yes to 3/4 indicates dependence
Paddington Alcohol Test (PAT)
1. Quite a few people have times when they drink more than usual - what is the most (in total number of units per day) you will drink in any one day?
2. If you drink more than 8 units a day for men or 6 units a day for women is this at least once a week?
If yes, PAT positive –> alcohol advice
If no, question 3
3. Do you feel your current attendance at the emergency department is related to alcohol?
Yes –> PAT positive
No –> interpret carefully
Hazardous drinking: more than twice the recommended daily limit. Advice and information.
Dependent drinking: more than twice recommended daily limit every day, or other signs of dependence. Do not benefit from brief intervention.
Signs of dependence –> compulsion to drink
Signs of tolerance --> repeated failed attempts to stop drinking?
CIWA score - out of 67
Nausea and vomiting
Headache, fullness in head
Reduced orientation and clouding of senses Risk assessments
characteristic of the act of self-harm - violence, evidence of planning
characteristic of the person - intention to die, previous self-harm, mental illness or personality disorder, substance misuse.
social circumstances and provoking events
Sex: male 1
Age: 15-24, 45-54, >75 1
Prior history 1
Rational thinking loss 1
Support system lack 1
Organised plan 1
No significant other 1
Sickness (cancer, HIV) 1
0-2 Discharge with follow up
3-4 Discharge with close monitoring
5-6 Consider admission
7-10 Definite admission
DSM-IV criteria for major depression
5 or more = major depressive episode
Low mood for most of the day every day
Recurrent suicidal ideation
Lack of concentration
Weight loss >5%
Loss of interest
(Loss of libido, poor concentration also worth asking about)
All Brides Should Make Tea Cakes in Summer
Behaviour - remember to ask about circumstances leading to hospital attendance, if the act had any significance, and if they believed their behaviour is strange or unusual.
Speech - pressure of speech, knight’s move thinking, clang associations, word salad
Thought - worthlessness, low self-esteem, flight of ideas, delusions of grandeur, delusions
Cognition - orientation, memory, concentration, calculation skills. Spell world backwards.
Insight - are you ill?
Summary - don’t forget focussed medical and psychiatric history.
Compulsory admission for up to 28days
2 practitioners (one approved)
Application made by social worker or nearest relative
Emergency section when an urgent admission is required
To be used when the patient poses a significant risk to others or themselves
Can be used when there is not enough time to get a second medical practitioner.
Cannot be used in the emergency department.