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.

Persistent Depressive Disorder (Dysthymia)


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

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 the 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

Diagnosis

History: According to standard criteria set forth in the DSM-5, the individual with persistent depressive disorder (dysthymia) has a depressed mood for most of the day, almost daily (by subjective account or observation by others), for at least 2 years. While depressed, the individual exhibits 2 (or more) of the following: poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, and feelings of hopelessness. During those 2 years the individual has never been free of the aforementioned symptoms for more than 2 months in a row; criteria for a major depressive disorder may be continuously present for 2 years (note the change with respect to DSM-IV-TR). The individual has never had a manic (note the deletion of "mixed") or hypomanic episode, and has never met the criteria for cyclothymic disorder. Persistent depressive disorder (dysthymia) is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum or other psychotic disorder (note the change with respect to DSM-IV-TR). The symptoms are not due to the physiological effects of a drug of abuse or a medication, or another medical condition. The symptoms produce clinically significant distress or impairment in social, occupational, or other important areas of functioning (DSM-5).

DSM-5 also states that since the criteria for a major depressive episode include four symptoms not listed in the symptoms of persistent depressive disorder (dysthymia), very few individuals will have depressive symptoms for more than 2 years but will not meet criteria for persistent depressive disorder. When full criteria for a major depressive episode have been met at some time during the current episode, a diagnosis of major depressive disorder should be assigned; otherwise, a diagnosis of other specified depressive disorder or unspecified depressive disorder may be given (DSM-5).

It is necessary to specify whether the disorder occurs with anxious distress; with mixed features, melancholic features, atypical features, mood-congruent or mood-incongruent psychotic features, or peripartum onset; if the disorder is in partial or full remission; if onset is early (before age 21 years) or late (age 21 years or older); if (for the most recent 2 years of persistent depressive disorder) the disorder is concurrent with pure dysthymic syndrome, a persistent major depressive episode, or intermittent major depressive episodes (with or without current episode); finally, it is necessary to specify whether disorder is currently mild, moderate, or severe (DSM-5).

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. 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 speech content may help diagnose the illness.

Tests: Persistent depressive disorder (dysthymia) cannot be diagnosed by laboratory tests. Psychological testing such as the Beck Depression Inventory (BDI), the PHQ9, the Minnesota Multiphasic Personality Inventory 2 (MMPI-2), or other tests may reveal evidence of depressed mood. The Prime MD Structured Clinical Interview for DSM-IV can be helpful.

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






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