272 Psychotic Disorder Due to a General Medical Condition

DSM-IV-TR criteria

• A. Prominent hallucinations or delusions
• B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition.
• C. The disturbance is not better accounted for by another mental disorder
• D. The disturbance does not occur exclusively during the course of a delirium
  • Code based on predominant symptom:
    • .81 With Delusions: if delusions are the predominant symptom
    • .82 With Hallucinations: if hallucinations are the predominant symptom
    • Coding note: Include the name of the general medical condition on Axis I, e.g., 293.81 Psychotic Disorder Due to Malignant Lung Neoplasm, With Delusions; also code the general medical condition on Axis III (see Appendix G for codes).
  • *Coding note: If delusions are part of vascular Dementia, indicate the delusions by coding the appropriate subtype, e.g., 290.42 Vascular Dementia, With Delusions.

Epidemiology

Prevalence rates for Psychotic Disorder Due to a General Medical Condition are difficult to estimate given the wide variety of underlying medical etiologies. Research does suggest that the syndrome is underdiagnosed in the general medical setting.

Psychotic symptoms may be present in as many as 20% of individuals presenting with untreated endocrine disorders, 15% of those with systemic lupus erythematosus, and up to 40% or more of individuals with temporal lobe epilepsy

Etiology

Psychotic Disorder Due to a General Medical Condition may be a single transient state or it may be recurrent, cycling with exacerbations and remissions of the underlying general medical condition.

Although treatment of the underlying general medical condition often results in a resolution of the psychotic symptoms, this is not always the case, and psychotic symptoms may persist long after the causative medical event )e.g., Psychotic Disorder Due to Focal Brain Injury).