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.

Dysthymic Disorder


Related Terms

  • Dysthymia
  • Neurotic Depression
  • Reactive Depression

Differential Diagnosis

  • Major depression
  • Mood disorder due to general medical condition
  • Personality disorders
  • Substance-induced mood disorder

Specialists

  • Clinical Psychologist
  • Internal Medicine Physician
  • Psychiatrist

Comorbid Conditions

  • Anxiety disorders
  • Major depression
  • Personality disorder
  • Post-traumatic stress disorder

Factors Influencing Duration

Length of disability may be influenced by severity of symptoms (i.e., sleep disturbance) or the degree of psychomotor retardation (slowing of physical and mental processes) and job requirements. A suicide attempt may lengthen disability due to necessary medical treatment and the need for further psychological assessment. Emotionally stressful job duties may increase length of disability. Symptoms may interfere with optimal work performance.

Medical Codes

ICD-9-CM:
300.4 - Dysthymic Disorder; Anxiety Depression, Depression with Anxiety, Depressive Reaction, Neurotic Depressive State, Reactive Depression

Overview

Dysthymic disorder is a chronic, low-grade depression. When the disorder begins in adulthood, it may be triggered by a major life transition such as the birth of a first child, bereavement, or job loss. Dysthymia can be related to personal stressors such as personality conflicts or relationship difficulties in some situations.

Individuals with dysthymia have persistent symptoms including a low mood, fatigue, hopelessness, difficulty concentrating, and problems with sleep and appetite. These symptoms persist most of the day and last over a period of 2 or more years. Individuals may have symptom-free periods but these seldom last longer than 2 consecutive months. The symptoms are generally milder but longer lasting than those of a major depressive episode.

Diagnosis is based on criteria listed in the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision). If the symptoms are associated with another psychiatric impairment such as major depression, schizophrenia, manic episodes, or organic psychosis, a diagnosis of dysthymia does not apply. For example, if chronic depressive symptoms include a major depressive episode during the first 2 years, then the diagnosis is major depression rather than dysthymic disorder. However, after the first 2 years of chronic depression, major depressive episodes may be superimposed on the dysthmic disorder, such that both diagnoses apply (double depression).

Incidence and Prevalence: In the course of their lifetime, about 5% to 6% of adults have dysthymic disorder. Point prevalence of the disorder is about 3% (DSM-IV-TR 379).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Women are 2 to 3 times more likely to develop dysthymia than men. Individuals originally diagnosed with dysthymic disorder before the age of 21 are more likely to experience major depressive episodes later and the disorder is more common in individuals with close biological relatives diagnosed with Major Depression (DSM-IV-TR 378-79).

Source: Medical Disability Advisor



Diagnosis

History: A diagnosis of dysthymic disorder is based on standard criteria set forth in the DSM-IV-TR. Persistent sadness, loss of pleasure (anhedonia), and withdrawal from usual activities over a period of 2 or more years are necessary to warrant this diagnosis.

The individual who suffers from dysthymic disorder experiences two or more of the following symptoms: poor appetite or overeating, insomnia or sleeping too much (hypersomnia), low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, or feelings of hopelessness.

Individuals with this disorder must not have had a major depressive episode during the first 2 years of the disturbance unless a full remission occurred without significant signs or symptoms for 2 months before development of the dysthymic disorder. Patients are diagnosed with chronic major depression if their depressive symptoms are caused by major depression and not dysthymic disorder during the first 2 years of the disturbance. If major depression recurs in a patient with dysthymic disorder after the first 2 years, the patient is diagnosed with double depression. The individual has never had a manic, mixed, or hypomanic episode and does not meet the criteria for cyclothymic disorder. The disturbance does not occur exclusively during the course of a chronic psychotic disorder and the symptoms are not due to physiological effects of a medication or a general medical condition such as an underactive thyroid (hypothyroidism) and must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Physical exam: There are no typical abnormalities on physical examination. Facial expressions may reveal a depressed mood. Some individuals show uncharacteristic disregard for their appearance. The individual may complain of insomnia, loss of appetite and irritability. Recent weight gain or loss or slowing of physical and mental processes (psychomotor retardation) may also be present. Observation of the individual's orientation, dress, mannerisms, behavior and content of speech may help diagnose the illness.

Tests: Dysthymia cannot be diagnosed by laboratory tests. Psychological testing such as the Beck Depression Inventory (BDI) or the Minnesota Multiphasic Personality Inventory - 2 (MMPI-2) may reveal evidence of depressed mood. The Prime MD - Structured Clinical Interview for DSM-IV can be helpful.

Source: Medical Disability Advisor



Treatment

Treatment usually consists of psychotherapy and/or antidepressant medications. Supportive counseling can address feelings of hopelessness. Cognitive therapy may help change the pessimistic ideas, unrealistic expectations, and overly critical self-evaluations that sustain the depressed mood, and can also help the individual distinguish between critical and minor life problems. Both cognitive behavioral therapy and interpersonal therapy are empirically-based treatment strategies with demonstrated effectiveness. A number of studies have found both of these psychotherapy strategies to be as effective as antidepressant medications in the treatment of dysthymic disorder. They can be delivered individually or in a group setting, and typically require 8 to 16 weekly sessions. Problem-solving therapy can help change stressful situations contributing to depression. Family and friends may benefit from counseling or a support group to help them cope with the demands of the loved one's illness.

Antidepressant medications, primarily selective serotonin reuptake inhibitors (SSRIs) are often seen as the treatment of choice in the treatment of dysthymic disorder. Treatment begins with low dosage and continues for up to 3 months. If there is significant improvement in symptoms, therapy should continue for 2 to 3 years or for life. Approximately 56% of individuals with dysthymic disorder benefit from antidepressant medication (Lima). Guidelines for assessing potential of drug therapy include a positive family history and a past history of poor response to other forms of treatment. Hospitalization is generally not necessary unless there is a suicide plan or attempt.

Source: Medical Disability Advisor



Prognosis

Outcome is good with improvement in symptoms, well-being, and functioning after several months of drug treatment and/or psychotherapy. Since the disorder is chronic, long-term or recurrent treatment may be necessary depending on the severity of symptoms. Up to 80% of individuals have severe, long-term symptoms that cause problems with social and occupational functioning. Individuals often have trouble forming or sustaining relationships. Emotional distress can be serious with incidence of suicide ranging from 3% to 12% (Cosentino). Accompanying symptoms such as sleep disorder and chronic fatigue can be debilitating and lead dysthymic individuals to use health care services five times more often than unaffected individuals.

Source: Medical Disability Advisor



Complications

The most common complication is major depression (sometimes known as double depression) or an underlying personality disorder. Suicidal thoughts, plans, or gestures may also complicate dysthymia. If a suicide attempt is made, the individual must be reassessed by a mental health professional and treated for ongoing psychological needs. Medical needs such as wound care or other physical complaints must be addressed and a new psychiatric diagnosis formulated. Treatment may be complicated if the individual has a personality disorder (an axis II diagnosis). If the individual has adopted ineffective coping techniques as part of the underlying personality disorder, this can also impede or complicate treatment.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions or accommodations are necessary infrequently, for the most serious cases. In these instances, time-limited restrictions and work accommodations should be individually determined based on the characteristics of the individual's response to the disorder, the functional requirements of the job and work environment, and the flexibility of the job and work site. The purpose of the restrictions/accommodations is to help maintain the worker's capacity to remain at the workplace without a work disruption or to promote timely and safe transition back to full work productivity.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Has diagnosis been confirmed?
  • Is functional impairment evident or reported by individual?
  • Does individual meet the specific criteria for this diagnosis?
  • Has substance abuse and/or the presence of underlying medical conditions been ruled out?

Regarding treatment:

  • What is the focus of the therapy individual received or is currently involved in?
  • Is individual currently receiving drug therapy? If not, would the addition of drug therapy be beneficial to the current treatment plan?
  • Does individual's treatment plan include inappropriate long-term use of amphetamines, barbiturates and/or benzodiazepines?
  • Is individual involved in a therapy group?
  • Is individual's family involved in therapy?
  • What education or support has the family received?

Regarding prognosis:

  • Is individual aware that depression of this kind is often chronic with recurring episodes?
  • Is individual able to ask for help if symptoms return?
  • Have relapse prevention strategies been planned?

Source: Medical Disability Advisor



References

Cited

Cosentino, Barbara Williams. "More Than the Blues: Understanding Dysthymia." CaroMont Health. Apr. 2003. 17 Dec. 2004 <http://www.caromont.org/13316.cfm>.

Frances, Allen, ed. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Association, 2000.

Lima, M. S., and J. Moncrieff. "Drugs Versus Placebo for Dysthymia." Cochrane Database of Systematic Reviews 4 (2000): CD001130. National Center for Biotechnology Information. National Library of Medicine. 17 Dec. 2004 <PMID: 11034701>.

Source: Medical Disability Advisor






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