F14 — Mental and behavioural disorders due to use of cocaine

What is this category?

F14's highest-yield teaching points are acute intoxication (marked euphoria, grandiosity, agitation) and psychotic disorder — stimulant-induced psychosis is one of the most classically taught substance-induced psychotic presentations, making the intoxication/psychotic-disorder/independent-illness boundary especially important here.

Core diagnostic concept

As with F12, F14's central classification question is often about timing and severity: are grandiosity, agitation, and suspiciousness confined to the intoxication period (resolving as the drug clears), or has a more sustained psychotic picture — often including formication (a sensation of insects crawling on the skin) and paranoid delusions — developed that persists beyond intoxication and requires separate classification as a psychotic disorder?

Key diagnostic features

Acute intoxication phenomena

Euphoria, grandiosity, agitation, increased energy and confidence, sometimes with transient suspiciousness, during and shortly after use.

Dependence syndrome

The same six-criteria cluster applied to cocaine, often developing rapidly given the drug's short-acting, intensely reinforcing effect and pronounced craving.

Psychotic disorder

A more sustained psychotic picture — paranoid delusions, tactile hallucinations such as formication, agitation — occurring during or shortly after heavy use, going beyond simple intoxication.

Withdrawal state

A 'crash' of fatigue, low mood, and increased sleep or appetite following cessation of heavy use — markedly different in character from alcohol or sedative withdrawal and not typically medically dangerous by itself.

Temporal relationship to use

As with F12, the decisive detail is usually how psychotic symptoms relate in time to use, and whether they resolve as expected.

How to weigh evidence

These learning labels are teaching aids, not official ICD-10 terminology (see Sources and Method).

• supports Marked agitation, grandiosity, and paranoid suspiciousness beginning during a cocaine binge, resolving within a day as the drug's effects cleared.
• consistent not decisive The person reports occasional cocaine use at social events. Occasional use alone does not establish dependence or a psychotic disorder.
• raises alternative Paranoid delusions and tactile hallucinations that have persisted for two weeks despite verified abstinence from cocaine.
• contradicts or weakens No prior psychotic episodes, no family history, and full resolution of symptoms within 24-48 hours of last use.
• missing and necessary to ask How long after the last use the psychotic symptoms have continued, and whether abstinence has actually been verified.

Duration and course

Minimum duration: Dependence syndrome, as elsewhere in this block, is typically established by three or more criteria present together within the past year.

Course: Cocaine's effects are short-acting; intoxication typically resolves within hours, a stimulant-induced psychotic disorder is expected to resolve within days to about a month of verified abstinence, and the post-use 'crash' (withdrawal) typically peaks within a few days.

Included presentations

• Transient intoxication with euphoria, grandiosity and agitation, resolving as expected.
• A pattern meeting three or more dependence-syndrome criteria for cocaine use within the past year.
• A sustained psychotic picture, including paranoid delusions or tactile hallucinations, temporally linked to heavy cocaine use.

Exclusions and distinguishing presentations

Four-character subtypes (orientation)

A learner should not assign the psychotic-disorder subtype from agitation or suspiciousness alone without checking duration beyond the expected intoxication window. Subtypes beyond F14.0 and F14.5 are taught here for orientation only and are not separately assessed in this pilot.

F14.0 — Acute intoxication

Euphoria, grandiosity, agitation and increased energy during and shortly after use. (in_depth)

F14.1 — Harmful use

A pattern causing demonstrable harm without the fuller dependence cluster. (taught for orientation only, not separately assessed in this pilot)

F14.2 — Dependence syndrome

Three or more of the six dependence criteria present together within the past year, often developing rapidly. (taught for orientation only, not separately assessed in this pilot)

F14.3 — Withdrawal state

A post-use 'crash' of fatigue, low mood and increased sleep/appetite — not typically medically dangerous. (taught for orientation only, not separately assessed in this pilot)

F14.4 — Withdrawal state with delirium

Rare with cocaine alone. (taught for orientation only, not separately assessed in this pilot)

F14.5 — Psychotic disorder

A sustained psychotic picture — paranoid delusions, tactile hallucinations — temporally linked to heavy use, beyond simple intoxication. (in_depth)

F14.6 — Amnesic syndrome

Chronic memory impairment associated with sustained use — less classically described than with alcohol. (taught for orientation only, not separately assessed in this pilot)

F14.7 — Residual and late-onset psychotic disorder

Cocaine-related changes persisting beyond the period of direct action. (taught for orientation only, not separately assessed in this pilot)

F14.8 — Other mental and behavioural disorders

A cocaine-related presentation not fitting the other listed states. (taught for orientation only, not separately assessed in this pilot)

F14.9 — Unspecified mental and behavioural disorder

A cocaine-related disturbance identified but without enough information to classify further. (taught for orientation only, not separately assessed in this pilot)

External causes to check first

Categories in this block require that the disturbance is not better explained by another external cause listed below. These short capsules are reminders, not full teaching modules.

Worked example — stimulant intoxication versus a substance-induced psychotic disorder

A 28-year-old used cocaine heavily over a weekend and became increasingly paranoid, convinced neighbours were plotting against him, and reported feeling insects crawling on his skin. His friends confirmed he had not used any cocaine for the past ten days, yet the paranoid beliefs and skin sensations have continued essentially unchanged throughout that time. He has no prior psychiatric history.

1. Step 1 — Check timing of onset: the paranoid beliefs and tactile hallucinations began during heavy use, consistent with a substance-related origin.
2. Step 2 — Check duration since last use: symptoms have persisted for ten days of verified abstinence, well beyond the hours-long window expected for simple intoxication.
3. Step 3 — Weigh against simple intoxication: because the timeframe far exceeds intoxication's expected resolution, this is not adequately explained as acute intoxication alone.
4. Step 4 — Check for independent-illness risk factors: no prior psychiatric history, and symptoms began clearly during a period of heavy use, which weighs against (though does not fully exclude) an independent illness developing coincidentally.
5. Conclusion — Given the sustained paranoid and tactile-hallucination picture temporally linked to heavy cocaine use and still within a plausible substance-induced resolution window, this is best classified as a cocaine-induced psychotic disorder (F14.5); continued monitoring would be needed to confirm resolution rather than an emerging independent illness.

Interactive practice

• Type A Wired, grandiose, and gone by morning Recognition / application · Foundation
• Type B Ten days clean, still convinced of surveillance Boundary / differential · Boundary

Retrieval prompts

Try answering each of these from memory before revealing where to check. Nothing you think or type here is sent or saved anywhere.

1. Without looking back at the page, name two features of cocaine-induced psychotic disorder.

   Reveal answer location

   Check Duration and course, Diagnostic boundary, or the rapid revision card below — the cue you need is one of those, in this category's own already-authored wording.

   I recalled this I need to review this

2. State the one question that most helps distinguish intoxication from a substance-induced psychotic disorder in this category.

   Reveal answer location

   Check Duration and course, Diagnostic boundary, or the rapid revision card below — the cue you need is one of those, in this category's own already-authored wording.

   I recalled this I need to review this

3. Explain in one sentence why cocaine withdrawal is not typically considered as medically dangerous as alcohol withdrawal.

   Reveal answer location

   Check Duration and course, Diagnostic boundary, or the rapid revision card below — the cue you need is one of those, in this category's own already-authored wording.

   I recalled this I need to review this

These self-checks are a personal study aid only, visible to you on this page for this visit — they are not stored and do not affect your mastery dimensions.

Related glossary terms

• Dependence syndrome

  A cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use, in which use of that substance takes on a much higher priority than other behaviours that once had greater value. Classically established when three or more of six criteria (strong desire/compulsion, difficulty controlling use, tolerance, a physiological withdrawal state, progressive neglect of alternative interests, and continued use despite clear harm) have been present together within the past year.

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• Craving

  A strong subjective desire or compulsion to use a substance. One of the six criteria contributing to a dependence-syndrome classification, and often prominent during withdrawal as well.

  Open full glossary entry →