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.

Schizophreniform Disorder


Related Terms

  • Brief Reactive Psychosis
  • Schizophrenia

Differential Diagnosis

  • Brain tumor (neoplasm)
  • Brief psychotic disorder
  • Encephalitis
  • Endocrine disorders
  • Metabolic disorders
  • Mood disorder with psychotic features
  • Partial complex seizures
  • Schizoaffective disorder
  • Schizophrenia
  • Substance abuse

Specialists

  • Clinical Psychologist
  • Psychiatrist

Comorbid Conditions

  • Alcohol abuse
  • Drug abuse
  • Organic mental disorder
  • Personality disorder

Factors Influencing Duration

Signs of a favorable outcome are the onset of psychotic symptoms within a month of the first noticeable changes in personality or behavior, feeling surprised and puzzled by the psychotic episode, and having good social and occupational functioning before the disorder started. Negative symptoms usually result in greater disability and are often accompanied by intellectual impairment. Lack of insight is a poor prognostic sign, due to poor cooperation with treatment including stopping the antipsychotic medication. Increased disability is also likely if the individual is in an unstable social environment.

Medical Codes

ICD-9-CM:
295.40 - Schizophreniform Disorder; Unspecified
295.41 - Schizophreniform Disorder; Subchronic
295.42 - Schizophreniform Disorder; Chronic
295.43 - Schizophreniform Disorder; Subchronic with Acute Exacerbation
295.44 - Schizophreniform Disorder; Chronic with Acute Exacerbation
295.45 - Schizophreniform Disorder; in Remission

Overview

Schizophreniform disorder is a mental disturbance with serious abnormalities in sensory perceptions, thought, speech, attention, mood, behavior, interpretation of everyday life events, and the capacity to enjoy life. Although similar to schizophrenia, schizophreniform disorder is a more acute illness lasting for longer than 1 month but less than 6 months. Serious impairment in social and occupational functioning may or may not have occurred, whereas the diagnosis of schizophrenia requires functional impairment and at least 6 months of illness. Schizophreniform disorder is not due to drug or alcohol abuse. It is diagnosed only after ruling out schizoaffective disorder or mood disorders with psychotic features such as bipolar disorder (manic-depression).

Symptoms of this disorder are described as positive or negative. Positive symptoms are an excess of normal functions, such as abnormalities of thinking (delusions), sensory perceptions (hallucinations), language (disorganized speech), or behavior (grossly disorganized or catatonic behavior). Negative symptoms involve a reduction or loss of normal functions, such as a restriction and flattening of emotions, severely reduced speech or thought, and lack of interest in any goal-directed activities.

Incidence and Prevalence: In developed countries, including the US, the incidence is low, possibly one-fifth less than that of schizophrenia. The greatest incidences are among 18 to 24 years in men and ages 24 to 35 years in women (Bhalla).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Schizophreniform disorder is more common in relatives of those who have either this condition or another mental illness.

Source: Medical Disability Advisor



Diagnosis

History: According the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), individuals with schizophreniform disorder have at least two of the following characteristic symptoms, each present for a significant part of time during a 1 month period (or less if successfully treated): delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms (diminished emotional expression or avolition). (According to DSM-IV, if delusions are bizarre, only this symptom is required, or if hallucinations consist of a voice keeping up a running commentary on the individual's behavior or thoughts, or two or more voices conversing with each other, also only one of these symptoms is required.) At least one of these must be delusions, hallucinations, or disorganized speech. An episode must last 1 month or more but less than 6 months. It is necessary to exclude schizoaffective disorder and depressive or bipolar disorder with psychotic features. The disorder is not attributable to the effects of a substance (a drug of abuse, or a medication) or another medical condition.

An episode must last 1 month or more but less than 6 months. If the diagnosis must be made without waiting for recovery, it is qualified as "provisional." It is necessary to specify if the disorder courses with good prognostic features, in which case there are two (or more) of the following: onset of noticeable psychotic symptoms within 4 weeks of the first noticeable change in usual behavior or functioning; confusion or perplexity (at the height of the psychotic episode, DSM-IV); good social and occupational functioning before the disorder; and absence of blunted or flat affect. If the disorder occurs without two or more of the good prognostic features, it is identified as being without good prognostic features. It is also necessary to specify if the disorder occurs with catatonia. Finally, it is recommended to specify the current severity rated by a quantitative assessment of the primary symptoms of psychosis.

Physical exam: An exam does not contribute to this diagnosis. Observation of the individual's orientation, dress, mannerisms, behavior, and content of speech provide signs that may be helpful in diagnosis.

Tests: Psychological tests may be helpful, but do not prove the diagnosis. Imaging studies such as magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT), and positron emission tomography (PET) all show abnormalities in multiple regions of the brain; however, these findings are not diagnostic.

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

Initial treatment is hospitalization to establish diagnosis and begin treatment with medication. Hospitalization may also be necessary for patient safety, to address the risk of suicide or homicide, and to take care of basic needs. Antipsychotic drug therapy is helpful for hallucinations and delusions, and later to prevent a relapse into psychosis. Antidepressants may also be helpful if the patient is depressed. Anticonvulsants and lithium can be added if the patient fails to respond to antipsychotic medication. Outpatient treatment includes crisis intervention, individual and group psychotherapy, family therapy, and development of social supports. When the individual has recovered sufficiently from the acute psychotic episode, vocational rehabilitation may be needed to provide assistance in returning to work.

Source: Medical Disability Advisor



Prognosis

About 33% of patients diagnosed with schizophreniform disorder achieve recovery within 6 months. The remainder become chronically ill. At that time, the diagnosis is redefined as schizophrenia or psychotic mood disorder (e.g., bipolar or schizoaffective disorder). Thus the diagnosis of schizophreniform disorder is made under two conditions: (1) when an episode of illness lasts between 1 and 6 months and the individual has already recovered, and (2) when an individual is symptomatic for less than the required 6 months' duration necessary for the diagnosis of schizophrenia but has not yet recovered. In this case, the diagnosis should be noted as "schizophreniform disorder (provisional)" because it is uncertain if the individual will recover from the disturbance within the 6-month period. If the disturbance persists beyond 6 months, the diagnosis should be changed to schizophrenia.

Source: Medical Disability Advisor



Complications

Complications include injuries, accidents, suicide, and homicide. Alcohol or drug abuse is common. Major mood disorders may also appear.

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. Other accommodations could include 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.

Risk: Risk is affected by the severity and length of the acute psychotic episode, whether the individual required hospitalization, and if the individual exhibited hallucinations, delusions, loss of normal function, and/or suicidal or homicidal thoughts.

Capacity: Once the acute episode has resolved, capacity is dependent on the success of treatment and whether the individual becomes chronically ill or is able to return to his or her regular job tasks. Because alcohol or drug abuse is common with this disorder, the individual may require periodic drug testing to ensure that substance abuse does not become a problem.

Tolerance: Tolerance factors include compliance with taking prescribed medications and attending individual and group psychotherapy sessions. Participation in structured, non safety-sensitive work task 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:

  • Is individual attending therapy sessions?
  • Does individual meet the DSM-IV-TR/DSM-5 criteria for schizophreniform disorder?
  • Has a diagnosis of schizophreniform disorder been confirmed or is it provisional?
  • If the illness has persisted beyond 6 months, as diagnosis been changed to schizophrenia or psychotic mood disorder (such as bipolar or schizoaffective disorder)?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Was treatment initiated with diagnosis?
  • Does current treatment appear to be effective? Is a change in treatment plan warranted?
  • Has individual reported any untoward side effects associated with antipsychotic medication?
  • Has individual talked with the doctor 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 different antipsychotic drug?
  • Does individual understand how important it is to continue medication?
  • Is individual capable of maintaining medication regime, or does he or she require more structured supervision?
  • If suicidal tendencies are exhibited, what is being done to protect individual from harming self?
  • Does individual exhibit or express violent tendencies towards others? What is being done to protect the individual from harming others?
  • Is psychiatric hospitalization warranted until the individual is no longer a threat to self or others?

Regarding prognosis:

  • Is individual capable of functioning on an independent basis with no threat to self or others?
  • Does individual exhibit at least two features that indicate a favorable outcome?
  • Has individual received appropriate outpatient care, including crisis intervention, individual and group psychotherapy, family therapy, and the development of social supports?
  • Has vocational rehabilitation been offered to provide assistance upon returning to work?

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.

Bhalla, Ravinder. "Schizophreniform Disorder." eMedicine. 3 Sep. 2013. Medscape. 10 Jun. 2015 <http://emedicine.medscape.com/article/2008351-overview#showall>.

Source: Medical Disability Advisor






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