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, Unspecified


Related Terms

  • Atypical Psychosis
  • Other Specified Schizophrenia Spectrum and Other Psychotic Disorder
  • Psychosis
  • Psychotic Disorder Due to Another Medical Condition
  • Unspecified Schizophrenia Spectrum and Other Psychotic Disorder

Differential Diagnosis

Specialists

  • Clinical Psychologist
  • Psychiatrist

Comorbid Conditions

Factors Influencing Duration

Length of disability may be influenced by the type and severity of symptoms and the individual’s response to treatment. If a specific psychiatric or medical diagnosis eventually emerges, the final diagnosis will determine disability.

Medical Codes

ICD-9-CM:
298.9 - Psychosis, Unspecified; Atypical Psychosis; Psychosis NOS; Psychotic Disorder NOS

Overview

In a psychotic disorder, perception and understanding of reality are severely impaired. Abnormalities in one or more of the following five domains are present: delusions, hallucinations, disorganized thinking (speech), grossly disorganized or abnormal motor behavior (including catatonia), and negative symptoms. Symptoms may include false beliefs strongly fixed in spite of invalidating evidence (delusions), perception of experiences (visual, auditory, olfactory, gustatory, or tactile) without external stimulus and with a compelling sense of their reality (hallucinations), confusion, disorganized speech, exaggerated or diminished emotions, or bizarre behavior. The individual's participation in everyday activities may be severely impaired by social withdrawal and an inability to attend to work, relationships, or even basic personal care. Individuals generally have little awareness of the mental abnormalities associated with their illness.

An unspecific psychotic disorder occurs when the psychotic symptoms do not meet all the diagnostic criteria for a specific psychotic disorder (e.g., schizophrenia) as stated in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), or in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It may be impossible to identify a specific psychotic disorder due to insufficient information or contradictory findings.

Psychotic symptoms are described as positive or negative. Positive symptoms are those that appear to reflect an excess or distortion of normal functions, including delusions, hallucinations, bizarre behaviors, and thought broadcasting, in which the individual believes others can supernaturally influence his or her thoughts or vice versa. Negative symptoms refer to a reduction in or loss of normal functions such as restriction and flattening of emotions, severely reduced speech or thought, and lack of interest in goal-directed activities.

A delusion is a firm belief that others cannot verify. The delusional individual clings to the belief despite evidence to the contrary. A common type of delusion involves thoughts of persecution such as being spied upon or conspired against. There may also be delusions of grandeur, in which individuals believe they have extraordinary powers, are on a special mission, or think they are someone important such as Jesus Christ. The delusion is termed bizarre if it is not based on ordinary life experiences, for example, the idea that aliens are controlling an individual's body and/or thoughts.

Hallucinations are sensory perceptions that no one else can detect and can involve sight, hearing, smell, taste, or touch. Hearing voices is the most frequent hallucination in psychosis. The hallucinations occur when the individual is awake.

Disorganized thoughts (loosening of associations) are characterized by jumping from one topic to another. Grossly disorganized behavior can result in neglect of personal appearance and hygiene, proper nutrition, and other tasks of living. The individual may dress inappropriately and act unpredictably, such as shouting or swearing in public. At the other behavioral extreme is catatonia, in which the individual becomes withdrawn, immobile, and unaware of the surrounding world.

Emotional flatness may include an unresponsive face and little eye contact with another individual. Emotions may be inappropriate for the situation, such as laughing at a situation no one else finds amusing or crying for any apparent reason. Unexplained fear, anger, or sadness may also be present. Abnormal movements can include continuous pacing, rocking, facial grimacing, or rigid immobility in strange postures.

Source: Medical Disability Advisor



Diagnosis

History: A psychotic episode can involve any combination of delusions, hallucinations, abnormal speech, bizarre or highly disorganized behavior, emotions that are flat or inappropriate, or a lack of any purposeful and productive activity.

In an unspecified psychotic disorder, however, the symptoms do not meet the criteria for any specific psychotic disorder, for example, symptoms that indicate postpartum psychosis but that fail to satisfy all the criteria for the following diagnoses: mood disorder with psychotic features, psychotic disorder due to a general medical condition, brief psychotic disorder, or substance-induced psychotic disorder. Inadequate or contradictory information may contribute to the difficulty in making a diagnosis. Examples of psychotic symptoms that contribute to an unspecified diagnosis include those that last less than a month but are not yet fully resolved, which means they do not meet the criteria for a brief psychotic disorder; persistent auditory hallucinations without any other symptoms; persistent nonbizarre delusions with overlapping mood episodes; or a psychotic disorder that appears to be present but has not yet been determined and may in fact be the result of a general medical condition or a substance.

Physical exam: Exam findings do not establish the diagnosis. Observation of the individual's orientation, dress, mannerisms, behavior, and content of speech provide essential signs that may help diagnose the illness.

Tests: Tests are not helpful in establishing this diagnosis but are used to rule out disorders that might be confused with acute psychosis, such as infections, substance abuse, and other metabolic causes of delirium.

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



Treatment

Psychiatric hospitalization may be needed to observe individuals and protect them from their own loss of reality, judgment, and impulse control. Antipsychotic medication may be given along with any appropriate psychotherapy. In certain situations, group therapy may be effective. With continued observation, it may be possible to reach a more specific diagnosis and initiate appropriate treatment.

Source: Medical Disability Advisor



Prognosis

Given this unspecific diagnosis, the outcome is unclear. With continued observation, it may be possible to reach a more specific diagnosis and allow for appropriate treatment and more prognostic information.

Source: Medical Disability Advisor



Complications

Accidental injuries, suicide, or homicide can occur during a psychotic episode. Loss of relationships or employment is common.

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 a timely and safe transition back to full work productivity.

Because this diagnosis is vague, any work restrictions will be contingent upon further assessment and identification of a more specific diagnosis. Contact physician for details.

Risk: Individuals working with an unspecified psychotic disorder, as well as the individuals’ coworkers, may be at risk during psychotic episodes that involve delusions, hallucinations, suicidal ideation, or homicidal tendencies.

Capacity: Capacity depends on tolerance, which is dependent on the severity and expression of psychotic symptoms. Work tasks that are familiar, simple, and not safety-sensitive may be appropriate.

Tolerance: Tolerance depends on the severity of the individual’s symptoms and on the underlying specific diagnosis. In many cases, involvement with work activities may be beneficial to recovery.

Source: Medical Disability Advisor



Maximum Medical Improvement

MMI is expected at 6 months of treatment or less.

Note: MMI is estimated under the assumption that the vagaries involved in psychiatric diagnoses have been taken into consideration.

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:

  • Do psychotic symptoms still not meet criteria for any specific psychotic disorder?
  • If more information has become available since the initial evaluation, has the physician determined if the disorder is primary, due to a general medical condition, or substance-induced?

Regarding treatment:

  • If the underlying or contributing condition has been identified, how is it being treated?
  • Are psychotic symptoms resolving?
  • Were antipsychotic medications and/or psychotherapy utilized? How effectively?
  • Because suicide and even homicide are possible during a psychotic episode, is psychiatric hospitalization needed to protect individual from his or her own loss of reality, judgment, or impulse control?
  • Would additional or a prolonged confinement be beneficial to monitor behavior and medication regime?

Regarding prognosis:

  • Has any more information become available that may direct the physician to a specific diagnosis?

Source: Medical Disability Advisor






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