case formulation (george engel)

Re: "Biopsychosocial Model & Case Formulation"

Fr: PsyDB https://www.psychdb.com/teaching/biopsychosocial-case-formulation

>definition: (in psychiatry) a way of UNDERSTANDING a patient as more than a diagnostic label by generating HYPOTHESES about the ORIGINS & CAUSES of a patient's SYMPTOMS

>importance: "The BSP approach is the MOST COMMON & CLINICALLY PRACTICAL way to formulate (c/o George Engel, 1980) & guide treatment and prognosis

>NB: like cooking, no right or wrong way to do things

>CASE FORMULATION

--is NOT a diagnosis = "a group of consistent symptoms in a population"

--"tells HOW the person acquired the symptoms as a result of their GENETICS, PERSONALITY, PSYCHOLOGICAL FACTORS, BIOLOGICAL FACTORS, SOCIAL CIRCUMSTANCES, & their ENVIRONMENT."

--"asks WHAT is wrong [PRESENT], HOW it got that way [PAST], & WHAT can be done about it [FUTURE]"

--the 4Ps of case formulation

(1) PREDISPOSING Factor = areas of VULNERABILITY that increases the risk for the presenting problem, e.g. genetic predisposition, prenatal exposure to alcohol

Q: "What is is their 'SET UP?" "What were they working with initially?"

(2) PRECIPITATING Factor = typically thought of as STRESSORS or other events (positive or negative) that may be precipitants of the symptoms, e.g. identity conflict, relationship conflicts, transitions

Q: "What ACUTE event happened & how did it affect them?"

(3)  PERPETUATING Factors = conditions in the patient, family, community, or larger systems that EXACERBATE rather than solve the problem, e.g. unaddressed relational conflicts, lack of education, financial stresses, occupational stress (or lack of employment)

Q: "What CHRONIC tings are going on?"

(4) PROTECTIVE Factors = includes the patient's own areas of COMPETENCY, skills, talents, interest, & supportive elements which COUNTERACT the 3 other "Ps"

Q: "What is protecting them & keeping them WELL?"

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