Synthetic cathinone withdrawal

Essential (Required) Features:

• The presence of a clinically significant cluster of symptoms, behaviours, and/or physiological features that occurs upon cessation or reduction in the use of synthetic cathinones in individuals who have developed dependence on synthetic cathinones or have used synthetic cathinones for a prolonged period or in large amounts.
• Presenting features of Synthetic Cathinone Withdrawal may include depressed or dysphoric mood, irritability, fatigue, insomnia or (more commonly) hypersomnia, vivid and unpleasant dreams, increased appetite, psychomotor agitation or retardation, and craving for stimulants, including synthetic cathinones.
• The symptoms are not better accounted for by another medical condition or another mental disorder.

Additional Clinical Features:

• Characteristic features of Synthetic Cathinone Withdrawal are opposite to the acute pharmacological effects of synthetic cathinones.
• Synthetic Cathinone Withdrawal symptoms become more severe with repeated episodes of withdrawal (termed ‘kindling’), with aging, or in the presence of comorbid medical conditions.

Boundary with Normality (Threshold):

• Synthetic Cathinone Withdrawal should only be diagnosed when symptoms are consistent with those recognized as occurring upon cessation or reduction in use of synthetic cathinones. Recent cessation or reduction of use and the presence of various non-specific transient symptoms is not sufficient to make the diagnosis of Synthetic Cathinone Withdrawal.
• Withdrawal symptoms should be differentiated from the transient physiological aftereffects of intoxication (‘hangover effect’).
• Some individuals who have previously had Synthetic Cathinone Dependence may experience symptoms similar to those of Synthetic Cathinone Withdrawal months after the last use of the substance, particularly when the individual encounters stimuli (e.g., drug paraphernalia) and contexts (e.g., location where use was frequent) previously associated with past synthetic cathinone use. These symptoms are more transient than those observed during Synthetic Cathinone Withdrawal and occur exclusively when in contact with associated stimuli and contexts. A diagnosis of Synthetic Cathinone Withdrawal should not be assigned under these circumstances.

Course Features:

• Synthetic Cathinone Withdrawal is time-limited. Factors that influence the features and time course of Synthetic Cathinone Withdrawal include: (1) the severity of Synthetic Cathinone Dependence, if present, (2) the dose, frequency of use, and duration of synthetic cathinone use prior to cessation or reduction of that use, (3) the half-life and duration of action of synthetic cathinones, and (4) the presence of comorbid medical conditions (e.g., metabolic disturbances).

Culture-Related Features:

• Symptoms of withdrawal depend largely on the psychotropic characteristics of synthetic cathinones. However, specific cultures may emphasize certain symptoms of withdrawal over others, making it more difficult to conduct a differential diagnosis. In addition, vernacular terms for withdrawal vary greatly.

Boundaries with Other Disorders and Conditions (Differential Diagnosis):

• Boundary with Synthetic Cathinone Dependence: Many individuals with Synthetic Cathinone Dependence develop Synthetic Cathinone Withdrawal upon cessation or reduction in the amount of the substance. In such cases, both Synthetic Cathinone Dependence and Synthetic Cathinone Withdrawal should be diagnosed. However, Synthetic Cathinone Withdrawal can be diagnosed in the absence of a diagnosis of Synthetic Cathinone Dependence.
• Boundary with Synthetic Cathinone Intoxication: The onset of Synthetic Cathinone Intoxication occurs immediately or shortly after the consumption of synthetic cathinones. In contrast, Synthetic Cathinone Withdrawal occurs upon cessation or reduction in the amount of synthetic cathinones in the context of Synthetic Cathinone Dependence or when synthetic cathinones have been taken for a prolonged period or in large amounts. For synthetic cathinones, the intoxication and withdrawal syndromes are typically distinct.
• Boundary with other Synthetic Cathinone-Induced Mental Disorders: Mental or behavioural symptoms that arise during Synthetic Cathinone Withdrawal should only be used as a basis for diagnosing a Synthetic Cathinone-Induced Mental Disorder if the intensity or duration of the symptoms is substantially in excess of those that are characteristic of the Synthetic Cathinone Withdrawal and the symptoms are sufficiently severe to warrant specific clinical attention. In such cases, if the withdrawal syndrome is ongoing, diagnoses of both Synthetic Cathinone Withdrawal and a Synthetic Cathinone-Induced Mental Disorder may be assigned.
• Boundary with other mental disorders: Various symptoms associated with Synthetic Cathinone Withdrawal overlap with those that are characteristic of other mental disorders (e.g., depressive and anxiety symptoms). Symptoms of Synthetic Cathinone Withdrawal occur in specific temporal relationship to the cessation of use of synthetic cathinones and diminish with the passage of time. Evidence supporting a mental disorder diagnosis would include the symptoms preceding the onset of synthetic cathinone use, the symptoms persisting for a substantial period of time after cessation of synthetic cathinones or withdrawal (e.g., 1 month or more, depending on the substance), or other evidence of a pre-existing mental disorder (e.g., a history of prior episodes not associated with synthetic cathinone use).
• Boundary with other medical conditions: It may be difficult to distinguish between various symptoms associated with Synthetic Cathinone Withdrawal (e.g., fatigue, sleep disruption, increased appetite, psychomotor agitation or retardation) and those that are characteristic of other medical conditions. Symptoms of Synthetic Cathinone Withdrawal occur in specific temporal relationship to the cessation of use of synthetic cathinones and diminish with the passage of time.
• Boundary with Foetus or Newborn Affected by Maternal Use of Tobacco, Alcohol, or Other Drugs of Addiction: The ICD-11 chapter on Certain Conditions Arising During the Perinatal Period contains categories for ‘Foetus or newborn affected by maternal use of tobacco, alcohol, and other drugs.’ A neonate exhibiting signs of Synthetic Cathinone Withdrawal may also be Synthetic Cathinone Withdrawal diagnosis in order to guide treatment together with appropriate diagnosis from the chapter on Certain Conditions Originating in the Perinatal Period.