Phencyclidine Use Disorder DSM-5 Multiple Diagnostic Codes
DSM-5 Category: Hallucinogen-Related Disorders
Introduction
Phencyclidine Use Disorder is a type of the larger category of Hallucinogen-Related Disorders according to the DSM-5 (American Psychiatric Association, 2013). This is actually a scope of ailments in which patients have utilized a range of mind-altering drugs and/or plants that are referred to as ‘hallucinogens’ as a collective term. Phencyclidine is more commonly recognized by its ‘street name’ PCP or ‘angel dust’. It is a highly addictive and dangerous substance (Weaver, 2011); originally designed to anesthetize people during surgery. In fact, mental health professionals believe it to be especially hazardous because it combines aspects of mind-altering hallucinogens as well as those that separate normally integrated human consciousness.
The category in which Phencyclidine Use Disorder is classified is similar to previous editions of the manual with some exceptions; of which this disorder in particular has been relabeled. In all, there are nine hallucinogen-related disorders including all of the following: phencyclidine use disorder, “other ” hallucinogen use disorder, phencyclidine intoxication, “other” hallucinogen intoxication, hallucinogen persisting perceptual disorder (HPPD), “other” phencyclidine-induced disorders, “other” hallucinogen-induced disorders, “unspecified” phencyclidine-related disorder, and “unspecified” hallucinogen-related disorder.
Symptoms of Phencyclidine Use Disorder
Phencyclidine use disorder appears for the first time in this heading as a new diagnostic label. It is also its first appearance in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, also known as DSM-5.
A diagnosis of this disorder requires the individual to have taken one or more drugs from the groups that follow; and have experienced two or more associated problems within a 12 month timeframe. Many of the symptoms mirror those found across the breadth of substance abuse disorders. For example, Phencyclidine Use Disorder occurs when an individual takes more of the drug than was intended; and is unable to curb or control its use (or that of a similar hallucinogen).
Other common symptoms include a driving preoccupation with obtaining, using or recovering from the effects of this hallucinogen (or others); and repeated cravings for it. A diagnosis of Phencyclidine Use Disorder can also be expected when use of this substance interferes with home, school or work life; causing repeated absences and/or neglect; and in the fact of social and/or interpersonal problems as well. Often the drug can be seen to ‘take over the person’s life’ to the degree that he or she no long participates in any activities outside of drug use (Maurer, 2010).
Finally, other symptoms that may be used as a guide for diagnosis are the development of a tolerance for Phencyclidine (or other hallucinogens), continuing to use the drug in full awareness of its harmful – if not deadly – side effects.
The DSM-5 also goes into some detail about the severity of the disorder and assigns a classification according to severity. Those who are diagnosed with a mild case of the disorder only manifest 2 or 3 symptoms; a moderate case will have the presence of 4 or 5 symptoms; and a severe case of Phencyclidine Use Disorder will present with 6 or more symptoms.
Daily Life
Individuals who have a substance abuse disorder must learn to control their urges to revert to drug use every day for the rest of their lives. Although, the longer an individual remains sober and drug free the better chance they have to continue on this path. However, there is no mistaking that substance addiction is insidious and ‘lays in wait’ for the abuser whose self-control weakens.
The support of family and friends is essential to aiding the person who is suffering from Phencyclidine Use Disorder to gain back some sense of a normal life and maintain a substance-free existence. Often the first step is to have the individual submitted to a patient care facility that will help them detoxify while plans are made for a life outside of a drug treatment facility. In these cases psychotherapy is critical. It should be ongoing and may include family and/or friends in the process.
Too, once the individual is outside of the facility and – likely – settled into the home of a family member who can devote the time and energy to supporting the patient in maintaining substance sobriety – it is important to develop a healthy lifestyle and routine to replace the previously destructive behaviors. This will include keeping the living environment free of all substances including tobacco, alcohol, caffeine and even prescription or over the counter medications. All of these are temptations that can lure the individual back into abusing substances – including PCP.
Exercise and healthy eating; as well as the development and execution of a regular schedule that is rewarding; are all systems that should be put into place and maintained for the sake of the abuser (the family will benefit as well). Substance abusers should be directed to return to school; pursue personal interests and hobbies and be made aware that their support system is firmly in place. In the case of substance abuse – there is no other way than one day at a time.
Treatment of Phencyclidine Use Disorder
The treatment of Phencyclidine Use Disorder relies in part on pharmacological and psychotherapeutic approaches. When an individual presents with the symptoms of delirium, seizures, agitation or even hypothermia; these are the symptoms that must be addressed medically before any long term treatment plan can be developed. The toxicity of this drug is extreme; and vital signs must be attended to. Dependent upon the manner in which the drug was ingested will also determine the type of medical response required. Consider this presentation a medical emergency and life-threatening.
Once the patient is through the initial phase of detoxification then psychiatric and addiction care is indicated. Depending on the ongoing severity of the symptoms; the patient may require transfer to a psychiatric unit if the psychosis is not as yet under adequate control. He or she should be evaluated for chemical dependency and referred for proper treatment. This type of substance abuse is usually indicative of underlying comorbidity such as mood or movement disorders (Brust, 2010); and the use of tricyclic antidepressants such as desipramine may be recommended for withdrawal when dependence is present.
The various types of common therapeutic responses to other forms of substance abuse may be indicated in this scenario as well. It is suggested that perhaps more than one mode of therapy will be beneficial; and there may be greater response to different aspects of the various behavioral therapies that address the emotional and psychological needs of the user. These could include Dialectical Behavioral Therapy (DBT) for stress management; Cognitive Behavioral Therapy (CBT) directed at maladaptive thinking patterns; Interpersonal Therapy (IPT) that focuses on interpersonal relations and social roles and supportive 12 step and similar programs designed to combat and overcome addition.
Any pharmaceutical treatments should be vetted through a licensed medical professional (Hermle, Simon, Ruchsow, & Geppert, 2012).
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Brust, J. (2010). Substance abuse and movement disorders. (review). Movement Disorders 25(13): 2010-2020.
Hermle, L.; Simon, M; Ruchsow, M.; Geppert, M. (2012). Hallucinogen-persisting perception disorder. Therapeutic advances in psychopharmacology. Vol. 2, Iss. 5: pp. 199 – 205.
Maurer H. (2010). Chemistry, pharmacology, and metabolism of emerging drugs of abuse. Therapeutic Drug Monitoring: 32(5): 544-549.
Weaver, M. (2011). Ketamine and Phencyclidine. Addiction Medicine: pp. 603 – 613.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
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