Synthetic cathinone-induced obsessive-compulsive or related syndrome

Essential (Required) Features:

• The presentation is characterized by symptoms that share primary clinical features with Obsessive-Compulsive or Related Disorders (e.g., obsessions, intrusive thoughts and preoccupations, compulsions, recurrent and habitual actions directed at the integument).
• The obsessive-compulsive or related symptoms develop during or soon after intoxication with or withdrawal from synthetic cathinones.
• The intensity or duration of the repetitive preoccupations and behaviours is substantially in excess of analogous disturbances that are characteristic of intoxication or withdrawal due to synthetic cathinones.
• The symptoms and behaviours are not better accounted for by another mental disorder, in particular an Obsessive-Compulsive or Related Disorder. Evidence supporting a diagnosis of another mental disorder would include obsessive-compulsive or related symptoms preceding the onset of the synthetic cathinone use, the symptoms persisting for a substantial period of time after cessation of the synthetic cathinone use or withdrawal (e.g., 1 month or more), or other evidence of a pre-existing mental disorder with obsessive-compulsive or related symptoms (e.g., a history of prior episodes not associated with synthetic cathinone use).
• The symptoms and behaviours are not a manifestation of another medical condition.
• The symptoms cause significant distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning.

When making a diagnosis of Synthetic Cathinone-Induced Obsessive-Compulsive or Related Disorder, an additional diagnosis indicating the related pattern of synthetic cathinone use should also be assigned. These include Episode of Harmful Use of Synthetic Cathinones, Harmful Pattern of Use of Synthetic Cathinones, and Synthetic Cathinone Dependence. A diagnosis of Synthetic Cathinone Intoxication or Synthetic Cathinone Withdrawal may also be assigned if applicable.

Additional Clinical Features:

• Synthetic Cathinone-Induced Obsessive-Compulsive or Related Disorder may present with patterns of symptoms that vary according to the characteristics of the user (e.g., genetics, metabolism, personality factors). Synthetic Cathinone use in higher amounts or over longer periods of time is more likely to be associated with the development of a Synthetic Cathinone-Induced Obsessive-Compulsive or Related Disorder.
• Symptoms of Synthetic Cathinone-Induced Obsessive-Compulsive or Related Disorder usually resolve or improve after sustained cessation of synthetic cathinone use.
• The duration of Substance Withdrawal for some substances can be protracted. For substances with more protracted withdrawal periods, the onset of symptoms of Substance-Induced Obsessive-Compulsive or Related Disorder can occur up to several weeks after the cessation of substance use. Substance-Induced Obsessive-Compulsive or Related Disorder symptoms related to substances with more protracted withdrawal periods may also last for correspondingly longer periods of time.
• In cases in which multiple psychoactive substance are used, it is often challenging to distinguish which substance is the cause of the Substance-Induced Obsessive-Compulsive or Related Disorder. When the specific etiological substance cannot be determined, a diagnosis of Substance-Induced Obsessive-Compulsive or Related Disorder Due to Multiple Specified Psychoactive Substances including Medications may assigned. In cases of multiple psychoactive substance use in which more than one specific substance can be identified as a cause of the Substance-Induced Obsessive-Compulsive or Related Disorder, the corresponding specific Substance-Induced Obsessive-Compulsive or Related Disorder diagnoses should be given instead.

Boundary with Normality (Threshold):

• Symptoms of Synthetic Cathinone-Induced Obsessive-Compulsive or Related Disorders should be differentiated from transient physiological aftereffects of intoxication (‘hangover effect’). The duration or severity of the symptoms in Synthetic Cathinone-Induced Obsessive-Compulsive or Related Disorders must be in excess of ‘hangover effects’ of Synthetic Cathinones and result in significant distress or impairment of functioning.

Boundaries with Other Disorders and Conditions (Differential Diagnosis):

• Boundary with Synthetic Cathinone Intoxication and Synthetic Cathinone Withdrawal: Mental or behavioural symptoms that occur during Synthetic Cathinone Intoxication or Synthetic Cathinone Withdrawal should only be used as a basis for diagnosing a Synthetic Cathinone-Induced Obsessive-Compulsive or Related Disorder if the intensity or duration of the symptoms is substantially in excess of those that are characteristic of Synthetic Cathinone Intoxication or Synthetic Cathinone Withdrawal and the symptoms are sufficiently severe to warrant specific clinical attention.
• Boundary with Episode of Harmful Use of Synthetic Cathinones, Harmful Pattern of Use of Synthetic Cathinones, or Synthetic Cathinone Dependence: The impact of repeated or continuous use of synthetic cathinones characteristic of Harmful Pattern of Use of Synthetic Cathinones and Synthetic Cathinone Dependence may include Synthetic Cathinone-Induced Obsessive-Compulsive or Related Disorder. Synthetic Cathinone-Induced Obsessive-Compulsive or Related Disorders can also be associated with a single episode of synthetic cathinone use. In such cases, a Synthetic Cathinone-Induced Obsessive-Compulsive or Related Disorder should be diagnosed together with a primary diagnosis of Episode of Harmful Use of Synthetic Cathinones, Harmful Pattern of Use of Synthetic Cathinones, or Synthetic Cathinone Dependence.
• Boundary with mental disorders not induced by synthetic cathinones: Synthetic Cathinone-Induced Obsessive-Compulsive or Related Disorders are differentiated from mental disorders with similar features that are not induced by synthetic cathinones on the basis of their onset, course and clinical features. A diagnosis of Synthetic Cathinone-Induced Obsessive-Compulsive or Related Disorder requires evidence from history, physical or mental examination, or laboratory findings of recent synthetic cathinone use, intoxication or withdrawal. Most Synthetic Cathinone-Induced Mental Disorders resolve or improve within several weeks of cessation of synthetic cathinone use. Mental disorders not induced by synthetic cathinones may precede the onset of synthetic cathinone use or may continue to be symptomatic during periods of sustained abstinence. The co-occurrence of synthetic cathinone use or withdrawal and onset of symptoms of mental disorders should not be taken as evidence for a presumptive diagnosis of a Synthetic Cathinone-Induced Obsessive-Compulsive or Related Disorder. Some people use substances to suppress symptoms of mental disorders (e.g., Schizophrenia and Other Primary Psychotic Disorders, Mood Disorders, Anxiety and Fear-Related Disorders, Personality Disorders) and full symptomatic presentations only emerge upon cessation or reduction in substance use. Furthermore, synthetic cathinone use can exacerbate symptoms or precipitate an episode of a pre-existing mental disorder. Finally, synthetic cathinone use may be associated with but not aetiologic for new onset of symptoms of a mental disorder. Although a diagnosis of a Synthetic Cathinone-Induced Obsessive-Compulsive or Related Disorder should not be assigned under these circumstances, an additional diagnosis of Episode of Harmful Use of Synthetic Cathinones, Harmful Pattern of Use of Synthetic Cathinones, or Synthetic Cathinone Dependence may still be appropriate.