647 



130 Organic Mental Svncromes and Disorders 



Diagnostic criteria for 305.90 Inhalant Intaxicatiort continued. 



(4) slurred speech 



(5) unsteadv gait 



(6) lethargy 



(7) depressed reilexes 



(8) psychomotor retardation 



(9) tremor 



(10) generalized muscle weakness 



(11) blurred vision or diplopia 



I'lZl StupUl Ol COIMd 



(13) euphoria 



D. Not due to anv phvsical or other mental disorder. 



Note: When the dirferential diagnosis must be made without a clear-cut histor,' cr 

 toxicologic analysis ot bodv fluids, it mav be qualified as "Provisional." 



NICOTINE-INDUCED ORGANIC MENTAL DISORDER 



292.00 Nicotine Withdrawal 



See p. 181 for a description of the different forms of nicotine and Nicotine Depen- 

 dence. 



The essential feature of this disorder is a charaaeristic withdrawal svndrome due to 

 the abrupt cessation of or reduction in the use of nicotine-containing substances le.g., 

 cigarettes, cigars, and pipes, chewing tobacco, or nicotine gumi that has been at least 

 moderate in duration and amount. The svndrome includes craving for nicotine; irntaoil- 

 itv, frustration, or anger: anxiety; difficulty concentrating; restlessness; decreased heart 

 rate; and increased appetite or weight gam. 



In many heavy cigarette-smokers, changes in mood and penormance that are 

 related to withdrawal can be detected within two hours after the last tobacco use. The 

 sense of craving appears to reach a peak within the first 24 hours after cessation of 

 tobacco use. and gradually declines thereafter over a few days to several weeks. In any 

 given case it is difficult to distinguish a withdrawal effect from the emergence of 

 psychological traits that were suppressed, controlled, or altered by the effects of nico- 

 tine or from a behavioral reaction (e.g., frustration) to the loss of a reinforcer. 



Mild symptoms of withdrawal mav occur after switching to low tar/nicotine ciga- 

 rettes and after stopping the use of smokefess (chewing) tobacco or nicotine gum. 



Associated features. Increased slow rhythms on an EEC, decreased catechol- 

 amines, decreased metabolic rate, tremor, increased coughing, REM change, gastroin- 

 testinal disturbance, headaches, insomnia, and impairment of performance on tasks 

 requiring vigilance are commonly associated features of Nicotine Withdrawal. 



Course. The symptoms begin within 24 hours of cessation of or reduction in 

 nicotine use and usually decrease in intensity over a period of a few days to seve.'al 

 weeks. Some former nicotine users report that craving for the substance continues for 

 longer periods. 



