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
  • Psychosis

Differential Diagnosis

Specialists

  • Clinical Psychologist
  • Psychiatrist

Comorbid Conditions

Factors Influencing Duration

Length of disability may be influenced by type and severity of symptoms and 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 is severely impaired. Symptoms may include fixed but untrue beliefs (delusions), seeing visions or hearing voices (hallucinations), confusion, disorganized speech, exaggerated or diminished emotions, or bizarre behavior. Level of functioning may be severely impaired with social withdrawal and 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 though present do not meet all the diagnostic criteria for a specific psychotic disorder such as schizophrenia. 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 delusions, hallucinations, bizarre behaviors, and thought broadcasting where the individual believes others can supernaturally influence his or her thoughts or vice versa. Negative symptoms refer to a reduction 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 where 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. An example is of aliens controlling an individual's body and/or thoughts.

Hallucinations are sensory perceptions that no one else can detect and can involve the sense of sight, touch, hearing, smell, or taste. 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 where 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 lack of any purposeful and productive activity.

In an unspecified psychotic disorder, however, the symptoms do not meet criteria for any other specific psychotic disorder. For example, a diagnosis like postpartum psychosis which fails to possess 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. This may be due to inadequate or contradictory information. Examples include psychotic symptoms lasting less than a month but not yet resolved so does not yet meet the criteria for a brief psychotic disorder, persistent auditory hallucinations without any other symptoms, persistent nonbizarre delusion with overlapping mood episodes, or when a psychotic disorder appears to be present but has not yet been determined and may in fact be the result of a general medical condition or 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.

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. Electroconvulsive therapy (ECT) is not as effective. Fifty to sixty percent of cases get better with ECT if the patient has a psychotic disorder (Ghaziuddin 119). With continued observation, it may be possible to reach a more specific diagnosis and initiate appropriate treatment.

Source: Medical Disability Advisor



Prognosis

Outcome is unclear given this nonspecific diagnosis. 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 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:

  • 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 or psychotherapy utilized? How effectively?
  • Because suicide and even homicide is 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



References

Cited

Ghaziuddin, N., S. P. Kutcher, and P. Knapp. "Summary of the Practice Parameter for the Use of Electroconvulsive Therapy With Adolescents." Journal of the American Academy of Child and Adolescent Psychiatry 43 1 (2004): 119-122.

Source: Medical Disability Advisor






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