Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Stimulant-Related Disorders (Cocaine)


Diagnosis

History: The euphoric effects of cocaine are extremely potent, and individuals exposed to it can develop dependence/stimulant use disorder after using the drug for very short periods of time. When cocaine is taken in small amounts (up to 100 mg), these effects may include intense elation (euphoria), feeling energetic, becoming more talkative, and being more mentally alert, with temporarily decreased need for food and sleep. Some users report that they can perform simple physical and mental tasks more quickly, while others report the opposite effect.

Individuals who have been using cocaine for a significant period of time may suffer from restlessness, extreme excitability, and insomnia. Repeated use of high doses of cocaine in some individuals may lead to a toxic psychosis characterized by mounting anxiety, paranoia, and auditory, visual, and tactile hallucinations.
For those who only occasionally use cocaine, physical symptoms associated with withdrawal will be minimal, if they occur at all, and may include abdominal cramps, nausea, diarrhea, fever, chills, and exhaustion. However, with chronic use, abrupt cessation of cocaine use will result in depression, sleep disturbances, sluggishness (lethargy), muscle aches, and often a powerful craving for the drug.

An early sign of cocaine dependence is when the individual finds it increasingly difficult to resist using cocaine when it is available. Because of its short half-life (approximately 30-50 minutes), there is a need for frequent dosing to maintain a "high."

Both DSM-5 and DSM-IV-TR agree that individuals with cocaine dependence/stimulant use disorder will manifest at least 2 (as specified in DSM-5) or 3 (as specified in DSM-IV-TR) of the following, occurring at any time in the same one-year period: (1) Tolerance, as defined by a need for greatly increased amounts of the substance to achieve intoxication or desired effect (regardless of the route of administration); (2) withdrawal, characterized by hypersomnia, increased appetite, and dysphoric mood, or other feature that leads to pursuit of the drug to alleviate withdrawal symptoms (see withdrawal syndrome below); (3) the substance is taken in larger amounts or over a longer period of time than was intended; (4) there is a persistent desire or unsuccessful efforts to cut down or control substance use; (5) a great deal of time is spent in activities necessary to obtain the substance; (6) important social, occupational, or recreational activities are given up or reduced because of substance abuse; (7) the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to be caused or exacerbated by the substance.

Withdrawal syndrome for cocaine appears after cessation and consists of a dysphoric mood and at least two of the following: fatigue; vivid, unpleasant dreams; insomnia or hypersomnia; increased appetite; and psychomotor retardation or agitation. The signs or symptoms develop within a few hours to several days after the cessation of cocaine; cause clinically significant distress or impairment in social, occupational, or other important areas of functioning; are not attributable to another medical condition, and are not better accounted for by another mental disorder, including intoxication or withdrawal from another substance (DSM-5).

Once a diagnosis is made, it is also necessary to specify the current severity: mild (presence of 2-3 symptoms), moderate (4-5 symptoms), or severe (6 or more symptoms) (DSM-5). It is important to specify if there is physiological dependence (evidence of tolerance or withdrawal, that is associated with an earlier onset of dependence and more cocaine-related problems), or if there is no physiological dependence (no evidence of tolerance or withdrawal). The course specifiers are: early full remission, early partial remission, sustained full remission, sustained partial remission, on agonist therapy, and in a controlled environment (DSM-IV-TR).

Physical exam: After a single dose of 100 mg or less, there may be enlarged (dilated) pupils (mydriasis), constricted blood vessels (causing pale, cool skin), increased blood pressure (hypertension), and increased core body temperature and heart rate (tachycardia). In long-term users, exam may reveal enlarged (dilated) reactive pupils, tachycardia and hypertension, rapid breathing (tachypnea), increased perspiration (diaphoresis), and anxiety. The individual should be examined for a perforated nasal septum or decreased sense of smell (from inhaling cocaine), or needle marks and abscesses indicating injection. With time, marked weight loss may be evident. A mental status examination may reveal signs of confusion, paranoia, hallucinations, impulsivity, agitation, and hyperactivity. Symptoms of a cocaine overdose include an elevated temperature, shallow respirations, and tachycardia and hypertension.

Tests: A poly-drug blood or urine screen test can confirm cocaine use and the approximate amount used, if done within a few hours of use. Electrocardiogram (ECG) may reveal disturbances of heart rhythm.

Note: It must be kept in mind that just because a physical diagnosis cannot be established as the cause of the presenting symptomatology, it does not necessarily mean that the cause is a mental one. That is to say that the presence of medically unexplained symptomatology does not necessarily establish the presence of a psychiatric condition. The first step in identifying the presence of a mental disorder is excluding the presence of malingering and/or of factitious disorder. Although factitious disorder is conscious and purposeful, it is classified as a psychiatric disorder. The strong need for this step is especially true whenever there is a medicolegal context associated with the presenting problem(s). Additionally, using DSM-5 and/or ICD-9-CM or ICD-10-CM, the clinician will find that many presentations fail to fit completely within the boundaries of a single mental disorder. There are systematic ways to go about making psychiatric diagnoses, however.

Source: Medical Disability Advisor