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.

Phencyclidine Abuse


Related Terms

  • Angel Dust Abuse
  • PCP Abuse
  • Phencyclidine Addiction
  • Phencyclidine Dependence

Differential Diagnosis

Specialists

  • Cardiovascular Internist
  • Clinical Psychologist
  • Neurologist
  • Occupational Therapist
  • Physical Therapist
  • Psychiatrist

Comorbid Conditions

Factors Influencing Duration

Length of disability is influenced by the duration and severity of phencyclidine abuse, presence or absence of organ damage, any underlying mental illness, other substance abuse, the individual's social support system, appropriateness of treatment choice, compliance with treatment, motivation to change, and adequacy of ongoing care.

Medical Codes

ICD-9-CM:
304.60 - Drug Dependence, Other Specified; Unspecified
304.61 - Drug Dependence, Other Specified; Continuous
304.62 - Drug Dependence, Other Specified; Episodic
305.30 - Hallucinogen Abuse; Unspecified
305.31 - Hallucinogen Abuse; Continuous
305.32 - Hallucinogen Abuse; Episodic
305.33 - Hallucinogen Abuse; in Remission

Overview

The phencyclidines, a group of drugs with pain-killing (analgesic), numbing (anesthetic), and hallucinogenic properties include phencyclidine (PCP, Sernylan), ketamine, and others. PCP is mainly used in veterinary medicine, but has become popular as an illegally obtained recreational drug. These drugs can be taken orally, smoked, or injected intravenously, and produce a sensory deprivation syndrome by affecting the central nervous system. Small doses create a feeling of euphoria, while larger doses may cause irrational rages and violent actions (suicide, mutilation, assault, or homicide), convulsions (seizures), psychosis, coma, or death.

Phencyclidine intoxication includes behavioral symptoms (such as belligerence, impulsiveness, unpredictability, or impaired judgment) and clinical symptoms (such as increased blood pressure [hypertension] or heart rate [tachycardia], uncoordinated muscle movements, or hypersensitive hearing [hyperacusis]). There are currently no strongly established symptoms of withdrawal for phencyclidines. These behavioral symptoms may be related to disturbances in two brain chemicals, dopamine and serotonin.

Diagnosis is based on criteria listed in the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision). Phencyclidine abuse occurs when use of the drug is maladaptive in the following ways: There is a need for increased amounts of substance to achieve the desired effect (tolerance); use in larger amounts or for longer periods of time than intended; a persistent, unsuccessful attempt to control use; giving up important activities in order to continue use; or continued use in spite of physical, emotional, occupational, legal, or relational difficulties related to phencyclidine use; or the pattern of use during the past 12 months has caused a decline in interpersonal, occupational, and social functioning.

Incidence and Prevalence: Seventy-five percent of ER cases involving the use of PCP are made by men (DSM-IV-TR 282). In Canada the PCP is just a popular as in the US and is a more popular drug in Mexico (Schmetzer).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Seventy-two percent of people who abuse phencyclidine are males, and men from 20 to 40 years old are twice as likely as females of the same age to use phencyclidines (Schmetzer; DSM-IV-TR 282). About 3% of adolescents of either sex over age 12 have used these drugs at least once, with the highest recent use (0.7%) being in the 12 to 17 year old age range (DSM-IV-TR 282). Fifty-four percent of PCP abusers are black (Schmetzer).

Source: Medical Disability Advisor



Diagnosis

History: Since there may be no dramatic physical effects when the drug is withdrawn, the history is of great importance in establishing this diagnosis. Violence, agitation, and bizarre behaviors such as confused wandering may lead to multiple emergency room visits or legal and relationship problems. The individual may complain of visual or hearing disturbances or illusions.

Physical exam: If intoxicated when examined, the individual may exhibit fast, jerky sideways movements of the eyeballs (nystagmus), increased blood pressure or heart rate, significantly increased or decreased body temperature, decreased sensitivity to pain, hypersensitive hearing, uncoordinated muscle movements, muscle rigidity, seizures, or coma. Other physical signs of chronic use might be evidence of injuries from accidents, fights, or falls. Needle tracks, hepatitis, HIV, or bacterial endocarditis might be present in individuals who inject phencyclidines intravenously.

Tests: Phencyclidines can be detected in the urine of those acutely intoxicated and may be detected for several weeks after use, since these drugs are fat-soluble. Muscle damage from falls and fights might show increased enzyme levels of creatine phosphokinase (CPK) or serum glutamic-oxaloacetic transaminase (SGOT). Hair analysis during active use detects PCP and its breakdown products (metabolites). If seizures occur, electroencephalogram (EEG) may be indicated. Imaging studies are not useful in detecting PCP intoxication.

Source: Medical Disability Advisor



Treatment

Abstinence is the treatment goal. Fatigue, restlessness, and depression may occur several days after quitting the drug. Although antidepressant medications can be helpful in combating the depressive symptoms, severely depressed individuals may become suicidal. For this reason, chronic users may need to be hospitalized during drug withdrawal. For individuals who experience delusions or hallucinations (lasting beyond 1 to 3 days), antipsychotic medications such as haloperidol or chlorpromazine may be given to calm and relieve distress. Generally atypical antipsychotic medication would be used first before traditional antipsychotic medication because of reduced extra-pyramidal signs (EPS). Individuals in this condition often benefit from psychiatric hospitalization. Patients generally benefit from being sedated with benzodiazepines because it not only helps to calm them down it also prevents seizures.

In general, phencyclidine recovery can be described as occurring in four phases. Although there are no formally recognized withdrawal symptoms, there is usually a detoxification phase of a few days. During the second phase of abstinence, lasting about a month, the individual focuses on changing his or her behaviors. The early remission phase can last up to 12 months, and the sustained remission phase lasts as long as the individual abstains from phencyclidine use. The most effective treatments for phencyclidine dependence appear to be cognitive therapy and addiction education and support groups. These interventions are designed to help modify the individual's thinking, expectancies, and behaviors, and to increase coping skills for various life stressors. Early treatment, following detoxification, which usually occurs in an outpatient setting, may include education on physical, emotional, and mental aspects of addiction and recovery, identification of stressors and stress management skills, improved coping skills, assertiveness training, relaxation training, or individual or family psychotherapy. Ongoing structured self-help programs such as Narcotics Anonymous and Rational Recovery are recommended as an adjunct to treatment services. Regular but random drug screens may be part of the treatment process.

Source: Medical Disability Advisor



Prognosis

Many individuals respond to treatment and stay in remission from substance abuse for many years. However, some individuals experience periods of relapse, in which they begin using phencyclidine after a period of remission, and again meet the criteria for substance abuse. There are other individuals who are never able to abstain from substance use/abuse and who do not experience any periods of remission. Individuals who are able to develop new relationships, and who consistently make use of self-help groups, are more likely to experience continued abstinence and achieve improvement in social and occupational functioning.

Factors usually associated with a more favorable outcome include a good occupational history, a group of supportive family and friends, older age of first use, motivation to change, lack of a criminal or antisocial lifestyle, and good psychosocial adjustment. Sixty-two percent of PCP abusers quit using the drug once they reach adulthood (Schmetzer).

Overdose can cause coma and death.

Source: Medical Disability Advisor



Rehabilitation

In addition to substance abuse treatment and support groups, physical therapy might be helpful if the individual has chronic problems with gait and balance and if the individual has become deconditioned due to inactivity during period of addiction and early recovery. Occupational therapy could assist the individual to develop communication skills, identify and match personal skills and work habits to the work place, and learn how participation in leisure activities unrelated to drug use contributes to overall health and well being.

Source: Medical Disability Advisor



Complications

Other psychiatric illnesses may complicate treatment of the phencyclidine abuse, while the substance use disorder complicates treatment of the other illness (dual diagnosis). About one-half of those with bipolar mood (affective) disorder or schizophrenia are thought to have drug or alcohol problems. Those with post-traumatic stress disorder (PTSD) may have substance abuse rates as high as 80%. The individual may experience psychological problems including disinhibition, anxiety, rage, aggression, panic, or flashbacks. Medical problems may include fever (hyperthermia), increased heart rate (tachycardia), increased blood pressure, or seizures. Intravenous use may lead to skin infections, bacterial endocarditis, HIV, or hepatitis. Respiratory problems might include bronchospasm, periods of not breathing (apnea), or aspiration during coma. Kidney (renal) impairment is seen in about 2% of those seeking emergency care. Patients with PCP abuse problems can have continued psychosis and flashbacks.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Many employers have systems in place for individuals recovering from alcohol dependence disorders to return to work under special contracts or conditions. These conditions may provide guidelines for random testing of blood and urine levels of identified substances and provide work performance and substance abuse treatment guidelines for the recovering individual.

Temporary work accommodations may include reducing or eliminating activities where the safety of self or others is contingent upon a constant and/or high level of alertness, such as driving motor vehicles, operating complex machinery, or handling dangerous chemicals; introducing the individual to new or stressful situations gradually under individually appropriate supervision; allowing some flexibility in scheduling to attend therapy appointments (which normally should occur during employee's personal time); promoting planned, proactive management of identified problem areas; and offering timely feedback on job performance issues. It will be helpful if accommodations are documented in a written plan designed to promote timely and safe transition back to full work productivity.

If the individual has medical complications of phencyclidine abuse, he or she may need to be restricted to sedentary type activities.

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:

  • Did individual's evaluation include detailed history of past and present substance use, including its effects on cognitive, psychological, behavioral, and physiologic functioning; general medical and psychiatric history and examination; history of prior psychiatric treatments with outcomes; family and social history; screening of blood, breath, or urine for abused substances; and other laboratory tests to help confirm the presence or absence of comorbid conditions frequently associated with substance use disorders? If not, what areas were omitted?
  • Would this information affect the current treatment plan? What changes should be made?
  • Have all underlying medical and psychiatric disorders been identified or ruled out?

Regarding treatment:

  • Since phencyclidine abuse may lead to irrational or violent behavior and multiple emergency room visits before individual is ready to seek treatment for substance abuse, what brought individual to treatment this time?
  • Does treatment include detoxification, behavioral therapies, and regular attendance at support groups such as Narcotics Anonymous or Rational Recovery?
  • Has individual experienced any psychotic symptoms?
  • Was drug therapy effective?
  • Would individual benefit from psychiatric hospitalization?
  • Is individual involved in a cognitive behavioral therapy program?
  • Does this therapy appear to be helping to modify the individual's thinking, expectancies, and behaviors, and increase coping skills for various life stressors?
  • Does individual's treatment plan consider all underlying psychiatric or general medical conditions, sex-related factors (including the possibility of pregnancy), social and living environment, cultural factors, and family characteristics? If current treatment plan does not take these factors into consideration, what changes could be made to better meet this individual's needs?
  • Is individual currently in a period of high relapse risk, such as the early stages of treatment, periods of transition to less intensive levels of care, or the first year after completion of active treatment? Is an intensive monitoring system for substance use in place during these periods of high relapse risk?
  • Are individual's needs being effectively met?

Regarding prognosis:

  • Is individual currently involved in a support group such as Narcotics Anonymous or Rational Recovery?
  • Does individual participate in a formal support group that provides the external support and motivation to continue in treatment beyond the initial stage of detoxification?
  • What other support systems does individual have in place? Family? Friends?
  • Is individual improving in social and occupational functioning?
  • Does individual have the necessary tools, skills, and encouragement to move ahead with his or her life?

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.

Schmetzer, Alan D., and Roland McGrath. "Phencyclidine (PCP)-Related Psychiatric Disorders." eMedicine. Eds. Barry I. Liskow, et al. 20 Sep. 2004. Medscape. 15 Dec. 2004 <http://emedicine.com/med/topic3118.htm>.

Source: Medical Disability Advisor






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