Dementia associated with Alcoholisim

F10.7 Residual And Late-Onset Psychotic Disorder

A disorder in which alcohol- or psychoactive substance-induced changes of cognition, affect, personality, or behaviour persist beyond the period during which a direct psychoactive substance-related effect might reasonably be assumed to be operating.

Diagnostic Guidelines

Onset of the disorder should be directly related to the use of alcohol or a psychoactive substance. Cases in which initial onset occurs later than episode(s) of substance use should be coded here only where clear and strong evidence is available to attribute the state to the residual effect of the substance. The disorder should represent a change from or marked exaggeration of prior and normal state of functioning.

The disorder should persist beyond any period of time during which direct effects of the psychoactive substance might be assumed to be operative (see F1x.0, acute intoxication). Alcohol- or psychoactive substance-induced dementia is not always irreversible; after an extended period of total abstinence, intellectual functions and memory may improve.

The disorder should be carefully distinguished from withdrawal-related conditions (see F1x.3 and F1x.4). It should be remembered that, under certain conditions and for certain substances, withdrawal state phenomena may be present for a period of many days or weeks after discontinuation of the substance.

Conditions induced by a psychoactive substance, persisting after its use, and meeting the criteria for diagnosis of psychotic disorder should not be diagnosed here (use F1x.5, psychotic disorder). Patients who show the chronic end-state of Korsakov's syndrome should be coded under F1x.6.

Differential Diagnosis
Consider: pre-existing mental disorder masked by substance use and re-emerging as psychoactive substance-related effects fade (for example, phobic anxiety, a depressive disorder, schizophrenia, or schizotypal disorder). In the case of flashbacks, consider acute and transient psychotic disorders (F23.-). Consider also organic injury and mild or moderate mental retardation (F70-F71), which may coexist with psychoactive substance misuse.

This diagnostic rubric may be further subdivided by using the following five-character codes:

F1x.70 Flashbacks
May be distinguished from psychotic disorders partly by their episodic nature, frequently of very short duration (seconds or minutes) and by their duplication (sometimes exact) of previous drug-related experiences.

F1x.71 Personality or behaviour disorder
Meeting the criteria for organic personality disorder (F07.0).

F1x.72 Residual affective disorder
Meeting the criteria for organic mood [affective] disorders (F06.3).

F1x.73 Dementia
Meeting the general criteria for dementia as outlined in the introduction to F00-F09.

F1x.74 Other persisting cognitive impairment
A residual category for disorders with persisting cognitive impairment, which do not meet the criteria for psychoactive substance-induced amnesic syndrome (F1x.6) or dementia (F1x.73).

F1x.75 Late-onset psychotic disorder