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.

Schizophrenia


Related Terms

  • Schizophrenia Disorder
  • Schizophrenic Reaction

Differential Diagnosis

  • Addison's disease
  • ALA dehydratase deficiency porphyria
  • Alcohol-related psychosis
  • Autism spectrum disorder or communication disorders
  • Behçet's disease
  • Bipolar disorder with psychotic or catatonic features
  • Body dysmorphic disorder
  • Brain abscess
  • Brief psychotic disorder
  • Churg-Strauss syndrome
  • Cocaine-related psychiatric disorder
  • Cytomegalovirus (CMV)
  • Delusional disorder
  • Encephalopathy, dialysis
  • Encephalopathy, hepatic
  • Encephalopathy, hypertensive
  • Encephalopathy, uremic
  • Folic acid deficiency
  • Head trauma
  • Huntington's disease dementia
  • Hypercalcemia
  • Hyperparathyroidism
  • Hyperthyroidism
  • Hypocalcemia
  • Hypoglycemia
  • Hypokalemia
  • Hypomagnesemia
  • Hyponatremia
  • Hypoparathyroidism
  • Hypothyroidism
  • Lung cancer, oat cell (small cell)
  • Major depressive disorder with psychotic or catatonic features
  • Mental disorders secondary to general medical conditions
  • Obsessive-compulsive disorder
  • Other mental disorders associated with a psychotic episode
  • Paraneoplastic syndromes
  • Phencyclidine (PCP)-related psychiatric disorders
  • Porphyria, acute intermittent
  • Posttraumatic stress disorder
  • Schizoaffective disorder
  • Schizophreniform disorder
  • Schizotypal personality disorder
  • Shared psychotic disorder
  • Substance-induced mood disorder, depressed type
  • Systemic lupus erythematosus (SLE)
  • Wernicke-Korsakoff's syndrome
  • Wilson's disease

Specialists

  • Clinical Psychologist
  • Psychiatrist

Comorbid Conditions

  • Alcohol use
  • Anxiety disorders
  • Depression
  • Drug dependency
  • Nicotine dependence
  • Obsessive compulsive disorder
  • Panic disorder
  • Paranoid personality disorder
  • Schizotypal personality disorder
  • Stress

Factors Influencing Duration

Negative symptoms (e.g., regressive behavior, emotional flatness, social withdrawal) lengthen disability because they are more difficult to treat than positive symptoms (e.g., hallucinations, delusions, anger, anxiety, violence), and are often accompanied by intellectual impairment. Lack of insight on the part of the affected individual also lengthens disability because such an individual has little incentive to cooperate with treatment and to adhere to a medication regimen. Another negative influence on length of disability is the individual's presence in an unstable or hostile environment. Strength of family and social supports, the quality of the individual’s relationship with his or her psychiatrist, response to treatment, and specific job duties also influence duration of disability.

Medical Codes

ICD-9-CM:
295.00 - Schizophrenia, Simple Type; Unspecified
295.01 - Schizophrenia, Simple Type; Subchronic
295.02 - Schizophrenia, Simple Type; Chronic
295.03 - Schizophrenia, Simple Type; Subchronic with Acute Exacerbation
295.04 - Schizophrenia, Simple Type; Chronic with Acute Exacerbation
295.05 - Schizophrenia, Simple Type; in Remission
295.10 - Schizophrenia, Disorganized Type; Unspecified
295.11 - Schizophrenia, Disorganized Type; Subchronic
295.12 - Schizophrenia, Disorganized Type; Chronic
295.13 - Schizophrenia, Disorganized Type; Subchronic with Acute Exacerbation
295.14 - Schizophrenia, Disorganized Type; Chronic with Acute Exacerbation
295.15 - Schizophrenia, Disorganized Type; in Remission
295.20 - Schizophrenia, Catatonic Type; Unspecified
295.21 - Schizophrenia, Catatonic Type; Subchronic
295.22 - Schizophrenia, Catatonic Type; Chronic
295.23 - Schizophrenia, Catatonic Type; Subchronic with Acute Exacerbation
295.24 - Schizophrenia, Catatonic Type; Chronic with Acute Exacerbation
295.25 - Schizophrenia, Catatonic Type; in Remission
295.30 - Schizophrenia, Paranoid Type; Unspecified
295.31 - Schizophrenia, Paranoid Type; Subchronic
295.32 - Schizophrenia, Paranoid Type; Chronic
295.33 - Schizophrenia, Paranoid Type; Subchronic with Acute Exacerbation
295.34 - Schizophrenia, Paranoid Type; Chronic with Acute Exacerbation
295.35 - Schizophrenia, Paranoid Type; in Remission
295.50 - Latent Schizophrenia; Unspecified
295.51 - Latent Schizophrenia; Subchronic
295.52 - Latent Schizophrenia; Chronic
295.53 - Latent Schizophrenia; Subchronic with Acute Exacerbation
295.54 - Latent Schizophrenia; Chronic with Acute Exacerbation
295.55 - Latent Schizophrenia; in Remission
295.60 - Schizophrenia, Residual Type; Unspecified
295.61 - Schizophrenia, Residual Type; Subchronic
295.62 - Schizophrenia, Residual Type; Chronic
295.63 - Schizophrenia, Residual Type; Subchronic with Acute Exacerbation
295.64 - Schizophrenia, Residual Type; Chronic with Acute Exacerbation
295.65 - Schizophrenia, Residual Type; in Remission
295.80 - Types of Schizophrenia, Other Specified; Unspecified
295.81 - Types of Schizophrenia, Other Specified; Subchronic
295.82 - Types of Schizophrenia, Other Specified; Chronic
295.83 - Types of Schizophrenia, Other Specified; Subchronic with Acute Exacerbation
295.84 - Types of Schizophrenia, Other Specified; Chronic with Acute Exacerbation
295.90 - Schizophrenia, Unspecified; Unspecified
295.91 - Schizophrenia, Unspecified; Subchronic
295.92 - Schizophrenia, Unspecified; Chronic
295.93 - Schizophrenia, Unspecified; Subchronic with Acute Exacerbation
295.94 - Schizophrenia, Unspecified; Chronic with Acute Exacerbation
295.95 - Schizophrenia, Unspecified; in Remission

Overview

Schizophrenia is a group of mental disorders characterized by a loss of contact with reality (psychotic behaviors) and by disturbances lasting longer than 6 months in thought, perception, emotions (affect), behavior, and communication.

Although the exact cause is unknown, the consensus is that schizophrenia is fundamentally a physical disease of the brain. It is associated with an imbalance in two of the complex neurochemical systems in the brain involving the neurochemicals dopamine and glutamate. According the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), there are five subtypes of schizophrenia: catatonic, paranoid, disorganized, undifferentiated, and residual; each subtype is characterized by four domains of distinctive and predictable symptoms: positive, negative, cognitive, and mood (DSM-IV-TR). These subtypes are no longer recognized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), although some of them continue to be used as specifiers. For example, criterion A provides for #4 "grossly disorganized or catatonic behavior," and there is a requirement to specify if the disorder is associated with catatonia.

Positive symptoms (called "positive" because they add to the individual's experience and behavior) include hearing voices (auditory hallucinations), seeing visions (visual hallucinations), false personal beliefs of being unfairly persecuted (delusions of persecution) or of being someone with great power or fame (delusions of grandiosity), anger, anxiety, and violence. These symptoms are typical of paranoid schizophrenia (DSM-IV-TR). Individuals perceive the hallucinations and delusions as very real sensory experiences and usually cannot recognize them as being part of the disease process.

Negative symptoms (called "negative" because they take away from the individual's behavior and experience) such as inappropriate laughter, incoherence, regressive behavior, emotional flatness, and social withdrawal are typical of disorganized schizophrenia, along with disorganized speech, thought, behavior, and mannerisms.

Catatonic schizophrenia is associated with positive symptoms of excitement, rigidity, and motor disturbances, and negative symptoms of withdrawal, immobility, decreased sensitivity to pain, stupor, and unresponsiveness to surroundings (DSM-IV-TR).

Individuals with undifferentiated schizophrenia may have symptoms from more than one of the five subtypes of the disorder. In residual schizophrenia, the prominent symptoms of the illness have abated, but some features, such as hallucinations (of which the auditory type are the most common) and emotional flatness, may remain (DSM-IV-TR).

Incidence and Prevalence: Estimated lifetime prevalence of schizophrenia is 0.3% to 0.7%, with reported variation by race/ethnicity, across countries, and by geographic origin of immigrants and their children. In the US, 1% to 1.5% of the population is affected, or approximately 2 million Americans. Schizophrenia has a worldwide prevalence of about 1% (Frankenburg).

Source: Medical Disability Advisor



Causation and Known Risk Factors

There are various theories to explain the development of schizophrenia, one being that it is caused by a first or second trimester "insult" (e.g., maternal malnutrition, exposure to influenza) that leads to dysfunction of part of the brain called the prefrontal cortex. The structural abnormality in the brain is thought to be present at birth, with schizophrenic symptoms manifesting in late adolescence when the prefrontal cortex matures. Other risk factors for development of this structural abnormality are intrauterine infections, postnatal complications, and Rh incompatibility in a second or subsequent pregnancy. Other theories hold that genetic factors may play a role, as close relatives of an individual with schizophrenia have a high risk of developing the disorder themselves. The probability of developing schizophrenia is 13% if one parent is affected by the disorder, 35% if both parents are affected, and 50% or more if an identical twin has the disorder (Frankenburg). Family problems and poor parenting do not appear to play a role in the development of schizophrenia, but stress may amplify symptoms in affected individuals.

The onset of schizophrenia typically occurs between the ages 16 and 25 in three-quarters of affected individuals; it is uncommon that the first psychotic episode will occur after age 30 and rare after age 40. Overall, schizophrenia occurs equally in men and women, but the onset is most common by age 25 in men and by age 30 in women. Some studies have shown that blacks are more likely to have schizophrenia than whites (Frankenburg).

Source: Medical Disability Advisor



Diagnosis

History: According to the DSM-5, individuals with schizophrenia have at least two of the following characteristic symptoms, each present for a significant length of time during a month (or less if successfully treated): delusions, auditory or visual hallucinations, disorganized speech (e.g., frequent derailment, incoherence), grossly disorganized or catatonic behavior, and negative symptoms (e.g., diminished emotional expression [affective flattening], lack of speech [alogia], or lack of motivation [avolition]). At least one of these symptoms must be delusions, hallucinations, or disorganized speech. (According to the DSM-IV-TR, a single symptom of delusions [if bizarre] or hallucinations [one voice of running commentary or two voices conversing with each other] may substantiate the diagnosis.)

Furthermore, for a significant portion of time since the onset of the disturbance, the level of functioning in at least one major social or occupational area (e.g., interpersonal relations, self-care, work) is markedly below the level present prior to the onset. Signs of the disturbance persist for at least 6 months or more, including at least 1 month of active-phase symptoms such as delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms; this may include periods of prodromal or residual symptoms characterized by only negative symptoms or an attenuated form of at least two of the following characteristic symptoms: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms (e.g., odd beliefs, unusual perceptual experiences).

It is necessary to exclude schizoaffective disorder, depressive or bipolar disorder with psychotic features (and mood disorder, DSM-IV-TR). The disturbance is not attributable to the effects of a substance/medication-induced disorder or another medical condition. In individuals with a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if there are also prominent delusions or hallucinations, in addition to the other symptoms of schizophrenia, for at least 1 month. The individual's developmental background, genetic and family history, current stress factors, level of functioning prior to the illness, and course of the illness may be helpful in ruling out other conditions, such as primary mood disorders with psychotic features.

After a 1-year duration of the disorder, the following longitudinal course specifiers are used only if they are not in contradiction to the diagnostic course criteria: first (single) episode, currently in acute episode, currently in partial remission, or currently in full remission; multiple episodes, currently in acute episode, currently in partial remission, or currently in full remission (with specification if the disorder courses with prominent negative symptoms, DSM-IV-TR); continuous (with specification if the disorder courses with prominent negative symptoms, DSM-IV-TR); and unspecified. Finally, it is recommended to specify the current severity rated by a quantitative assessment of the primary symptoms of psychosis (DSM-5).

According to the DSM-IV-TR subtypes, individuals with the paranoid type of schizophrenia have preoccupation with one or more delusions or frequent auditory hallucinations. Disorganized speech, disorganized or catatonic behavior, or flat or inappropriate affect are not prominent. Individuals with the disorganized type of schizophrenia have disorganized speech, disorganized behavior, and flat or inappropriate affect, all of which are prominent. The criteria are not met for catatonic type. Individuals with the catatonic type of schizophrenia have a clinical picture dominated by two or more of the following features: motoric immobility as evidenced by indefinitely prolonged fixed body postures (catalepsy) with a tendency for the limbs to remain in any position in which they are externally placed by another person (waxy flexibility) or stupor; excessive motor activity that is apparently purposeless and not influenced by external stimuli; an apparently motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved (extreme negativism); not engaging in speech (mutism); peculiarities of voluntary movement as evidenced by assuming inappropriate or bizarre postures; stereotyped movements; prominent mannerisms or grimacing; and involuntary imitation of another person’s vocalizations (echolalia) or actions (echopraxia). Individuals with the undifferentiated type of schizophrenia have characteristic symptoms of the disorder, but do not meet the criteria for the paranoid, disorganized, or catatonic type. Individuals with the residual type of schizophrenia have absence of prominent delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior. There is continuing evidence of the disturbance with expression of negative symptoms or an attenuated form of at least two characteristic symptoms of schizophrenia (e.g., odd beliefs, unusual perceptual experiences).

Physical exam: A general physical exam is performed to rule out psychotic disorders due to substance or medication abuse and those associated with underlying physical conditions. The physician also looks for signs of emphysema or lung or heart disease because of the high rate of nicotine addiction in schizophrenics. Subtle neurological abnormalities may be suggestive of schizophrenia. Finally, the physician takes note of the individual's presentation during the exam including dress, mannerisms, behavior, content of speech, and style of relating to others. Individuals with schizophrenia typically exhibit unusual attire, poor hygiene, and may look off to the side as though they are talking to people who are not there.

Tests: No definitive test exists for schizophrenia although neuropsychological tests may aid in diagnosis. Neuroimaging with a computed tomography (CT) scan of the brain may reveal large ventricles characteristic of schizophrenia. Performance of an electroencephalogram (EEG) may also be helpful. Furthermore, clinical laboratory tests are necessary to rule out underlying medical, neurologic, and endocrine disorders that can present as psychoses, such as vitamin deficiencies, uremia, thyrotoxicosis, and electrolyte imbalances. A complete blood count (CBC) and testing for HIV and syphilis should be considered. Additional tests include toxicology screen, antinuclear antibodies (ANA), and urinalysis with culture to rule out the presence of heavy metals and porphyrins.

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

General goals of treatment are to reduce the severity of psychotic symptoms, prevent recurrence of symptomatic episodes and associated deterioration of functioning, and help individuals to function at the highest level possible. The sooner treatment begins, the better the outcome. With early intervention it may be possible to forestall the worst long-term outcomes of schizophrenia. Hospitalization, medication, rehabilitation with community support, and psychotherapy are the major components of treatment.

Hospitalization is necessary to treat severe delusions or hallucinations, serious suicidal ideations, the inability to care for oneself, or serious problems with drugs or alcohol, while allowing observation by trained mental health professionals to determine whether schizophrenia is the appropriate diagnosis. Hospitalization also allows for the initiation of a medication regimen under close supervision.

Antipsychotic drugs (neuroleptics) can dramatically improve the functioning of individuals with schizophrenia. Once the troubling symptoms are controlled by the drugs, the individual does not require hospitalization. However, schizophrenics often fail to take their medications as prescribed, and some individuals are better managed with long-lasting injections of antipsychotic medications that are repeated every 2 to 4 weeks on an outpatient basis.

The first line of treatment for most individuals with schizophrenia involves atypical antipsychotic drugs (second-generation antipsychotics). Some individuals need to be treated with anticholinergic and antiparkinsonian agents to combat the extrapyramidal side effects (EPS) of prescribed medications. Individuals undergoing drug therapy should be regularly observed by their physicians and tested for movement disorders and abnormal, involuntary movements of the tongue and lips (tardive dyskinesia) using the Abnormal Involuntary Movement Scale (AIMS). Those experiencing weight gain as a medication side effect may benefit from referral to a nutritionist.

Antipsychotic drugs may affect other neurotransmitter systems, including serotonin, or may have selective affinity for specific dopamine receptor subtypes. Newer atypical antipsychotic drugs are more effective and have fewer adverse effects than older, conventional antipsychotics, which are associated with tardive dyskinesia; this troubling side effect is much less common with the newer agents.

Electroconvulsive therapy (ECT) is sometimes used to treat catatonic and severely depressed schizophrenic individuals.

Outpatient treatment includes crisis intervention, individual and group psychotherapy, family education and therapy, community support services, and vocational rehabilitation to assist returning to work after recovery from an acute psychotic episode. These individuals may benefit from assertive case management, in which a case worker visits the individual in the home.

Treatment is usually long-term, most often for a lifetime.

Source: Medical Disability Advisor



Prognosis

The predicted outcome of schizophrenia varies considerably, ranging from complete recovery to death. Only about 10% of schizophrenics have a good outcome. Most often, there is a gradual decline in functioning after the onset of schizophrenia, affecting personal relationships, work, education, and even basic self-care. Some individuals go through periods of improvement and relapse, while others remain disturbed. Complete recovery is unlikely; less than 30% return to work after being hospitalized, 40% attempt suicide, and 10% die from suicide. The excessive mortality rate associated with schizophrenia is often related to smoking, with higher than expected death rates from diseases of the circulatory, digestive, endocrine, nervous, and respiratory systems. About 50% of schizophrenics will have a substance abuse problem during their lifetime. Eighty percent of schizophrenics experience symptom recurrence if they stop taking their medication within a year. If individuals are compliant with their medications, the relapse rate drops to 20% (Frankenburg). However, about 80% of schizophrenics fail to take their medications regularly and continuously at least at some point during the course of their disease.

Better outcomes tend to be associated with female sex, family history of affective disorder, absent family history of schizophrenia, good functioning before the onset of illness (premorbid functioning), higher IQ, being married, sudden onset following a stressful incident, fewer prior episodes (both in number and length), a pattern of episodes followed by remissions, older age, fewer associated illnesses, paranoid subtype, and symptoms that are predominantly positive (e.g., delusions, hallucinations) and not disorganized (e.g., thought disorder, disorganized behavior) or negative (e.g., emotional flatness, depression). Better quality of the individual’s relationship with his or her psychiatrist is also associated with better outcomes. The course of this condition may also be influenced by cultural and societal complexity, with better outcomes occurring in developing countries.

Source: Medical Disability Advisor



Complications

Alcohol and drug abuse complicate schizophrenia by exacerbating symptoms. Between 20% and 70% of individuals with schizophrenia have problems with drug abuse (Frankenburg). Stress, unemployment, poverty, and homelessness are other possible complications. Schizophrenics are 3 times as likely to smoke as the general population, and are therefore prone to smoking-related health risks including heart disease and cancer. Individuals with schizophrenia have a high risk (5% lifetime risk) of suicide (Frankenburg).

Use of conventional antipsychotic drugs may cause side effects including muscle stiffness, tremors, weight gain, and tardive dyskinesia, which is most often characterized by puckering or smacking of the lips and tongue and/or writhing of the arms and legs.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

An individual with schizophrenia returning to work would benefit from a schedule that incorporates flex-time or a part-time position, time off for scheduled medical appointments, flexible break times that meet the individual's needs rather than following a fixed schedule, a workspace where visual and auditory distractions are minimized, and additional leave after a hospitalization. Individuals would also benefit from the opportunity to phone professionals during the workday, and to meet regularly with the employer, supervisor, and job coach.

Risk: There may be a risk to coworkers if individuals with schizophrenia exhibit positive symptoms such as paranoia, anger, anxiety, hallucinations, or violence. Because schizophrenia is associated with an increased risk of suicide and drug and alcohol addiction, adequate supervision should be provided to maintain workplace safety. Recurrence may be mitigated by compliance with prescribed medications during the course of the disease.

Capacity: Capacity is dependent on the severity and expression of psychotic symptoms, both positive and negative. Simple work tasks that are not safety-sensitive may be appropriate. Individuals taking prescribed conventional or atypical antipsychotic drugs to control their symptoms may require periodic drug testing to ensure that substance abuse does not become a problem.

Tolerance: Tolerance factors depend on the long-term regular attendance of individual and group psychotherapy sessions, whether the individual is stable or gradually declining in function, and whether the individual taking conventional antipsychotic drugs experiences significant side effects.

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 individual been experiencing psychotic loss-of-reality symptoms for at least 6 months with increasing difficulty in normal functioning?
  • Has the diagnosis been confirmed or does it need to be revisited in light of these criteria?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Since early intervention may forestall the worst long-term outcomes of this disorder, was treatment initiated with diagnosis?
  • Does current treatment appear to be effective?
  • Is a change in treatment plan warranted?
  • If individual is experiencing severe delusions, hallucinations, serious suicidal inclinations, inability to care for oneself, or severe problems with drugs or alcohol, can individual be hospitalized until condition can be stabilized?
  • Has individual reported any untoward side effects from antipsychotic medication?
  • Has individual talked with the physician about these or any other expected side effects?
  • Is individual capable of weighing the risks against the potential benefits that antipsychotic drugs can provide?
  • Would individual benefit from changing to a newer antipsychotic drug?
  • Does individual understand how important it is to continue medication?
  • Is individual capable of maintaining medication regime or would more structured supervision be beneficial?
  • Does individual exhibit suicidal tendencies?
  • What is being done to protect individual from harming self or others?

Regarding prognosis:

  • Is individual capable of functioning on an independent basis with no threat to self or others?
  • Does individual and/or family know and accept the realistic prognosis of this illness?
  • Although no cure is available for schizophrenia, is individual aware that with proper treatment, he or she may still be able to lead a productive and fulfilling life?
  • Is individual capable of complying with a long-term medication regime?
  • Did psychotherapy help the individual regain the confidence to take care of himself/herself and live a fuller life?
  • Were individual and family members able to participate in a therapy program that helped them better understand this illness and share coping problems?
  • Does individual have an effective support system in place? If not, what can be done to establish one?

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.

Frankenburg, Frances R. "Schizophrenia." eMedicine. 22 Dec. 2014. Medscape. 23 Jun. 2015 <http://emedicine.medscape.com/article/288259-overview#showall>.

Source: Medical Disability Advisor






Feedback
Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment. If you are seeking medical advice, please contact your physician. Thank you!
Send this comment to:
Sales Customer Support Content Development
 
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the author, editors, and publisher are not engaged in rendering medical, legal, accounting or other professional service. If medical, legal, or other expert assistance is required, the service of a competent professional should be sought. We are unable to respond to requests for advice. Any Sales inquiries should include an email address or other means of communication.