Formulation Flashcards
1
Q
What are the 7 key variables to keep in mind during formulation?
A
- culture + ethnicity
- religion
- identity
- age
- children
- elderly
- gender
2
Q
Explain the summary statement
A
- succinct + chronological
- key features drawn from case history
- 1-2 paragraphs
- re-state demographics: name, age, marital status, living situation, employment status, income and legal status
- presenting complaints + symptoms organized chronologically
- salient features in the background
3
Q
Explain the diagnostic formulation
A
- arrive at primary WORKING diagnosis + rationale for this + consider differentials
- give specific examples of how their sx match DSM criteria
- mental health: disorders, comorbid, differentials you can rule out
- PD/personality traits: comorbidity b/w and within clusters
- medical conditions: may/may not be causally related to mental dx
- psychosocial + environmental stressors: do they contribute sig to the dev and exacerbation of disorders? housing, finance, education, occupation, primary support group, social environment, health care access, legal
4
Q
What are the 4 key things to consider in a diagnostic formulation?
A
- mental health
- PD/traits
- medical conditions
- psychosocial factors
5
Q
What are the steps to accurate diagnosis?
A
- Is the presenting problem real?
- Is there substance abuse?
- Is there a medical condition?
- Accurate diagnosis!
6
Q
Explain the etiological formulation
A
- develop hypotheses to address in therapy
- consider context of sign/sx
- hypothesis about development + maintenance of disorder(s)
- integrate info across bio-psycho-social domains
- allows clinician to draw upon multiple theoretical perspectives
- 3 dimensions: biopsychosocial, developmental, temporal
7
Q
What biopsychosocial factors do you need to consider?
A
- biological: genetics, physical medication condition, drugs
- psychological: info processing, attitudes/emotions towards self/others
- social: culture, gender, family structure, economic circumstances, rships to social groups
8
Q
What are the aspects of an MSE?
A
- behaviour
- orientation
- talk + thought
- affect
- mood
- insight + judgment
9
Q
What developmental factors do you need to consider?
A
- family (genogram)
- age
- job
- support/conflict/isolation
- life hx: infancy, early childhood, primary school, secondary school, training/university, work, relationships
10
Q
What is the temporal dimension of formulation?
A
- 4 Ps
- predisposing
- precipitating
- perpetuating
- protective
11
Q
What disorders may have low insight? Why is this important?
A
OCD psychosis ED PTSD PD (eg. narcissism) neurocog (eg. ALZ) substance use
- tx non-adherence
- involuntary commitment
- more complicated illness course
- criminaztion
12
Q
What factors may impact prognosis?
A
- insight
- comorbidity
- motivation to change
- supports
- duration of sx (chronicity)
13
Q
What are the different types of formulations?
A
- CBT
- systematic/family therapy
- psychodynamic therapy
- applied behaviour analysis
- CAT
14
Q
Why would you use the SCID? What are it’s limitations?
A
- semi-structured more reliable than self-report
- encourage more thorough + objective approach to ax
- widest coverage of dx
- hierarchical: screen out dx to expedite administration
- high diagnostic reliability
- one-to-one correspondence to DSM-5
LIMITATIONS
- limited depth (only assesses minimal requirements for diagnosis)
- transparency (worded in pathological direction > vulnerable to response biases)
15
Q
Why might chronic self-harm NOT be an indicator for suicide?
A
- might be about surviving rather than dying
- way of not feeling (numb, dissociate)
- way to get help or communicate distress to others
- turning in of anger (harm self instead of others)
