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ICD-10 Learning Lab Exit Presentation Mode

Category: F10 F11 F12 F13 F14 F15 F16 F17 F18 F19

F14 — Mental and behavioural disorders due to use of cocaine: facilitator sheet

Teaching objective

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?

Choose material

Worked example · Case: Wired, grandiose, and gone by morning · Case: Ten days clean, still convinced of surveillance

Worked example

Show scenario

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.

(or reveal one step at a time below)
  1. Reveal step 1

    Step 1 — Check timing of onset: the paranoid beliefs and tactile hallucinations began during heavy use, consistent with a substance-related origin.

  2. Reveal step 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. Reveal step 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. Reveal step 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. Reveal step 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.

Comparison points

F14's intoxication state is distinguished from its psychotic-disorder subtype by duration and severity beyond the expected intoxication window, and both are distinguished from an independent psychiatric illness by persistence well beyond that window and by personal/family history.

Discussion prompts

(or reveal one at a time below)
  1. Prompt 1

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

  2. Prompt 2

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

  3. Prompt 3

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

Summary

Cocaine intoxication produces euphoria and agitation that resolve within hours; a more sustained paranoid or hallucinatory picture temporally linked to heavy use, resolving within weeks of abstinence, is a substance-induced psychotic disorder rather than simple intoxication.