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 Obsessive-Compulsive and Related Disorder


Differential Diagnosis

  • Anxiety disorder due to a general medical condition (DSM-IV-TR)
  • Anxiety disorder not otherwise specified (DSM-IV-TR)
  • Delirium
  • Obsessive-compulsive and related disorder (i.e., not induced by a substance)
  • Obsessive-compulsive and related disorder due to another medical condition
  • Primary anxiety disorder (DSM-IV-TR)
  • Substance intoxication
  • Substance withdrawal (DSM-IV-TR)

Medical Codes

ICD-9-CM:
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.

In the DSM-IV-TR, substance/medication-induced obsessive-compulsive and related disorder is discussed in the section on anxiety disorders, including Substance-Induced Anxiety Disorder, With Obsessive-Compulsive Symptoms; Substance-Induced Anxiety Disorder, With Generalized Anxiety; Substance-Induced Anxiety Disorder, With Panic Attacks; and Substance-Induced Anxiety Disorder, With Phobic Symptoms. In the DSM-5, anxiety disorders and obsessive compulsive disorders have been divided into two separate categories. This condition, substance/medication-induced obsessive-compulsive and related disorder, is discussed in the obsessive-compulsive disorders section, where a distinction is made concerning whether the onset of symptoms occurs during intoxication, during withdrawal, and/or with onset after medication/substance use.

Incidence and Prevalence: Substance-induced obsessive-compulsive and related disorder is very rare.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Substance/medication-induced obsessive-compulsive and related disorder may ensue in association with intoxication or discontinuation/withdrawal states; symptoms may also appear with modification or change in use of a medication/substance, including at the time of initiation of use of the medication/substance.

Intoxication with the following classes of substances can be associated with substance/medication-induced obsessive-compulsive and related disorder: alcohol, amphetamine and related substances, caffeine, cannabis, cocaine, hallucinogens, inhalants, phencyclidine and related substances, and other (or unknown) substances (DSM-IV-TR).

Withdrawal from the following classes of substances can be associated with substance/medication-induced obsessive-compulsive and related disorder: alcohol; cocaine; sedatives, hypnotics, and anxiolytics; and other (or unknown) substances (DSM-IV-TR).

Medications reported to evoke obsessive-compulsive symptoms include, among others, anesthetics and analgesics, sympathomimetics or other bronchodilators, anticholinergics, insulin, thyroid preparations, oral contraceptives, antihistamines, antiparkinsonian agents, corticosteroids, antihypertensive and cardiovascular medications, anticonvulsants, lithium carbonate, antipsychotics, and antidepressants (DSM-IV-TR).

Obsessive-compulsive symptoms may also be caused by heavy metals and toxins (e.g., volatile substances such as gasoline and paint, organophosphate insecticides, nerve gases, carbon monoxide, carbon dioxide) (DSM-IV-TR).

Source: Medical Disability Advisor



Diagnosis

History: According to the DSM-5, for individuals with substance/medication-induced obsessive-compulsive or related disorder, the clinical picture is dominated by obsessions, compulsions, skin picking, hair pulling, other body-focused repetitive behaviors, or other symptoms characteristic of the obsessive-compulsive and related disorder. The history reveals that the obsessive-compulsive or related disorder 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 an obsessive-compulsive or related disorder.

The disturbance is not better accounted for by an obsessive-compulsive or related disorder that is not substance/medication-induced. Evidence of an independent obsessive-compulsive and related 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 acute 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.

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 obsessive-compulsive or related disorder predominates in the clinical picture (only when the obsessive-compulsive 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-induced obsessive-compulsive and related disorder includes specifying the offending substance: amphetamine (or other stimulant), cocaine, or other (or unknown) substance. The DSM-IV-TR also includes: amphetamine-like substance; caffeine; cannabis; hallucinogen; inhalant; phencyclidine (or phencyclidine-like substance); and sedative, hypnotic, or anxiolytic. 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 substance/medication-induced obsessive-compulsive or related disorder, and for dependence on/abuse of the particular substance/medication.

Tests: Please refer to the tests for the particular substance/medication-induced obsessive-compulsive or related 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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