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 Sexual Dysfunction


Differential Diagnosis

  • Non-substance/medication-induced sexual dysfunction (DSM-5)
  • Primary sexual dysfunction (DSM-IV-TR)
  • Sexual dysfunction due to a general medical condition (DSM-IV-TR)
  • Substance intoxication (DSM-IV-TR)

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

Overview

In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), substance/medication-induced sexual dysfunction falls into the category of sexual dysfunction rather than the substance use category. For the approach to substance dependence/abuse established by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (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: The incidence and prevalence of substance/medication-induced sexual dysfunction is unknown, most likely because sexual side effects from drug therapies are underreported. This type of sexual dysfunction typically is associated with antidepressants and antipsychotics. The prevalence of antidepressant-induced sexual dysfunction varies with the specific agent; about 25% to 80% of individuals taking different types of antidepressants report sexual side effects. Also, about 50% of individuals taking antipsychotics will experience adverse sexual side effects (DSM-5). The incidence and prevalence of sexual dysfunction among users of nonpsychiatric medications (e.g., cardiovascular, cytotoxic, gastrointestinal, or hormonal agents) is also unknown. Elevated rates of sexual dysfunction have been reported with methadone or high-dose opioid drugs prescribed for pain. Illicit substance use, and chronic drug abuse in particular, is also associated with increased rates of sexual dysfunction; about 60% to 70% of individuals who abuse heroin report sexual problems. Chronic alcohol abuse and chronic nicotine abuse are associated with elevated rates of erectile problems.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Intoxication with the following classes of substances can be associated with sexual dysfunction: alcohol; amphetamine and related substances; cocaine; opioids; sedatives, hypnotics, and anxiolytics; and other or unknown substances.

Acute intoxication with, chronic abuse of, or dependence on substances/medications has been reported to decrease sexual interest and may cause arousal problems in both sexes.

The following prescribed medications may cause sexual dysfunction: antihypertensives, histamine H2 receptor antagonists, antidepressants (especially selective serotonin reuptake inhibitors), neuroleptics, anxiolytics, anabolic steroids, and antiepileptics. Painful orgasm has
been reported with fluphenazine, thioridazine (no longer available in the US), and amoxapine. Prolonged, painful erections (priapism) have been reported with chlorpromazine; trazodone; doxepine; and agents treating erectile dysfunction such as Viagra, Cialis, and Levitra; and after penile injections of papaverine or prostaglandin.

Source: Medical Disability Advisor



Diagnosis

History: According to the DSM-5, in individuals with substance/medication-induced sexual dysfunction the disturbance in sexual function causes significant distress. Substance-induced sexual dysfunction is usually generalized and is not limited to certain types of stimulation, situations, or partners. The history reveals that the disturbance in sexual function 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 that can produce a disturbance in sexual function.

The disturbance does not occur exclusively during the course of a delirium, and must not be better accounted for by a sexual dysfunction unrelated to a substance of abuse or medication. Evidence of an independent sexual dysfunction may include the following: symptoms that began before substance/medication use; persistence of the symptoms for about 1 month after acute withdrawal or severe intoxication, or symptoms that are much worse than what would be expected based on the type or amount of the substance consumed or the duration of consumption (DSM-IV-TR); or the presence of other evidence suggesting an independent sexual dysfunction, including a history of recurring episodes not related or medications or substances of abuse.

This diagnosis should be made instead of a diagnosis of substance intoxication or substance withdrawal only when the disturbance in sexual function predominates in the clinical picture (only when the sexual dysfunction exceeds that usually associated with the intoxication, according to the DSM-IV-TR) and when its severity warrants clinical attention. It is necessary to specify if the onset occurred during intoxication, during withdrawal, or after medication use (the DSM-IV-TR does not include "during withdrawal" or "after medication use"). It is also necessary to specify the current severity: mild, moderate, or severe (and to specify if the disturbance involves impaired desire, impaired arousal, impaired orgasm, or sexual pain, according to the DSM-IV-TR).

According to both the DSM-5 and DSM-IV-TR, coding of substance-induced sexual dysfunction includes specifying the offending substance: alcohol; opioid; sedative, hypnotic, or anxiolytic; cocaine; 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. The DSM-5 also requires consideration of whether the disorder began during intoxication, began during withdrawal, or had its onset after medication/substance use (meaning either at the initiation of use of the substance or after a modification or change in the use of that substance).

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

Tests: Please refer to the tests for the particular sexual dysfunction, 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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