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©2013 UpToDate ® Print Email Behaviors suggesting impairment Relationships Discord in primary relationship (always present) Divorce Isolation and avoidance of peers and friends Sexual acting out, infidelity Chaotic relationships Domestic violence Social Social activities are abandoned No longer involved in hobbies they once enjoyed Embarrassing behaviors at social gatherings Intoxicated at social gatherings Miss appointments Emotional Depression Talk of suicide, or passive suicidal ideation Irritability, mood swings Inappropriate level of response Argumentative Mental Memory lapses, forgetfulness Easily overwhelmed Poor coordination Appearance of oversedation Physical Recurrent non-specific health problems Recurrent flu-like symptoms Alcohol on breath at work Frequent musculoskeletal complaints, bruises or other evidence of trauma Repeated injuries Car accidents Significant weight changes Sexually transmitted diseases Financial Worsening debts Gambling problems Bankruptcy Credit problems Legal Arrests, shoplifting charges, driving under influence Restraining orders Board of Medicine complaints Patient complaints Malpractice suits Spiritual Loss of sense that life is worthwhile Pessimism, hopelessness No longer attending religious services Loss of connection and empathy with patients and peers Activities not consistent with their values Work Excessive absenteeism or sick time used Charting mistakes Medical mishaps Frequent bathroom breaks Unable to contact - "broken beepers" Unexplained disappearances Not keeping up with medical records Make rounds at inconsistent times Diversion Volunteers to give medications to patient Missing or broken vials Failure to document wastage or have wastage witnessed More attention to patients receiving mood altering drugs Asking peers to prescribe for them Coming in on off days