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 Depressive Disorder


Differential Diagnosis

  • Delirium (DSM-IV-TR)
  • Depressive disorder due to another medical condition
  • Depressive disorder not otherwise specified (DSM-IV-TR)
  • Mood disorder due to a general medical condition (DSM-IV-TR)
  • Primary depressive disorder
  • Substance intoxication and 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
292.84 - Drug-induced Mood Disorder; Depressive State Induced by Drugs

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.

In the DSM-IV-TR, substance/medication-induced depressive disorder is included in the sections Substance-Induced Mood Disorder, With Depressive Features; Substance-Induced Mood Disorder, With Manic Features; and Substance-Induced Mood Disorder, With Mixed Features, contingent on the predominant mood (DSM-5).

Incidence and Prevalence: The lifetime prevalence of substance/medication-induced depressive disorder is 0.26% in a nationally representative US adult population (DSM-5).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Individuals with underlying alcohol or drug use disorders are at greater risk of substance/medication-induced depressive disorder. Temperamental risk factors, common to all drugs, for substance/medication-induced depressive disorder include a history of major depressive disorder, a history of drug-induced depression, and psychosocial stressors.

Environmental risk factors pertain to specific types of medication or high doses of medication. Individuals with substance/medication-induced depressive disorder are most likely to be black males with a high school diploma at most, no insurance, a low family income level, and who report a personal history of stressful life events and a family history of substance use disorders and antisocial behavior. These individuals are also likely to meet a greater number of DSM-IV-TR major depressive disorder criteria, as well as to report feelings of worthlessness, insomnia/hypersomnia, and thoughts of death and suicide attempts. They are less likely to report a depressed mood or the death of a parent before 18 years of age (DSM-5).

Intoxication with the following classes of substances may be associated with depressive mood disorders: alcohol; amphetamine and related substances; cocaine; hallucinogens; inhalants; opioids; phencyclidine and related substances; sedatives, hypnotics, and anxiolytics; and other (or unknown) substances (DSM-IV-TR).

Withdrawal from the following classes of substances may be associated with depressive mood disorders: alcohol; amphetamine and related substances; cocaine; sedatives, hypnotics, and anxiolytics; and other (or unknown) substances (DSM-IV-TR).

Medications reported to evoke depressive mood symptoms include, among others, anesthetics, analgesics, anticholinergics, anticonvulsants, antihypertensives, antiparkinsonian agents, anti-ulcer medications, cardiac medications, oral contraceptives, psychotropics, muscle relaxants, steroids, and sulfonamides. High doses of reserpine, corticosteroids, and anabolic steroids have an especially high likelihood of producing depressive features, although many medications may occasionally produce an idiosyncratic depressive reaction. Heavy metals and toxins (e.g., volatile substances such as gasoline and paint, organophosphate insecticides, nerve gases, carbon monoxide, carbon dioxide) may also cause mood symptoms (DSM-IV-TR).

Source: Medical Disability Advisor



Diagnosis

History: According to the DSM-5, for individuals with substance/medication-induced depressive disorder the clinical picture is dominated by a prominent and persistent disturbance in mood characterized by depressed mood or markedly diminished interest or pleasure in all, or almost all, activities. The history reveals that the disturbance in mood 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 can produce a disturbance in mood.

The disturbance is not better accounted for by a depressive disorder that is not substance/medication-induced. Evidence of an independent depressive 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 — as well as a history of recurrent non-substance/medication-related episodes (DSM-5), or major depressive episodes (DSM-IV-TR).

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 disturbance in mood predominates in the clinical picture (only when the mood symptoms exceed those usually associated with the intoxication or withdrawal syndrome, DSM-IV-TR) and when its severity warrants clinical attention. It is necessary to specify if the onset occurred during intoxication, or during withdrawal.

According to both the DSM-5 and DSM-IV-TR, coding of substance/medication-induced depressive disorder includes specifying the offending substance: alcohol; caffeine; cannabis; phencyclidine or other hallucinogen; inhalant; opioid; sedative, hypnotic, or anxiolytic; amphetamine or other stimulant; cocaine; other (or unknown) substance (or phencyclidine-like substance or amphetamine-like substance, DSM-IV-TR). 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 depressive disorder, and for dependence on/abuse of the particular substance/medication.

Tests: Please refer to the tests for the particular depressive 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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