Disorders due to use of sedatives, hypnotics or anxiolytics

Disorders Due to Use of Sedatives, Hypnotics or Anxiolytics are characterized by the pattern and consequences of use of these substances. Sedatives, hypnotics, and anxiolytics are typically prescribed for the short-term treatment of anxiety or insomnia and are also employed to provide sedation for medical procedures. They include the benzodiazepines and the non-benzodiazepine positive allosteric modulators of GABA receptors (i.e., ‘Z-drugs’) as well as many other compounds. Sedatives, hypnotics, and anxiolytics include barbiturates, which are available much less commonly now than in previous decades. Sedatives, hypnotics, and anxiolytics have dependence-inducing properties that are related to the dose and duration of their use. They may cause intoxication, dependence and withdrawal. Several other mental disorders induced by sedatives, hypnotics, or anxiolytics are recognized.

Diagnostic Categories that Apply to Sedatives, Hypnotics, or Anxiolytics

Following is a list of specific diagnostic categories of that apply to sedatives, hypnotics, or anxiolytics:

• 6C44.0 Episode of Harmful Use of Sedatives, Hypnotics, or Anxiolytics
• 6C44.1 Harmful Pattern of Use of Sedatives, Hypnotics, or Anxiolytics
• 6C44.2 Sedative, Hypnotic, or Anxiolytic Dependence
• 6C44.3 Sedative, Hypnotic, or Anxiolytic Intoxication
• 6C44.4 Sedative, Hypnotic, or Anxiolytic Withdrawal
• 6C44.5 Sedative, Hypnotic, or Anxiolytic-Induced Delirium
• 6C44.6 Sedative, Hypnotic, or Anxiolytic-Induced Psychotic Disorder
• 6C44.70 Sedative, Hypnotic, or Anxiolytic-Induced Mood Disorder
• 6C44.71 Sedative, Hypnotic, or Anxiolytic-Induced Anxiety Disorder
• 6C44.Y Other Specified Disorder Due to Use of Sedatives, Hypnotics, or Anxiolytics
• 6C44.Z Disorder Due to Use of Sedatives, Hypnotics, or Anxiolytics, Unspecified

Additional categories of disorders induced by psychoactive substances are included in other parts of the ICD-11 chapter on Mental, Behavioural, and Neurodevelopmental Disorders. They are cross-listed in the section below on Substance-induced Mental Disorders for reference. These categories include:

• 6A41 Catatonia Induced by Substances or Medications
• 6D72.11 Amnestic Disorder Due to Use of Sedatives, Hypnotics or Anxiolytics
• 6D84.1 Dementia Due to Use of Sedatives, Hypnotics or Anxiolytics

The first three diagnoses listed above (Episode of Harmful Use of Sedatives, Hypnotics, or Anxiolytics, Harmful Pattern of Use of Sedatives, Hypnotics, or Anxiolytics, and Sedative, Hypnotic, or Anxiolytic Dependence) describe the pattern of sedative, hypnotic, or anxiolytic use. One of these three diagnoses, or Disorder Due to Use of Sedatives, Hypnotics, or Anxiolytics, Unspecified, for cases in which the use pattern in unknown at the time of evaluation, is considered to be the primary diagnosis. That is, one of these four diagnoses should be assigned when making a diagnosis of a Disorder Due to Sedative, Hypnotic, or Anxiolytic Use.

The remaining diagnoses reflect the impact of the pattern of sedative, hypnotic, or anxiolytic use and are thus considered to be associated with one of the primary use pattern diagnoses. These diagnoses should therefore be assigned together with the relevant primary diagnosis. For example, 6C44.1/ 6C44.5 is Harmful Pattern of Use of Sedatives, Hypnotics, or Anxiolytics associated with Sedative, Hypnotic, or Anxiolytic-Induced Psychotic Disorder, 6C44.2/6C44.70 is Sedative, Hypnotic, or Anxiolytic Dependence associated with Sedative, Hypnotic, or Anxiolytic-Induced Mood Disorder, 6C4Z/6C44.3 is Disorders Due to Substance Use, Unspecified associated with Sedative, Hypnotic, or Anxiolytic Intoxication (i.e., the pattern of use in this last case is unknown).

Sedative, Hypnotic or Anxiolytic-induced Mental Disorders are characterized by psychological, cognitive, or behavioural symptoms that develop during or soon after sedative, hypnotic or anxiolytic intoxication or withdrawal or use or discontinuation of a psychoactive medication. The duration or severity of the symptoms is substantially in excess of the characteristic syndrome of Sedative, Hypnotic or Anxiolytic Intoxication or Sedative, Hypnotic or Anxiolytic Withdrawal.