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.

Organic Psychosis


Related Terms

  • Delirium
  • Dementia
  • Metabolic Encephalopathy
  • Organic Brain Syndrome
  • Organic Brain Syndrome with Psychotic Features
  • Organic Mental Syndrome
  • Senile Organic Psychosis

Differential Diagnosis

Specialists

  • Clinical Psychologist
  • Endocrinologist
  • Internal Medicine Physician
  • Neurologist
  • Psychiatrist

Comorbid Conditions

Factors Influencing Duration

Discovery of an underlying, treatable cause may lead to improvement or recovery.

Medical Codes

ICD-9-CM:
290 - Senile and Presenile Organic Psychotic Conditions
290.4 - Dementia, Arteriosclerotic
290.9 - Senile Psychotic Condition, Unspecified
291 - Alcoholic Psychoses
291.0 - Alcohol Withdrawal Delirium; Alcoholic Delirium; Delirium Tremens
291.2 - Alcoholic Dementia, Other
291.3 - Alcohol-induced Psychotic Disorder with Hallucinations; Alcoholic Hallucinosis (Acute), Psychosis with Hallucinosis
291.4 - Alcohol Intoxication, Idiosyncratic; Pathologic Alcohol Intoxication, Drunkenness
291.9 - Alcoholic Psychosis, Unspecified
292 - Drug Psychoses; Drug-induced Mental Disorders
292.11 - Drug-induced Psychotic Disorder with Delusions; Paranoid State Induced by Drugs
292.12 - Drug-induced Psychotic Disorder with Hallucinations; Hallucinatory State Induced by Drugs
293 - Transient Mental Disorders Due to Conditions Classified Elsewhere
293.89 - Transient Mental Disorders Due to Conditions Classified Elsewhere, Other Specified; Catatonic Disorder in Conditions Classified Elsewhere
293.9 - Transient Mental Disorder in Conditions Classified Elsewhere, Unspecified; Organic Psychosis, Infective NOS, Posttraumatic NOS, Transient NOS; Psycho-organic Syndrome
294 - Persistent Mental Disorders Due to Conditions Classified Elsewhere
294.0 - Amnestic Disorder in Conditions Classified Elsewhere; Korsakoffs Psychosis or Syndrome, Nonalcoholic
294.9 - Persistent Mental Disorders Due to Conditions Classified Elsewhere, Unspecified; Cognitive Disorder NOS; Organic Psychosis, Chronic

Overview

Organic psychosis, formerly known as organic brain syndrome, refers to a wide group of psychological and behavioral abnormalities thought to be secondary to a disturbance in brain structure or function, although the specific cause is unknown. These abnormalities in brain function may be temporary or permanent. An organic cause is suspected when there is no indication of a clearly defined psychiatric or "inorganic" cause such as a mood disorder. However, as more is understood about derangement in the brain chemistry underlying psychiatric disorders, the distinction between organic and inorganic processes has become increasingly unclear.

Now the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision) has broken up the diagnoses that once fell under the diagnostic category organic mental disorder into three categories: delirium, dementia, and amnestic and other cognitive disorders; mental disorders due to a general medical condition; and substance-related disorders. This change was made because the descriptive word organic gives the false impression that conditions that are not organic have no biological explanation. An example of a mental disorder due to a general medical condition is major depression caused by hypothyroidism. An example of substance-related disorder is psychosis secondary to drug abuse.

Incidence and Prevalence: Delirium has a prevalence of 0.4% in those aged 18 and above; at age 55 and older, the prevalence increases to 1.1% (DSM-IV-TR 138).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Men are more at risk for delirium. Children are more susceptible, as well as the elderly.

Source: Medical Disability Advisor



Diagnosis

History: The individual may have a history of major disturbances in thinking, emotions, behavior, and/or level of consciousness. Observation of the individual's orientation, dress, mannerisms, behavior, and content of speech provides essential clues for diagnosing this illness.

Physical exam: The exam may reveal decreased levels of consciousness, stupor, agitation, restlessness, response to hallucinations, or neurological abnormalities such as tremors or other abnormal movement patterns.

Tests: To rule out more specific causes of these findings, the following tests may be done: blood chemistries and cell count, drug and alcohol screen, brain computed tomography (CT) or magnetic resonance imaging (MRI), toxicological screen, electroencephalogram (EEG), and spinal tap (lumbar puncture), if indicated. These tests are negative or nondiagnostic in unspecified organic psychosis. Experimental studies looking at brain function, such as positron emission tomography (PET) or single photon emission computed tomography (SPECT), are considered more of a research tool than a true help in diagnosing this syndrome.

Source: Medical Disability Advisor



Treatment

Once specific, treatable causes are ruled out, treatment is directed at maintaining safety for the individual and for others. It can involve antipsychotic, anti-anxiety, or antidepressant medication, and confinement. Observation and testing, if indicated, should continue in hopes of clarifying the diagnosis and lead to more specific treatment. When dementia (disturbances in thinking and memory) is prominent, cholinergic agonists should be considered. In central nervous system disease, aggressiveness and rage states can be reduced with lipophilic beta-blockers.

Visiting nurses, homemakers, and adult protective services may be helpful in keeping the individual at home. Counseling may help the family cope with problems involved in keeping the individual at home as long as possible. When family is no longer able to care for the individual, substitute home care, board and care, or convalescent home care may be helpful. The setting should include familiar people and objects, light at night, and a simple schedule.

Source: Medical Disability Advisor



Prognosis

The course and outcome are extremely variable. There can be lucid intervals between disturbances. If the cause is transient, such as unsuspected drug overdose or withdrawal, the disorder will totally clear within a few days. If it is caused by a progressive condition such as Alzheimer's disease, the individual never recovers. Efforts to clarify the diagnosis should be ongoing, because a specific diagnosis will help predict the outcome and may even lead to treatment that could improve or reverse the condition.

Source: Medical Disability Advisor



Complications

The individual may become injured falling out of bed, wander, get lost, or may be unable to take care of basic nutritional and hygienic needs. Other possible complications include susceptibility to infections, severe depression, suicide, or injury to others.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

It is unlikely that the individual with organic brain syndrome is able to maintain competitive employment.

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 of organic psychosis been confirmed?
  • Did evaluation include a comprehensive physical examination (including a search for neurologic abnormalities, infection, or hypoxia), laboratory tests (including a toxicologic screen), and a lumbar puncture for cerebrospinal fluid analysis?
  • Did diagnostic tests include electroencephalography, CT, MRI, PET, and SPECT?
  • Has organic psychosis, which is caused by structural brain changes, been differentiated from functional psychiatric illness?

Regarding treatment:

  • Has a primary brain disease or underlying medical disorder been identified?
  • Is individual receiving appropriate treatment to resolve or control underlying condition(s)?
  • Has physician explored the option of using drugs to increase cholinergic activity?
  • If condition is due to a central nervous system disease, would individual benefit from the use of lipophilic beta-blockers to reduce aggressiveness and rage?
  • Is individual receiving proper care in an appropriate setting?
  • Has family received the counseling and support necessary to cope with problems involved in keeping individual at home for as long as possible?
  • As family becomes unable to care for individual, have appropriate arrangements been made for substitute home care, board and care, or convalescent home care?

Regarding prognosis:

  • Has individual responded to treatment of underlying medical condition?
  • If underlying condition was reversible, to what extent has mental functioning been recovered?
  • Because medication (particularly sedatives) may further impair thinking abilities and contribute to overall problems, could unnecessary medications be discontinued?
  • Have impulsive behavior, poor judgment, and deterioration in the total behavior of individual made major rearrangement of lifestyle necessary?
  • What input has the physician given individual and family in this regard?
  • Does individual exhibit both the organic effects due to brain damage and psychological reactions to the deficits?
  • Do impulsive behavior, depression, and suicide attempts pose a threat to individual's safety? Would individual benefit from closer observation, monitoring, or confinement?

Source: Medical Disability Advisor



References

Cited

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

Source: Medical Disability Advisor






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