Diagnosis and Formulation Flashcards
What is the difference between Diagnosis and Formulation of a psychiatric illness?
Diagnosis = patients symptoms are classified under illness heading
Formulation = How patient becomes ill e.g. genetics, personality etc
What are the 4 Ps involved in formulation?
Predisposing Factors
Precipitating Factors
Perpetuating Factors
Protective Factors
What is meant by predisposing factors?
- areas of vulnerability that cause an increased risk of a psychiatric problem developing
- e.g. genetics, family hx, traumatic birth
What are precipitating factors?
- Stressors/events which are related to the symptom/ cause the current problem
- e.g. relationship breakdown, bereavement, developmental transitions as a child
What are perpetuating factors?
- Things making the situation worse and preventing recovery e.g. drinking alcohol/using drugs
- Can also be larger systems e.g. relationship/employment may be exacerbating problem
What are protective factors?
- Things which make the situation BETTER for the patient
- family, support network, activity they enjoy etc
i. e. opposite to other 3 Ps
Describe the rough structure of a psychiatric history that will enable you to get all predisposing, precipitating, perpetuating and protective factors a patient may have?
Hx taking including personal/forensic
MSE integrated with history
Detailed social History
Specifically then ask about:
- Social predisposing factors (e.g. parental divorce)
- Psychological predisposing factors (e.g. fear of abandonment in childhood)
- Psychological precipitating factors (e.g. relationship break up causes feeling of abandonment)
as these are the most difficult to get out of patients
What type of disorder usually has an irrational intense fear of abandonment?
Borderline Personality Disorder
Give examples to differentiate between biological, Psychological and Social predisposing factors
Biological:
- Genetics
- Family Hx (especially suicide, due to increased risk)
Psychological:
- Insecurities about themselves
- Insecurities about others judging them
- Insecurities about the world being unsafe
- Attachment Disorders
Social:
- unemployment (no purpose of the day)
- given up childhood activity that she previously enjoyed
- Childhood Trauma
Give examples to differentiate between biological, Psychological and Social precipitating factors
Biological:
- drunk/intoxicated at time of situation
Psychological:
- relationship breakdown (cause of breakdown that day)
Social:
- unemployment
- financial struggle
Give examples to differentiate between biological, Psychological and Social perpetuating factors
Biological:
- regular drink/drug use
- medication side effects (e.g. depression)
Psychological:
- Poor value of self
Social:
- Financial stress
Give examples to differentiate between biological, Psychological and Social protective factors
Biological:
- Not drinking or using drugs
- If patient has no physical health issues
Psychological:
- Previous enjoyment from certain activity (this can be used to find similar level of enjoyment again)
Social
- Good relationships with family members/ friends
How should you manage a patient medically, psychologically, occupationally and environmentally?
Medical - target low mood/anxiety/ psych problems
Psychological - Use of CBT/DBT
Occupational - support access to training/employment
Environmental - support group work to improve social skills
What is DBT?
“Dialectical Behavioural Therapy”
- it teaches people how to live in moment, cope healthily with stress, regulate emotions, and improve relationships
