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.

Substance/Medication-Induced Anxiety Disorder


Differential Diagnosis

  • Anxiety disorder due to another medical condition
  • Anxiety disorder not induced by a substance/medication
  • Delirium
  • Substance intoxication or substance withdrawal

Medical Codes

ICD-9-CM:
291.89 - Alcoholic Psychoses, Other; Alcohol-induced Anxiety Disorder; Alcohol-induced Mood Disorder; Alcohol-induced Sexual Dysfunction; Alcohol-induced Sleep Disorder
292.89 - Drug-induced Mental Disorders, Other; Drug-induced Anxiety Disorder; Drug-induced Organic Personality Syndrome; Drug-induced Sexual Dysfunction; Drug-induced Sleep Disorder; Drug Intoxication

Overview

This topic follows the approach to substance-induced disorders established by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). For the approach to substance dependence/abuse established by DSM-IV-TR, please refer to specific topics including Polysubstance Dependence; Alcohol and Drug Detoxification and Rehabilitation; Alcohol Intoxication, Acute; Alcoholism; Stimulant-Related Disorders (Amphetamine-Type Substance); Stimulant-Related Disorders (Cocaine); Cannabis Use Disorder; Tobacco Use Disorder; Opioid Dependence; or Sedative, Hypnotic or Anxiolytic Dependence.

Incidence and Prevalence: General population data suggest that substance/medication-induced anxiety disorder may be rare, with a 1-year prevalence of about 0.002%; however, the prevalence is probably higher in clinical populations (DSM-5).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Substance/medication-induced anxiety disorders ensue only in association with intoxication or withdrawal states.

Intoxication with the following classes of substances can be associated with panic or anxiety: alcohol, caffeine, cannabis, phencyclidine and other hallucinogens, inhalants, stimulants (including cocaine), and other (or unknown) substances.

Withdrawal from the following classes of substances can be associated with panic or anxiety: alcohol; opioids; sedatives, hypnotics, and anxiolytics; stimulants (including cocaine); and other (or unknown) substances.

Medications that produce anxiety symptoms include anesthetics and analgesics, sympathomimetics, bronchodilators, anticholinergics, insulin, thyroid preparations, oral contraceptives, antihistamines, antiparkinsonian agents, corticosteroids, antihypertensive and cardiovascular medications, anticonvulsants, lithium carbonate, antipsychotics, and antidepressants. Heavy metals and toxins (e.g., organophosphate insecticides, nerve gases, carbon monoxide, carbon dioxide, volatile substances such as gasoline and paint) may also produce panic or anxiety symptoms.

Source: Medical Disability Advisor



Diagnosis

History: According to the DSM-5, in individuals with substance/medication-induced anxiety disorder, the clinical picture is dominated by panic attacks or anxiety (or obsessions or compulsions, DSM-IV-TR). The history reveals that the panic attacks or anxiety developed in the course of, or shortly after (within 30 days, DSM-IV-TR), substance intoxication, or after withdrawal from, or exposure to, a medication. The involved substance/medication must be capable of producing panic attacks or anxiety.

The disturbance is not better accounted for by an anxiety disorder that is not substance/medication-induced. Evidence of an independent anxiety disorder may include the appearance of the symptoms before the onset of the substance/medication use, the persistence of the symptoms approximately 1 month after withdrawal from the substance/medication use, or symptoms that exceed those normally produced by the substance/medication use.

The disturbance does not occur exclusively during the course of a delirium. The disturbance produces clinically significant distress or impairment in social, occupational, or other areas of functioning. This diagnosis should be made instead of a diagnosis of substance intoxication or substance withdrawal only when the panic attacks or anxiety predominate in the clinical picture (or, according to the DSM-IV-TR, only when the anxiety symptoms exceed those usually associated with the intoxication or withdrawal syndrome) and when the anxiety severity warrants clinical attention. It is necessary to specify if the onset occurred during intoxication or withdrawal (or after medication use, DSM-5). According to the DSM-IV-TR, it is also necessary to specify if the disturbance manifests with generalized anxiety, panic attacks, obsessive-compulsive symptoms, or phobic symptoms.

According to both the DSM-5 and DSM-IV-TR, coding of substance/medicated-induced anxiety disorder includes specifying the offending substance: alcohol; caffeine; cocaine; cannabis; phencyclidine (or phencyclidine-like substance, DSM-IV-TR); other hallucinogen; inhalant; opioid; sedative, hypnotic, or anxiolytic; amphetamine or other stimulant (or amphetamine-like substance, DSM-IV-TR); or other (or unknown) substance. In the DSM-5, coding includes "with use disorder, mild"; "with use disorder, moderate or severe"; or "without use disorder" for each substance based on the ICD-10-CM.

Physical exam: Please refer to the physical exam for the particular anxiety disorder, and for dependence on/abuse of the particular substance/medication.

Tests: Please refer to the tests for the particular anxiety disorder, and for dependence on/abuse of the particular substance/medication.

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.

Source: Medical Disability Advisor






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