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.

Major Depressive Disorder, Severe, with Psychotic Features


Treatment

The goal of treatment is to improve the individual's mood, diminish negative symptoms (anxiety, fatigue, insomnia or hypersomnia, lack of appetite, tearfulness, rumination, suicidal ideation), and diminish or eliminate the psychotic features (delusions and hallucinations) of the depressive episode. Hospitalization may be needed if the physician or mental health professional believes that the individual is dangerous to self or others.

The first line of treatment is the use of antipsychotic and antidepressant medication. Antipsychotic drugs can be effective in reducing or eliminating symptoms such as delusions, hallucinations, and disorganized thinking. Selective serotonin reuptake inhibitor (SSRI) antidepressants and the newer atypical antipsychotics are the medications of choice because of their effectiveness and low level of side effects. For example, a common regimen combines the atypical (second-generation) antipsychotic olanzapine, and the selective serotonin reuptake inhibitor (SSRI) antidepressant fluoxetine.

After the acute symptoms have cleared, the continued use of antipsychotic drugs substantially reduces the probability of future episodes, if the individual does not develop significant adverse effects such as sedation, muscle stiffness, tremors, weight gain, or abnormal muscle movements (tardive dyskinesia). Informed medical monitoring must be a mandatory part of all treatment. Most side effects can be eliminated or minimized by adjustment in dosage or type of medication. Psychotic symptoms should clear up within a few days or weeks of treatment, but depressive symptoms may take 3 to 12 weeks to diminish. Somatic symptoms, such as sleep, appetite, and psychomotor disturbances, usually respond first to medication; and then the cognitive symptoms, such as low self-esteem, poor attention and concentration, guilt, pessimism, or suicidal ideation, diminish.

For proper diagnosis and administration of antidepressant and antipsychotic medication, physicians who are expert in diagnosis and in psychopharmacotherapy must be consulted. It may be necessary to try more than one medication or a combination of medicines to achieve a good result. Because responses differ, several trials of medicine may be needed before an effective treatment is found.

For individuals whose depression is incapacitating, severe, or life-threatening or for those who cannot take or do not respond to antidepressant medications, electroconvulsive therapy (ECT) is a safe and often effective treatment for severe depression. Some newer treatments are on the horizon, but not yet approved.

Biological treatments are the interventions of choice during the acute phase of the disorder. Once the symptoms of severe depression with psychosis are brought under control with medication, then psychotherapy may be added in treating the depressive disorder. Supportive psychotherapy generally provides a therapeutic explanation of the depressive symptoms, includes education and feedback about the progression of the depression, and may include identification of stressors and training in stress management skills. As an empirically based approach, cognitive behavioral therapy has continued to gain in popularity because it is often effective. The goals of therapy may include simple emotional support; insight into sources of thoughts, feelings, perceptions, or behaviors; relief of symptoms such as anxiety or depression; stress management; behavioral changes; or crisis planning. These interventions are designed to help modify the individual's thinking, expectations, and behaviors and improve the individual’s ability to cope with various life stressors.

Source: Medical Disability Advisor