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.

Psychotic Disorder, Brief


Related Terms

  • Brief Reactive Psychosis

Differential Diagnosis

Specialists

  • Clinical Psychologist
  • Psychiatrist

Comorbid Conditions

Factors Influencing Duration

A prompt recovery is likely with good mental and social functioning prior to the disorder, short duration of symptoms, and having no schizophrenic relatives.

Medical Codes

ICD-9-CM:
298.8 - Reactive Psychosis, Other and Unspecified; Brief Psychotic Disorder; Brief Reactive Psychosis NOS; Hysterical Psychosis; Psychogenic Psychosis NOS; Psychogenic Stupor

Overview

Brief psychotic disorder is a short-term break from reality, or an acute episode of psychotic symptoms lasting more than a day but less than 1 month. The symptoms may or may not affect daily functioning, and may include fixed but false beliefs (delusions), hearing voices or seeing things that aren't there (hallucinations), disorganized speech, or seriously disorganized behavior. Associated symptoms may include a learning problem, decreased activity (hypoactivity), elated (euphoric) or depressed mood, sexual dysfunction, or hyperactivity. The person may be screaming or silent, behavior or dress may be outlandish, and memory of recent events may be impaired. However, there is complete recovery after the episode to the pre-existing mental state.

The essential feature of brief psychotic disorder is the sudden onset of psychotic symptoms, sometimes shortly after one or more events that would cause marked distress for most individuals. Examples of these events include wartime combat, an auto accident, or death of a loved one, which was previously termed a "brief reactive psychosis." Individuals who experience mental illness following pregnancy and delivery (postpartum psychosis) may also be given this diagnosis.

This diagnosis is not made if a major mood disorder, schizoaffective disorder, or schizophrenia is present. It is not due to the effects of substance or alcohol abuse or a medical condition such as head injury.

Incidence and Prevalence: Although brief psychotic disorder is a rare condition, exact prevalence is difficult to estimate since the disorder is brief in duration. One study of patients admitted to the hospital for the first time showed that among patients with psychotic symptoms secondary to affective or nonaffective disorder, 9% had brief psychosis and 3% had acute brief psychosis; in developing countries another study showed that the incidence of psychosis not due to affective disorders was 10 times greater than in Western countries (Memon).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Onset of this condition usually occurs in individuals who are in their late twenties or early thirties. Brief psychotic disorder is more common in females than males (Memon). A pre-existing personality disorder such as histrionic, paranoid, or schizotypal personality disorder may make an individual more likely to have a brief psychotic disorder.

Source: Medical Disability Advisor



Diagnosis

History: To decide whether a stressful event has caused a psychotic episode, it may be necessary for a mental health professional to interview a spouse, relative, or friend to learn about the individual's past history and the chronological relationship between the stressful event and the onset of symptoms. Warning signs reported by the family may include changes in eating or sleeping habits, energy level, or weight; confusion, inability to make decisions; hallucinations, delusions, ideas that do not connect or make sense; repetitive actions; hours of immobility; and strange statements and behaviors. They may stop socializing or going to work, and may be inattentive to personal hygiene.

According to the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision), the following criteria must be satisfied to make the diagnosis. One or more of the following symptoms must be present: delusions, hallucinations, disorganized speech, grossly disorganized behavior, or severely withdrawn, immobile behavior (catatonia). If the symptom is a culturally sanctioned response, it cannot be included. Duration of the episode must be at least 1 day but less than 1 month, with eventual full return to premorbid level of functioning. The disturbance is not better explained by a mood disorder with psychotic features, schizoaffective disorder, or schizophrenia, and is not due to the direct physiological effects of a drug or medication or a general medical condition. The disorder can be specified as being with marked stressor(s) (if a major crisis precipitated the symptoms), without marked stressor(s), or with postpartum onset, if it began within 4 weeks of delivering a baby.

Physical exam: The exam does not contribute much to this diagnosis. However, observation of the individual's dress, mannerisms, behavior, and content of speech may provide helpful signs to diagnose the illness, such as evidence of poor hygiene, total lack of voluntary motion (catatonia), hyperactivity, lack of emotional reaction, or inappropriate emotional reaction, such as laughing at bad news.

Tests: Laboratory tests such as blood tests and urinalysis are needed to rule out substance intoxication or acute medical condition. It is also useful to obtain further imaging studies like CT scan and MRI of the brain to rule out any central nervous system (CNS) condition that might be causing the psychotic symptoms. An electroencephalogram (EEG) can also be helpful in detecting regions of abnormal brain activity.

Source: Medical Disability Advisor



Treatment

Hospitalization is usually indicated, for psychiatric evaluation as well as for the protection of the individual and others. If the person's behavior is problematic, an antipsychotic medication may be used. After the acute episode has subsided, psychotherapy or group therapy is useful to address a personality abnormality and any loss of self-esteem due to the psychotic symptoms. Treatment should be limited to 1 month because of symptom duration. Continuing psychiatric follow-up is important to make sure no similar episodes occur, and that the diagnosis was accurate. Support groups and family education may be helpful, while alcohol and recreational drugs should be avoided.

Source: Medical Disability Advisor



Prognosis

Recovery of mental functioning occurs within 1 month of symptom onset, without major psychiatric disturbances in the future. This quick recovery is inherent in the diagnosis. In Europe, 50% to 80% of individuals experience no further psychotic symptoms following (Memon).

Source: Medical Disability Advisor



Complications

The presence of a personality disorder or another psychiatric illness may complicate this disorder. There is a higher risk of accidental death or suicide for younger individuals primarily in the first year after the episode.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

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 a motor vehicle, 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 the 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.

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:

  • If symptoms have lingered longer than a month, is the diagnosis being revisited?
  • Have conditions with similar symptoms been ruled out?
  • Was diagnosis revised if a major mood disorder, schizoaffective disorder, or schizophrenia was present or if symptoms are due to alcohol and substance abuse or other medical conditions (such as head injury)?

Regarding treatment:

  • Since hospitalization is usually recommended for psychiatric evaluation as well as for the protection of individual and others, was individual hospitalized? If not, why not?
  • Does individual pose a threat to self or others?
  • Are suicidal tendencies present?
  • Are individual's nutritional and hygienic needs being met?
  • Would individual benefit from hospitalization at this time?
  • After the acute episode subsided, was individual engaged in any counseling or therapy?
  • Would individual benefit from psychotherapy to address the loss of self-esteem resulting from the psychotic episode?

Regarding prognosis:

  • If symptoms have persisted (recovery of mental functioning should occur within 1 month with no further major psychiatric disturbances) is individual undergoing further evaluation and a revised diagnosis?

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.

Memon, Mohammed, and Michael Larson. "Brief Psychotic Disorder." eMedicine. Eds. Alan D. Schmetzer, et al. 14 Jan. 2004. Medscape. 28 Dec. 2004 <http://emedicine.com/med/topic3479.htm>.

Source: Medical Disability Advisor






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