Clinical Formulation Flashcards
What does ICD and DSM stand for?
International Statistical Classification of Diseases and Related Health Problems (ICD)
Diagnostic and Statistical Manual for Mental Disorders (DSM)
What are the criticisms of the classification systems?
Many diagnostic labels aren’t valid, not all discrete entities with natural boundaries
Inadequate reliability between clinicians and across patients
Diagnoses do not rely on presence of all symptoms in a list
Many disorders are associated with diverse aetiological factors e.g. trauma, family, childhood experiences
Do not allow for a continuum- suggest presence or absence
What’s the difference between classification and diagnosis?
Classification: identifying set of symptoms that co-occur as clusters
Diagnosis: assigning clusters with a label
Why is psychiatric diagnosis useful for clinicians?
Provides a common language for professionals
Facilitates research into aetiology, outcomes and interventions
Help make decisions in clinics
Provide access to services and support
Identify prevalence rates
What are the problems with psychiatric diagnosis?
Relies on symptom reporting rather than objective measurable signs
Labelling: risk that people are understood in terms of their diagnosis and the associated stereotypes
Depersonalisation: reduce a person to a collection of symptoms which can obscure understanding of a whole person and ability to help them in ways which are meaningful
Money making scheme in the pharmacological industry
What is transference in the psychodynamic approach? In the transference model, what does hidden feelings, defence and anxiety mean?
Triangle map: defence, anxiety, hidden feelings
Therapy: getting in touch with feelings we have tried to avoid
The hidden feelings: a wish or an impulse. Awareness of this leads to anxiety because of this conflict between the feeling and another perceived need. This need is for success and admiration, associated with fear and shame.
Anxiety: triggers danger, resolve conflict by conflicting aspects of self
Defence: avoid conscious acknowledgement of the conflict, if a person cannot tolerate the conflict there is self deception and this aspect is disguised
What are the key characteristics of the psychodynamic approach?
Symptoms and problems are expressed by an underlying meaning in the client’s emotional life. Rises from conflicting relationships, desires and fears
Defensive strategies give rise to unhelpful cycles of attempted solutions
Approach is centres on themes of unconsciousness
Formulation not shared with client
What is cognitive behavioural formulation? What happens to a patient in a bad situation? How do Clinicians help?
The client with experience a bad situation. This will give them bad THOUGHTS e.g. I can’t do anything right. In turn, giving them BODILY REACTIONS e.g. heart racing, sweating. This can impact the client’s ACTIONS e.g. go to bed, avoid work. Client may have FEELINGS of sadness.
Thoughts, bodily reactions, actions and feelings interact together.
Clinicians will help by encouraging clients to remember their strengths and how to use them to help the situation. Also, clinicians may help the client to see what their initial trigger was.
What is Clark’s model of panic? How can Clinicians use this model to improve patients panic?
Vulnerability beliefs e.g. my symptoms are triggered by noise and light
Trigger e.g. light in supermarket
Threat appraisal e.g. is this the start of a crisis?
Escalation of symptoms in emotions (anxiety), physical feelings (dizziness) and thoughts (I’m having a seizure)
These will confirm the vulnerability of the beliefs
Safety behaviours e.g. wear sunglasses, check lighting
This will reduce the symptoms of emotions, physical feelings and thoughts
What happens to a client in Beck’s cognitive model of depression?
Early experiences e.g. praised by parents for following rules
Core beliefs e.g. I am a rule follower
Rules to live by e.g. I must adhere to the rules
Critical incidents e.g. uncertainty, not coping
This all impacts the thoughts, behaviours, bodily sensations and emotions
What are the systematic models of formulation?
Problem
Difficulty e.g. Jack’s parents divorce, he feels grief and wants them back together
Attempted Solution e.g. drinking alcohol and taking drugs to dull the pain of grief and sadness
What are feedback loops in systematic models?
Example:
Feelings of failure when we can’t live up to the expectations
Avoiding school gives a sense of relief
Anxiety increases
Trying to always get the test results at school
What is triangulation in systematic models?
Third party affects the relationship between 2 others
e.g. when parental arguments occur, a toddler has a tantrum and they’re distracted by calming the child. The child’s behaviour regulates the conflict in the family
What is meant by deconstructing the problem in systematic models?
Deconstruct the problem
When did the problem start? Who noticed it first?
What were the attempted solutions?
Beliefs about the problems and attempted solutions
What did and didn’t work?
What decisions were made to persist with the solutions?
What are genograms?
Get client to draw family tree
Family tree shows clients relationships with others e.g. some are close, some are more difficult
What are the key characteristics of systematic formulation?
Collaborative process
Problems reside in relationships
Focus on family members perceptions and explanations of problems
What are social inequalities?
Exist when an ascribed characteristic such as gender, race, class and disability influences access to money, power, rights and privileges
What is social inequalities formulation?
Structured inequality e.g. gender, race, class
Interpersonal context e.g. family partnerships, economic and employment
Lives experience e.g. subordination, marginalised, appeasement (being controlled)
Symptoms of inequality e.g. wellbeing, health
Solidarity e.g. social support, community participation
Social justice e.g. resistance, diversity, liberty
What are the key characteristics of social inequality formulation?
Provide recognition and respect
Naming of power and abuses
Recognising ‘othering’
Situating personal accounts in social and political contexts
Attention to language, positions and sense making
