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I read with interest the article "Acute psychosis caused by co-
amoxiclav" by Bell et al in the october 25th issue of the journal.[1] The
authors very well justify the presence of a psychotic episode with onset
coinciding with the repeated administration of the medication. In this
case, the authors have made a diagnosis of "drug induced psychosis", and
they make a case for the diagnosis of drug induced psychosis in such
situation.
According to the ICD-10 Classification of Mental and Behavioural
Disorders, this situation would be classified as "F 06 - Other mental
disorders due to brain damage and dysfunction and to physical disease" and
not "Drug induced psychosis".[2] This is because ICD 10 clearly states,
"this category includes miscellaneous conditions causally related to brain
dysfunction due to ... some exogenous toxic substances (but excluding
alcohol and drugs classified under F10-F19) or hormones". It goes on to
add "The following are among the conditions known to increase the relative
risk for the syndromes classified here: toxic effects of nonpsychotropic
drugs (propranolol, levodopa, methyldopa, steroids, antihypertensives,
antimalarials)".
The relevance of the correct nomenclature of the diagnosis cannot be
more emphasised in this case, as
1. Medication induced psychosis/delirium is a common occurence in
general medical condition, hence the need for right nomenclature is
imperative in order to avoid confusion and delays in management.
2.The term "drug" induced psychosis has a negative connotation,
especially among the general public, who equate "drugs" to "recreational
drugs" or "psychoactive substances". This could lead to stigma and
prejudice, especially when the diagnosis goes on the patient's records
including discharge summaries and GP notes. Any psychiatric diagnoses come
with stigma attached to it. This case is an example of the stigma being
attached inadvertantly and this should be avoided at any cost. [3]
Reference
1.Claire L Bell, Bruce Watson, W Stephen Waring. Acute psychosis
caused by co-amoxiclav. BMJ 2008;337:a2117
2. World Health Organization. International Statistical
Classification of Diseases and Related Health Problems (ICD–10). WHO, 1999
3. David G Kingdon, Yoshihiro Kinoshita, Farooq Naeem, Maged Swelam,
Lars Hansen, Selveraj Vincent, and Shanaya Rathod BMJ 2007 334: 221-222.
A case for uniform nomenclature
Dear Editor,
I read with interest the article "Acute psychosis caused by co-
amoxiclav" by Bell et al in the october 25th issue of the journal.[1] The
authors very well justify the presence of a psychotic episode with onset
coinciding with the repeated administration of the medication. In this
case, the authors have made a diagnosis of "drug induced psychosis", and
they make a case for the diagnosis of drug induced psychosis in such
situation.
According to the ICD-10 Classification of Mental and Behavioural
Disorders, this situation would be classified as "F 06 - Other mental
disorders due to brain damage and dysfunction and to physical disease" and
not "Drug induced psychosis".[2] This is because ICD 10 clearly states,
"this category includes miscellaneous conditions causally related to brain
dysfunction due to ... some exogenous toxic substances (but excluding
alcohol and drugs classified under F10-F19) or hormones". It goes on to
add "The following are among the conditions known to increase the relative
risk for the syndromes classified here: toxic effects of nonpsychotropic
drugs (propranolol, levodopa, methyldopa, steroids, antihypertensives,
antimalarials)".
The relevance of the correct nomenclature of the diagnosis cannot be
more emphasised in this case, as
1. Medication induced psychosis/delirium is a common occurence in
general medical condition, hence the need for right nomenclature is
imperative in order to avoid confusion and delays in management.
2.The term "drug" induced psychosis has a negative connotation,
especially among the general public, who equate "drugs" to "recreational
drugs" or "psychoactive substances". This could lead to stigma and
prejudice, especially when the diagnosis goes on the patient's records
including discharge summaries and GP notes. Any psychiatric diagnoses come
with stigma attached to it. This case is an example of the stigma being
attached inadvertantly and this should be avoided at any cost. [3]
Reference
1.Claire L Bell, Bruce Watson, W Stephen Waring. Acute psychosis
caused by co-amoxiclav. BMJ 2008;337:a2117
2. World Health Organization. International Statistical
Classification of Diseases and Related Health Problems (ICD–10). WHO, 1999
3. David G Kingdon, Yoshihiro Kinoshita, Farooq Naeem, Maged Swelam,
Lars Hansen, Selveraj Vincent, and Shanaya Rathod BMJ 2007 334: 221-222.
Competing interests:
None declared
Competing interests: No competing interests