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.

Schizoaffective Disorder


Related Terms

  • Schizo-affective Psychosis

Differential Diagnosis

  • Amphetamine-related psychiatric disorders
  • Bipolar affective disorder
  • Cushing's syndrome
  • Delirium
  • Delusional disorder
  • Dementia
  • Depression
  • Human immunodeficiency virus (HIV)
  • Hyperparathyroidism
  • Neurosyphilis
  • Phencyclidine (PCP)-related psychiatric disorders
  • Schizophrenia
  • Steroid use
  • Stroke (infarction)
  • Substance abuse
  • Temporal lobe epilepsy
  • Thyroid problems

Specialists

  • Clinical Psychologist
  • Psychiatrist

Comorbid Conditions

  • Personality disorder

Factors Influencing Duration

The depressed form of schizoaffective disorder can have a longer disability and poorer prognosis than the bipolar type. Family and social supports, job history, job duties, the severity of the illness, and the individual's response to treatment and compliance with treatment may all influence the length of disability.

Medical Codes

ICD-9-CM:
295.70 - Schizoaffective Disorder; Unspecified
295.71 - Schizoaffective Disorder; Subchronic
295.72 - Schizoaffective Disorder; Chronic
295.73 - Schizoaffective Disorder; Subchronic with Acute Exacerbation
295.74 - Schizoaffective Disorder; Chronic with Acute Exacerbation
295.75 - Schizoaffective Disorder; in Remission

Overview

Schizoaffective disorder is a combination of a thought disorder, mood disorder, and anxiety disorder characterized by features of both schizophrenia and a significant emotional disturbance resembling either major depression (depressive type) or mania (bipolar type). The psychotic aspects—fixed, untrue beliefs (delusions), hearing voices or seeing visions (hallucinations), disorganized speech, disorganized behavior, or severely diminished emotions, speech, or activity—are present continuously, with the mood disturbance present for a significant portion of that time.

Manic episodes are associated with sudden elation, euphoria, or extreme irritability. Depressive episodes are characterized by feelings of sadness as well as worthlessness or hopelessness, loss of pleasure and interest in life, and thoughts of death or suicide attempts. With this illness, there is often impairment of occupational and social functioning and basic self-care.

Incidence and Prevalence: Schizoaffective disorder has a lifetime prevalence of approximately 0.3%. Schizoaffective disorder appears to be about one-third as common as schizophrenia (DSM-5; Brannon).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Onset can be any at age from adolescence onward. Schizoaffective disorder affects more women than men.

Source: Medical Disability Advisor



Diagnosis

History: For a diagnosis of schizoaffective disorder, criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) require an uninterrupted period of illness during which, at some time, there is either a major depressive episode, a manic episode, or a mixed episode. At the same time there are symptoms that meet the criteria for schizophrenia (two or more of the following): delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, or negative symptoms such as flat or bland emotional affect. Delusions or hallucinations must be present for at least 2 weeks in the absence of prominent mood symptoms. Symptoms that meet the criteria for a mood episode must have been present during almost all the active and residual periods of the illness, and must not be related to a substance such as drugs or alcohol or a general medical condition such as endocrine disease. Schizoaffective disorder is labeled bipolar type if the disorder includes a manic or a mixed episode (or a manic or a mixed episode and major depressive episodes), or depressive type if the disorder only includes major depressive episodes.

A typical history consists of hearing voices for 2 months, becoming severely depressed for the next 3 months while still hearing the voices, and then recovering from depression but continuing to have auditory hallucinations.

For a diagnosis of schizoaffective disorder, criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) require an uninterrupted period of illness during which there is a major mood episode (major depressive or manic), as well as symptoms that meet criterion A for schizophrenia (two or more of the following): delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, or negative symptoms such as flat or bland emotional affect or avolitional issues.

During the lifetime duration of the illness, there must be delusions or hallucinations for at least 2 weeks in the absence of a major mood episode. During almost all the active and residual parts of the illness, the individual has symptoms of a major mood episode. These symptoms must not be caused by a substance such as drugs or alcohol or a general medical condition such as endocrine disease.

If a manic episode is part of the presentation (major depressive episodes may also occur), then the disorder is labeled bipolar type; if the individual experiences only major depressive episodes, then it is called depressive type. Individuals with this disorder may also have catatonia. After a year, if the specifiers do not contradict the diagnostic course criteria, the physician must specify whether the current episode is the first, and whether it is currently acute, in partial remission, or in full remission. For individuals who report multiple episodes, the physician must note whether there are multiple episodes, and describe them as currently acute, in partial remission, or in full remission. The disorder must also be labeled as continuous or unspecified. Finally, the physician may specify the current severity, rated by a quantitative assessment of the primary symptoms of psychosis.

Physical exam: The exam does not contribute significantly to the diagnosis other than to rule out neurological abnormalities that may suggest another diagnosis. Observation of the individual's orientation, attire, mannerisms, behavior, and content of speech provide essential signs to diagnose the illness.

Tests: Tests are not needed to establish this diagnosis, although personality testing such as the Minnesota Multiphasic Personality Inventory (MMPI or MMPI-2) may be helpful. Other laboratory tests that may be helpful include urinalysis, complete blood count, thyroid function test, urine toxicology screen, rapid plasma reagin (RPR), a test for syphilis, and an electroencephalogram (EEG). A head computed tomography (CT) or magnetic resonance imaging (MRI) may be helpful to rule out brain lesions.

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

During acute psychotic episodes, psychiatric hospitalization is often needed to protect individuals from their own loss of reality, judgment, and impulse control. The manic (bipolar) type of schizoaffective disorder is treated with antipsychotic medications and mood stabilizers such as lithium. Individuals with the depressive form of schizoaffective disorder receive antidepressant medications and antipsychotics. As very few individuals with schizoaffective disorder tend to remain on their oral medications after the first year of treatment, long-acting antipsychotics given by injections deep into the muscle, spaced 2 to 4 weeks apart, are often needed.

Benzodiazepines may also be given for anxiety and insomnia in the acute stages. Anti-parkinsonian drugs are commonly given to treat side effects of the traditional antipsychotic drugs but are rarely needed with the newer antipsychotic agents. Electroconvulsive therapy (ECT) is rarely used and is not generally effective for this condition.

Psychotherapy and strengthening of family, social, and occupational support are useful. Social and occupational rehabilitation therapy may help overcome the unemployment, homelessness, and poverty often associated with this disorder. Step-down treatment after hospitalization may include day treatment and residing in a halfway house.

Source: Medical Disability Advisor



Prognosis

The outcome is highly variable. The prognosis is worse than that for mood disorders, and better than that for schizophrenia.

Source: Medical Disability Advisor



Complications

There is an increased risk of suicide during depressive episodes. Alcohol and drug abuse can occur. A break with reality secondary to psychotic symptoms can lead to accidental injury, death, homicide, or injury to others. Poor impulse control and lack of judgment during manic episodes may lead to loss of employment, financial or legal problems, divorce, or other problems in society and relationships.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Temporary work accommodations may include reducing or eliminating activities in which 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 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.

Risk: Risk is affected by the severity and length of the manic and depressive psychotic episodes, whether the individual required psychiatric hospitalization, and if the individual exhibited hallucinations, extreme irritability, poor impulse control, and/or suicidal thoughts. Adequate supervision should be provided to maintain workplace safety for both the individual and his or her coworkers.

Capacity: Capacity depends on the severity and expression of psychotic symptoms. As long as risk has adequately been addressed, individuals with schizoaffective disorder may work without limitations. Affected individuals may require periodic drug testing to ensure that alcohol and drug abuse does not occur.

Tolerance: Tolerance factors include compliance with taking prescribed medications (e.g., antidepressants, antipsychotics), attending psychotherapy sessions, and participating in social and occupational rehabilitation. Engagement in structured, non safety-sensitive work tasks may be beneficial to recovery.

Source: Medical Disability Advisor



Maximum Medical Improvement

MMI is expected at 12 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:

  • Has a diagnosis of schizoaffective disorder been confirmed?
  • Have conditions with similar symptoms been ruled out?
  • Have conditions directly due to physiological effects of a substance or general medical conditions been identified or ruled out?
  • Since diagnostic criteria for schizoaffective disorder dictate that the illness has a mixture of both schizophrenia and bipolar or depressive disorder symptoms, does individual's diagnosis need to be readdressed?

Regarding treatment:

  • If individual is experiencing acute psychotic episodes, is psychiatric hospitalization warranted to protect the individual from loss of reality, poor judgment, and impulse control?
  • Has drug therapy, including antidepressants and lithium, been effective?
  • Were antipsychotic (neuroleptic) drugs used while the individual was in a psychotic state? With what response?
  • If antipsychotic drugs are causing unpleasant side effects, what alternatives exist?
  • Can individual change medications at this point in treatment?
  • What long-term therapy regime has physician planned for this individual?
  • Would individual benefit from supervised step-down treatment after hospitalization, such as day treatment or residing in a halfway house?

Regarding prognosis:

  • What is individual's current level of occupational functioning?
  • To what extent is social dysfunction obvious?
  • Is individual having trouble communicating with co-workers or other family members?
  • Is individual experiencing difficulties with self-care such as cooking and personal grooming?
  • Is individual demonstrating increased risk of suicide?
  • Is rehabilitation focused on helping individual regain confidence for self-care and living a fuller life? What more can be done to meet these needs?
  • Does individual have an effective support system in place?
  • Is individual and/or family involved in a psychotherapy experience that helps both individual and family members better understand this illness and share coping problems?

Source: Medical Disability Advisor



References

Cited

Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. American Psychiatric Association, 2013.

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

Brannon, Guy E. "Schizoaffective Disorder." eMedicine. 1 Dec. 2014. Medscape. 9 Jun. 2015 <http://emedicine.medscape.com/article/294763-overview#showall>.

Source: Medical Disability Advisor






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