidrug withdrawal syndrome

This is a diverse combination of symptoms, depending on the types of psychoactive substances used.

/F1х.4/ Withdrawal state

(withdrawal syndrome) with delirium

Withdrawal syndrome (see F1x.3) complicated by delirium (see criteria for F05.-).

This refers to a short-term (transient), caused by psychoactive substances (mainly alcohol and some others), sometimes a life-threatening acute psychotic state, occurring with a disorder of consciousness, hallucinations and concomitant somatic disorders. It usually occurs as a result of the complete or partial cessation of the substance in people who are addicted to it and use the substance for a long time. In cases where delirium occurs at the exit from a severe kurtosis, it is also encoded in this paragraph.

Prodromal symptoms typically include insomnia, tremors, anxiety, and fear. Seizures may occur before onset. The classic triad of symptoms includes disturbance of consciousness, vivid hallucinations and illusions affecting any sphere of the senses, and severe tremor. Delusions, agitation, insomnia or sleep cycle inversion, and autonomic disturbances are also commonly present.

Presence of a canceled state, as defined in /F1x.3/.

The presence of delirium as defined in /F05.-/.

- delirium tremens (alcoholic) (F10.4x);

- Gaye-Wernicke encephalopathy (F10.4x);

- encephalopathy of Marchiafava-Bignami (F10.4x);

- other acute alcoholic encephalopathies (F10.4x).

- delirium not caused by alcohol or other psychoactive substances (F05.-);

- chronic encephalopathies caused by the use of psychoactive substances (F1x.73x).

The diagnosis of withdrawal syndrome with delirium should be specified by the fifth character, depending on the form (type of flow) of delirium.

F1x.40x Withdrawal (withdrawal syndrome) with delirium ("classic" delirium)

F1x.41x Withdrawal state (withdrawal syndrome) with delirium with convulsive seizures

F1x.42x Withdrawal state (withdrawal syndrome) with excruciating delirium ("muttering" delirium)

F1x.43x Withdrawal state (withdrawal syndrome) with "professional delirium"

F1x.44x Withdrawal state (withdrawal syndrome) with delirium without hallucinations (lucid)

F1x.46x Withdrawal state (withdrawal syndrome) with abortive delirium

F1x.48x Withdrawal state (withdrawal syndrome) with delirium, other

F1x.49x Withdrawal state (withdrawal syndrome) with delirium, unspecified

/F1x.5/ Psychotic disorder

A disorder that occurs during or immediately after substance use, characterized by vivid hallucinations (usually auditory, but often involving more than one sensory area), false recognitions, delusions and/or ideas of attitude (often of a paranoid nature), psychomotor disturbances (agitation or stupor), an abnormal affect that ranges from intense fear to ecstasy. Consciousness is usually clear, although some degree of confusion is possible. The disorder usually resolves at least partially within 1 month and completely within 6 months.

A psychotic disorder occurring during or immediately after substance use should be reported here unless it is a manifestation of withdrawal with delirium (see F1x.4xx) or late-onset psychosis. Psychotic disorders may occur with a late onset (more than 2 weeks

after ingestion), but they should be coded as

Psychotic disorders caused by substance use can vary in their symptoms. It depends on the type of substance used and the personality of the user. With the use of stimulant drugs such as cocaine and amphetamines, psychotic disorders are usually caused by high doses and/or long-term use.

When taking substances with a primary hallucinogenic effect (LSD, mescaline, high doses of hashish), the diagnosis of a psychotic disorder should not be based solely on the presence of a perceptual disorder or hallucinations. In such cases, as well as in states of confusion, the diagnosis of acute intoxication (F1x.0xx) should be considered.

Particular care should be taken to rule out the possibility of misdiagnosis of another disorder (eg, schizophrenia) when a diagnosis of substance-induced psychosis is appropriate. In most cases, when psychoactive substances are stopped, these psychoses are of short duration (for example, psychoses caused by amphetamine and cocaine). False diagnoses in such cases lead to negative moral and material consequences for both the patient and the health service.

The possibility of other psychotic disorders aggravated or accelerated by drug use should be considered: for example, schizophrenia (F20.-), affective disorders (F30-F39), paranoid or schizoid personality disorder (F60.0x; F60.1x). In such cases, the diagnosis of a substance-induced psychotic disorder would be incorrect.

Psychotic disorder can occur at any stage of addiction, but predominantly in the middle and final stages.

Psychotic symptoms develop during the use of the substance or within 2 weeks after taking it.

Psychotic symptoms persist for more than 48 hours.

- acute alcoholic hallucinosis;

- alcoholic delirium of jealousy (initial period);

- acute alcoholic paranoia;

- alcoholic psychosis NOS.

- subacute alcoholic hallucinosis (F10.75);

- chronic (recurrent) alcoholic hallucinosis (F10.75);

- alcoholic delirium of jealousy (F10.75);

- alcoholic or caused by the use of another psychoactive substance, residual and delayed psychotic disorders (F10 - F19 with a common fourth character. 7).

The diagnosis of a psychotic disorder should be specified by the fifth digit according to the leading psychotic syndrome.

F1x.50x Schizophrenia-like disorder

F1x.51 Predominantly delusional disorder

- the initial period of delirium of jealousy.

- remote period of delirium of jealousy (F1x.75x).

F1x.52 Predominantly hallucinatory disorder

(includes alcoholic hallucinosis)

F1x.53 Predominantly polymorphic psychotic disorder

F1x.54 Disorder with predominantly depressive psychotic symptoms

F1x.55 Disorder with predominantly manic psychotic symptoms

F1x.6x Amnestic syndrome

Syndrome associated with chronic severe impairment of memory for recent events: memory for distant events is sometimes impaired, while immediate recall may be preserved. There is usually a disturbance in the sense of time and order of events, in severe cases leading to amnestic disorientation, as well as the ability to assimilate new material. Confabulations are possible, but not required. Other cognitive functions are usually preserved, and memory defects are disproportionately large relative to other impairments.

Amnestic syndrome due to alcohol or other psychoactive substances must meet the general criteria for an organic amnestic syndrome (see F04.-).

Personality changes may also be present, often with the onset of apathy and loss of initiative (tendency to not take care of oneself), but these should not be considered indispensable for a diagnosis.

Amnestic syndrome occurs predominantly in the final stage of dependence on psychoactive substances (as an outcome of acute encephalopathies).

Memory impairment, manifested by two signs:

1) impaired memorization and memory defect for recent events (impaired assimilation of new material) to a degree sufficient to cause difficulties in everyday life, up to amnestic disorientation;

2) reduced ability to reproduce past experience.

Absence (or relative absence) of the following features:

1) obscuration of consciousness and disorders of attention, as they are defined by the criterion

2) general intellectual decline (dementia).

Absence of objective data (physical and neurological examination, laboratory tests) and/or anamnestic information about brain disease, other than alcoholic encephalopathy, that could reasonably be considered the cause of clinical manifestations in accordance with the criteria for memory impairment described above.

Consideration should be given to the possibility of an organic (non-alcoholic) amnestic syndrome (see F04.-); other organic syndromes, including severe memory impairment (eg dementia or delirium) (F00-F03, F05.-), depressive disorder (F31-F33).

- amnestic syndrome caused by alcohol or other psychoactive substance;

- amnestic disorder caused by alcohol or drugs;

- Korsakov's psychosis or syndrome caused by alcohol or other psychoactive substance or unspecified.

- Korsakoff's psychosis, non-alcoholic and not caused by another psychoactive substance, or syndrome (F04.-).

/F1x.7/ Residual and delayed

Substance-induced disorders characterized by changes in cognition, personality, or behavior that continue beyond the period of direct effect of the psychoactive substance.

The occurrence of the disorder must be directly related to the use of the substance.

The disorder must continue beyond the period of direct exposure to the psychoactive substance (see F1x.0x, acute intoxication). Substance-induced dementia is not always permanent, and after a long period of complete abstinence, intellectual function and memory may improve.

The disorder must be distinguished from conditions associated with withdrawal (see F1x.3xx and F1x.4xx). It must be remembered that, under certain conditions and types of psychoactive substance, withdrawal may occur for many days or weeks after stopping the substance.

Substance-induced and persisting post-use conditions that meet the diagnostic criteria for psychotic disorders should be classified in F1x.5xx (psychotic disorder). Chronic end states of Korsakoff's syndrome should be coded in F1x.6x.

Residual effects can be distinguished from the psychotic state (as defined in F1x.5xx) in part by their episodic nature, predominantly of very short duration, duplicating prior manifestations of substance use.

Consideration should be given to the possibility of pre-existing psychiatric disorders masked by substance use and recurring during the period of withdrawal of alcohol or drug effects (eg, phobia-related anxiety, depressive disorder, or schizotypal disorder). Consider acute transient psychotic disorder (F23.-) in case of spontaneous recurrence of intoxication pattern. Also be aware of organic damage and mild or moderate mental retardation (F70-F71), which may be associated with substance abuse.

- alcoholic dementia NOS;

- mild forms of persistent cognitive impairment;

- disturbance of perception after the use of a hallucinogen;

- residual emotional (affective) disorder;

- residual disorder of personality and behavior.

- alcoholic or narcotic Korsakov's psychosis or a syndrome caused by alcohol or other psychoactive substances (F10

- F19 with a common fourth character.6);

- alcoholic or narcotic psychotic state (F10 - F19 with a common fourth sign.5).

This diagnostic rubric is subdivided by the following five-digit codes according to the leading mental disorders.

Spontaneous short-term relapses of symptoms of acute intoxication in the absence of actual substance use. It occurs at any stage of dependence on a psychoactive substance.

F1x.71x Personality and behavior disorder

Specific personality changes accompanied by social maladaptation.

Meets the general criteria F07.- (“Personal and behavioral disorders due to disease, damage or dysfunction of the brain”).

F1x.72x Residual affective disorder

Persistent non-psychotic emotional and volitional disorders (blunting of higher feelings, coarseness, irritability).

Meets general criteria F06.3- (“Organic mood disorders (affective disorders)”).

The general criteria for dementia (F00 - F03) are met.

- chronic encephalopathy caused by the use of psychoactive substances.

F1x.74 Other persistent cognitive impairment

Persistent intellectual-mnestic decline, not reaching the degree of dementia.

Criteria F06.7- (“Mild cognitive impairment”) are met, except for criterion G., which excludes the use of a psychoactive substance.

F1x.75x Late onset psychotic disorder

The general criteria for F1x.5x must be met, except that the disorder occurs more than two weeks after the substance has been taken and continues for more than 6 months.

- chronic (recurrent) alcoholic hallucinosis;

- delirium of jealousy (remote period).

- the initial period of delirium of jealousy (F1x.51x).

/F1x.8/ Other mental disorders and

Any other disorders where substance use is identified as directly affecting the patient that do not meet the criteria for the disorders listed above are coded here.

F1x.81x Other psychotic disorders

Any other psychotic disorders where substance use is identified as having a direct effect on the patient's condition and not meeting the criteria for the psychotic disorders listed above are coded here.

F1x.82x Other non-psychotic and behavioral disorders

Any other non-psychotic disorders and

behavioral disorders where substance use is identified

as directly affecting the patient's condition, not responding

criteria the above non-psychotic disorders and races

/F1x.9/ Mental disorder

and conduct disorder, unspecified

Differentiation of these disorders should take into account the possibility of pre-existing psychiatric disorders masked by substance use and recurring during the period of withdrawal of alcohol or other psychoactive substances (eg, phobia-related anxiety, depressive disorder, or schizotypal disorder).

F1x.91x Unspecified psychotic disorders

psychosis NOS caused by the use of psychoactive substances.

F1x.92x Unspecified non-psychotic and behavioral disorders

non-psychotic disorder NOS caused by the use of psychoactive substances.

F1x.99x Unspecified mental disorders

- mental disorder NOS caused by the use of psychoactive substances.

All forms of abuse of psychoactive drugs in the ICD-10 are grouped under section F1 "Mental and behavioral disorders due to the use of psychoactive substances." In the ICD-10 classification there is no division into drug addiction and substance abuse. While maintaining the ICD-10 terminology, the terms “drug addiction” and “substance abuse” accepted in Russia will be used along with it, a presentation of their clinical features based on the nosological principle, implying their conditional division into stages (I, II and III), highlighting the corresponding course options etc.

E.A. Babayan (1988) identifies the following most common groups toxic substances, causing a painful addiction to them: 1) sleeping pills; 2) tranquilizers; 3) stimulants (derivatives of sydnonimine, caffeine alkaloids); 4) analgesics (analgin, amidopyrine, phenacetin); 5) antiparkinsonian drugs (cyclodol, norakin, radinol); 6) antihistamines (diphenhydramine, pipolfen); 7) volatile aromatic substances (solvents, varnishes, nitro paints, stain removers containing acetone, glue and volatile liquids used in industry and as household chemicals).

The section "Mental and behavioral disorders due to the use of psychoactive substances" is coded in the ICD-10 with the symbol F1. It includes a number of subsections.

F10 Mental and behavioral disorders due to alcohol use.

F11 Mental and behavioral disorders resulting from the use of opioids.

F12 Mental and behavioral disorders resulting from the use of cannabinoids.

F13 Mental and behavioral disorders resulting from the use of: sedatives or hypnotics.

F14 Mental and behavioral disorders resulting from the use of: cocaine.

F15 Mental and behavioral disorders due to use of other stimulants, including caffeine.

F16 Mental and behavioral disorders resulting from the use of hallucinogens.

F17 Mental and behavioral disorders due to tobacco use.

F18 Mental and behavioral disorders resulting from the use of volatile solvents.

F19 Mental and behavioral disorders resulting from the combined use of drugs and the use of other psychoactive substances.

Mental and behavioral disorders due to opioid use (F11)

This group of addictions includes the use of drugs obtained from different varieties of poppy, opium and its preparations, about 20 alkaloids and derivatives of opium (morphine, codeine, thebaine, heroin, dionine, pantopon, omnopon, etc.), synthetic drugs with a morphine-like effect ( phenadon, promedol, etc.). All these substances are united by morphine-like action. In the structure of the incidence of drug addiction, the consumption of narcotic substances of this group in the Russian Federation ranges from 50 to 60%, and up to 95% of them is the consumption of narcotic substances from different varieties of poppy. IN last years(since 1996) there has been a sharp increase in the number of people who abuse heroin, which is mainly obtained in an artisanal way or imported from countries in the Asian region. In large cities, in the structure of consumption of narcotic and substance abuse drugs, heroin consumption is more than 90%.

Poppy straw (hay, straw, nibbling, dry) - all parts (whole and crushed, dried and not dried), with the exception of ripe seeds of any variety of poppy, harvested by any method, containing narcotic active opium alkaloids (morphine, codeine, thebaine), is manufactured artisanal way (thermal and mechanical processing).

It usually circulates in the form of crushed plant mass from yellow to Brown packed in paper bags (10-15 g), plastic bags(0.1-500 g), larger quantities (5-10 kg) can be placed in bags or pillowcases. The amount of poppy straw in illegal transactions with small dealers is measured in glasses (“arshins”).

Opium(raw opium; karahan, opiyukha, khimkhanka, black, black, Black Sabbat) - curdled juice of opium or oil-bearing poppy containing narcotic active opium alkaloids (morphine, codeine, thebaine).

Opium is obtained by cutting poppy pods and collecting the milky juice released from them (by scraping or impregnating fabrics). The isolation of the main alkaloids from opium is carried out by extraction with water at a temperature of 50-55 ° C, while morphine, codeine and thebaine, most of papaverine and about a third of the total amount of narcotine are almost completely transferred to the aqueous extract. In addition to alkaloids, water extracts meconic acid, the presence of which may indicate the use of an opium extract. It should be noted that opium obtained from wild varieties of poppy has a low content of narcotic active alkaloids (morphine, codeine, thebaine).

It circulates in the form of a viscous or plastic mass, during long-term storage - solid pieces, the color of which can be from light brown to black, has a peculiar licorice smell and a bitter taste. It burns with a bright, strongly smoky flame, producing smoke with a pleasant smell. The mass of opium can vary from 0.5 g to tens, hundreds of grams, or several kilograms, a typical packaging is a polymer film. In jargon, a gram of raw opium is called a check.

In addition, opium can also be seized in the form of aqueous solutions in glass vials or syringes. Solutions of raw opium are sold in cubic centimeters (milliliters), called "squares" in the jargon. Syringes and bottles containing opium solutions are usually confiscated from users and small drug dealers.

Extraction opium- a narcotic drug obtained from poppy straw by extraction of narcotic alkaloids (morphine, codeine, thebaine) with water or organic solvents, followed by removal (evaporation) of the solvent. On the illegal market, it circulates in the form of brown or dark brown solutions or a black pasty substance with the smell of dried fruits.

Poppy Straw Extract- a narcotic drug obtained from poppy straw by extraction of narcotic alkaloids (morphine, codeine, thebaine) with water or other solvents. On the illegal market, it circulates in the form of brown liquids.

Morphine (MORPH, WHITE, STUFF, MISS, EMMA, MONKEY)- isolated from the opium poppy. Depending on the degree of purification, technical and pure morphine are distinguished; it is a powdery substance of white (pure) or gray color(technical). Morphine base is also found in the form of compressed brown forms, it is used in its pure form (by dissolving the powder in water, followed by intravenous administration), or as a substance for the manufacture of narcotic medicines and heroin.

Codeine (methylmorphine)- isolated from the opium poppy. It is usually used to create medicines (available in powders or tablets), and is also part of combined preparations (codterpine, cough tablets, pentalgin, sedalgin, vicodil, solpadein, etc.). ). Codeine is most commonly used as a cough suppressant. Specially for use in trafficking not manufactured.

Omnopon- a mixture of opium alkaloids, which is a light brown powder, easily soluble in water, contains 48-50% morphine, is produced as medicinal product pharmaceutical industry in powders and tablets.

Heroin(“Hera”, “gerych”, “gloomy”, etc.) are obtained by acetylation (treatment with acetic anhydride or acetyl chloride) of morphine isolated from the opium poppy in order to obtain diacetylmorphine. Heroin is a white, gray or dark brown (depending on the degree of purification) powdered substance containing diacetylmorphine (20-99%), administered intravenously as aqueous solution or inhaled while smoking.

Unlike heroin, which is obtained by acetylation of morphine, "Russian heroin"(acetylated opium ) - is produced by acetylation (boiling with acetic anhydride or acetyl chloride) of ordinary or extraction opium, aimed at converting the morphine and codeine contained in them into more active acetyl derivatives (monoacetylmorphine, diacetylmorphine, acetylcodeine).

The action of opiates. Morphine is the most typical description of the action of opium group drugs. The narcotic effect can be obtained from a therapeutic dose of morphine (10 mg). The introduction of morphine into an intact organism causes a number of successive states (phases) presented in Table. 82.

Diagnosis of opium intoxication is quite simple. The most significant symptom is pupillary constriction. The skin and mucous membranes are dry, pale. Hypotension, bradycardia, increased tendon reflexes are noted. At

Table 82 Phase in morphine intoxication [Pyatnitskaya I.N., 1994]

Codeine intoxication, in addition to the above symptoms, revealed psychomotor agitation, rapid speech. With an overdose of opiates psychotic symptoms usually does not occur. The dream-like state turns into a coma. Death occurs from paralysis of the respiratory center.

The development of opiomania. A single use of the drug does not cause attraction to it. Repeated use (from 3-5 injections of heroin, 10-15 injections of morphine, 30 doses of codeine) contributes to the formation of a pathological craving for the drug. Narcotization becomes regular. There are no withdrawal symptoms yet, but there is a feeling of dissatisfaction.

Regular anesthesia means I stage of the disease. I stage. The physiological effect of the drug at this stage is not changed. The addict sleeps little, sleep is superficial, but there is no feeling of lack of sleep. Appetite suppressed. The amount of urine decreases, stool retention appears for several days. There is a gradual addiction to the drug. To achieve the same effect, an increase in dose is required. The absence of the drug affects the patient's well-being only . after 1-2 days, mainly in the form of mental disorders: a feeling of tension, mental discomfort, the desire to inject drugs. | Thus, stage I is characterized by a syndrome of altered reactivity to the drug (systematic use, disappearance of itching, an increase in tolerance by 3-5 times) and a syndrome of mental dependence (an obsessive desire for mental comfort in intoxication). The duration of stage I is different: with morphinism - 2-3 months, with the use of opium - 3-4 months, codeine - up to 6 months, with opiophagia - up to several years. At this stage, patients, as a rule, hide their anesthesia.

II stage. The syndrome of the changed reactivity is completely formed. The syndrome of mental dependence also reaches the height of its development. Narcotization is regular, an individual rhythm of administration is formed. Tolerance to the drug is growing, increasing by 100-300 times in comparison with therapeutic doses. With a break in anesthesia, tolerance decreases. Patients often enter treatment to reduce the dose of the drug they use. Amnesia is not noted. The nature of drunkenness is changing. The physiological effect of the drug disappears. In patients, stool and diuresis normalize, with colds, a cough appears, and there is no antitussive effect of opiates. Sleep is restored. However, the constriction of the pupil remains stable. The behavior of the addict is changing. If in the first stage of the disease the drug addict was alert and active before the injection, but sluggish and inhibited after it, then starting from the second stage of the disease, he becomes lethargic and powerless before the injection and brisk after it.

There are signs of physical dependence. The syndrome of physical dependence is expressed by compulsive attraction, the ability for physical comfort in intoxication and withdrawal symptoms. Compulsive attraction occurs outside of intoxication and is included in the structure of the withdrawal syndrome. There is no compulsive attraction in intoxication. Opium intoxication is not accompanied by a loss of quantitative control. Withdrawal syndrome is formed gradually (Table 83). Formation of withdrawal syndrome takes a short period of time (1-2 months of regular drug use).

Patients cannot eat, body weight decreases by 10-12 kg, they do not sleep at night. The severity of withdrawal is directly proportional to the duration of the disease and the dose. Codeine abstinence is somewhat different from morphine, it develops more slowly, reaching a height on the 5-6th day, less intense, but longer.

Table 83 Signs and phases of withdrawal syndrome in opiomania [Pyatnitskaya I.N., 1994]

telna. Affect is less intense, depression is insignificant. Mental anxiety is usually absent. Dyspeptic phenomena are not so pronounced.

The reverse development of withdrawal symptoms occurs lytically. If the withdrawal syndrome was not treated, then the residual effects can persist up to 1.5-2 months. These include: 1) recurring compulsive addiction to the drug; 2) depressed mood, a state of dissatisfaction; 3) increased appetite; 4) unstable sleep rhythm, short-term sleep, sometimes sleepless nights; 5) single sneezing; 6) periodic chills or sweating; 7) pain in the temporomandibular joint at the beginning of a meal; 8) inability to mental and physical activity. The duration of the withdrawal syndrome and its residual effects involves the treatment of patients for at least 4 months. The duration of the II stage of opiomania from the time of the appearance of the syndrome of physical dependence is 5-10 years.

III stage. At this stage, not only the drug addiction syndrome is expressed, but also the consequences of chronic intoxication. Signs of mental dependence in conditions of continuous anesthesia are suppressed by signs of physical dependence. There is a change in symptoms included in the syndrome of altered reactivity. The form of consumption remains systematic, tolerance falls (by about 1/3 of the previous dose) and the form of intoxication changes dramatically. In stage III, the effect of the drug on the addict is exclusively stimulating (tonic). The addict needs a dose of 1/8-1/10 of the regular dose (sufficient dose) in order to achieve a state of comfort, a sign of physical dependence. Outside of intoxication, the patient is characterized by a lack of energy up to the inability to move. Having taken a sufficient dose, the patient is not inhibited and relaxed, but mobile and able-bodied. The mode of taking the drug is 3-4-5 times a day.

Physical dependence also changes its quality. Withdrawal is severe, occurs within the first day after drug deprivation. Withdrawal syndrome also develops in phases.

The first phase occurs 4-5 hours after the last drug intake. The patient notes a feeling of melancholy, apathy. There are no intense affects, functional energy exhaustion is observed. Yawning, runny nose, sneezing, lacrimation are minor. Pupils dilate. The body is covered with sticky sweat. The extremities are cold, acrocyanosis is pronounced.

The second phase occurs 12 hours after drug withdrawal. Depressive affect is accompanied by immobility. A feeling of hopelessness and despair prevails. Muscle pain is minor. In the region of the heart, the pain is of a compressive, pressing nature.

The third phase occurs on the second day of drug withdrawal and is characterized by worsening psychopathological symptoms. There are cramps in the limbs. There is a deep longing, a feeling of hopelessness. Patients lie for hours in one position, turned away to the wall, they cannot stand the noise, laughter, light. Complete anorexia and insomnia. Bradycardia up to 60 beats / min, decrease in blood pressure to 90-70 / 60-40 mm Hg. Art.

The fourth phase occurs by the end of the second day of withdrawal and is characterized by dyspeptic symptoms. Patients are lethargic and exhausted. Constantly in bed. The skin is dry, earthy-gray in color, deep sunken dull eyes. On the face is an expression of grief, sadness. Exhausting diarrhoea, tenesmus and cramps along the bowels. There is no nausea and vomiting. The acute withdrawal period lasts up to 14 days, the total duration of the withdrawal syndrome is up to 5-6 weeks. The way out of the state of abstinence is lytic, prolonged. Symptoms disappear in reverse order. Residual symptoms persist for a long time.

Most often, patients in stage III go to the doctor, because they cannot get the appropriate amount of the drug and suffer from recurrent withdrawal symptoms. Patients independently try to give up the drug, trying to replace it with large amounts of ethanol, barbiturates, tranquilizers, or gradually reducing the dose of the usual drug. However, as a rule, these attempts are not crowned with success, and the patient again returns to the usual dose of the drug. Sometimes there is a transformation into another form of drug addiction, in particular barbituromania.

From the II stage of the disease, patients have asthenic syndrome. Working capacity decreases, interest in previous activities disappears. Concentration is difficult. Morphine users report inaccurate memory, a drop in productivity mental work, especially creative, increased fatigue, the impossibility of systematic work. Characterized by irritability, affective manifestations of asthenic order. The general mood background is depressive. Affects are not saturated, easily exhausted. Somatic patients are exhausted, the body weight deficit is 7-10 kg. All patients look older than their years. In stage III of the disease, the psychosomatic state of the drug addict is characterized by the aggravation of all manifestations typical of stage II. There is a sharp premature aging, depletion of the immune system.

The disease develops progressively, but the degree of progression is less than with the abuse of sleeping pills and hashish, psychostimulants. Progression is determined by the intensity of abuse. The malignant course is characteristic of emotionally unstable psychopaths who reach tolerance up to 3-5 g of morphine per day. In premorbidly healthy people who started using the drug in adulthood, tolerance usually does not exceed 0.2-0.3 g of morphine per day. With this form of abuse, a drug addict can maintain his psychophysical abilities and social position for decades. But such cases are rare. Most opioid addicts begin to abuse the drug at a young age, when the personality is not formed either mentally or socially. Narcotization interferes with the development of personality, leads to asocial and antisocial actions. At the same time, cases of premature, including violent, death are frequent.

Mental and behavioral disorders resulting from the use of cannabinoids (F12)

One of the first places among drug addictions in the world is occupied by drug addictions arising in connection with the abuse of drugs from different types hemp, such as anasha, marijuana, hashish, bang, kief, guaza, khusus, plan, haras, khurrus, dagga, gunya, cheres, kafur. Different varieties of hemp grow in Asia, Africa, South America are widely cultivated in many countries around the world. Hemp plants, depending on the variety and variety, contain aromatic cannabinol aldehydes in different concentrations. Tetrahydrocannabinols have a psychotomimetic effect, in particular, ∆ 9 -tetrahydrocannabinol, which mainly determines the intoxicating effect when consumed. The highest concentration of cannabinol is found in Indian hemp (Cannabis indica). The incidence of hashish addiction in the overall structure of the incidence of drug addiction in the Russian Federation ranges from 20 to 30%. In some southern Muslim countries, where alcohol is traditionally prohibited, up to 60% of men aged 20 to 40 are affected by hashishism. After alcoholism, hashishism is the most common type of drug addiction in the world.

Marijuana(weed, dope, plan, clover, hash, marijuana, lady's weed, weed, Mary Janes, Robert Plant) - a mixture of both dried and not dried tops with leaves and the remains of the stem of any cannabis varieties without a central stem, sometimes with some seeds, containing tetrahydrocannbinol.

Marijuana can be made from any variety of hemp, but wild cannabis that grows in the south and Far East(Indian, southern Arakhonian, southern Chui, southern Manchurian, southern Krasnodar hemp).

On the illegal market, it circulates in the form of crushed plant mass from green to brown, packaged in matchboxes of 3-4 g, paper rolls of 1-3 g, plastic bags of 15-600 g. In large quantities (1-4 kg ) can be packed in bags, boxes.

Hashish(sawdust, plan, marijuana, dope, nigella, bhang, haras, kifa, huss, dagga) - a mixture of separated resin and pollen of hemp or hemp apical parts, containing tetrahydrocannabinol.

On the illegal market, it circulates in the form of powder, shapeless pieces, various compressed forms with a characteristic spicy smell.

hash oil(khimka) - a viscous mass obtained from parts of plants of any species and varieties of hemp, by extracting from them (with various solvents: gasoline, alcohol, hexane, etc.) the narcotic active substance tetrahydrocannabinol. On the illegal market, it circulates in the form of a viscous mass of dark green color with a characteristic spicy smell.

The action of hashish. Hashish is usually smoked both in the form of pure resin (in hookahs, nargile, jose, kilims), and mixed with tobacco, chewed (bang), sometimes swallowed | in pills, brewed like coffee, added to food, taken in the form of a liquid extract with spices, mixed with henbane or dope. Like \ reception forms are common in Arabic and Asian countries. In the countries of European civilization, hashish intoxication is achieved by smoking mixed with tobacco, i.e. there is a mixed hashish-nicotine intoxication.

The action of cannabis preparations, in particular hashish, begins with a feeling of thirst and hunger, dry mouth. Gradually, a feeling of warmth spreads throughout the body. There is a feeling of weightlessness, a desire to jump, dance, take fancy poses. Minor actions of others cause ridiculous uncontrollable laughter. It becomes impossible to concentrate. Associations arise easily and quickly replace each other. Pronounce a set of phrases, often unfinished. There is a fast flow of thoughts. Contact with others narrows more and more, mutual understanding with them is violated. There is impulsivity. There are massive illusions, fantasies, all sounds acquire a special resonance, the feeling that the conversation is taking place in a hall with enhanced acoustics.

With an overdose of hashish, vegetative overexcitation occurs: the pupils are sharply dilated, do not react to light, the face is hyperemic, visible dryness of the lips and oral cavity, hoarseness of the voice, tachycardia up to 100-120 beats / min, hypertension up to 170-150 / 130-120 mm Hg. Art., coordination impaired, tremor,

Table 84 The sequence of changing symptoms in hashish intoxication [Babayan E.A., 1988]