Formulation in psychiatry.pptx

formulation in psychiatric practice, origin, types and why

1. CASE FORMULATION IN PSYCHIATRIC PRACTICE ORIGIN , TYPES AND WHY? Ehab Elbaz , MD,MBA Consultant Psychiatrist Director of psychiatry hospital, Maadi Military Medical Complex Lecturer of psychiatry, Military Medical Academy

2. Objectives Try to answer the following questions: Where did the concept of formulation in psychiatry come from? How did formulation evolve over time? Do psychiatrists understand formulation all the same? What are the basic contents of formulation? What is the function of formulation? How can we assess the quality of case formulation?

3. Adolf Meyer (1866 – 1950) Was a Swiss-born psychiatrist who was the first psychiatrist-in-chief of the Johns Hopkins Hospital (1910-1941). He was president of the American Psychiatric Association in 1927–28 Meyer’s central ideas were holism and integration . The complaint had to be understood in terms of the life course of all their organ systems, their instincts and their life events and formulated as a ‘ psychobiological reaction’.

4. Line drawing of the life chart by Adolf Meyer

5. George Kelly (1905 -1967) Psychologist, who developed personal construct theory in the 1950s, noted his complaint against traditional diagnosis in his book The Psychology of Personal Constructs (1955) In place of nosological categories, Kelly used the word "formulation" and mentioned two types of formulation: structuralization , in which the clinician organizes clinical case information "in terms of dimensions rather than in terms of disease entities“ while focusing on "the more important ways in which the client can change. construction , in which the clinician seeks a kind of negotiated integration of the clinician's organization of the case information with the client's personal meanings

6. George Engel, 1913 – 1999 The biopsychosocial model of illness was first presented in 1977 by George Engel. His landmark idea described a dynamic interaction between psychological, social and pathophysiological variables, and highlighted the hypothesis that, the workings of the mind, could affect the body, as much as the workings of the body, could affect the mind. Such a model has since been recognized in explaining chronic pain syndromes and has led to an important shift in the way that pain is researched, diagnosed and treated.

7. Confusing concepts Case formulation Diagnostic formulation Psychiatric formulation Psychological formulation Biopsychosocial formulation Psychotherapy case formulation Clinical formulation Problem formulation

8. Definition It is the process or product of gathering and integrating diverse clinical information to develop a concise account of the relevant variables affecting a person’s mental health to guide decision-making. McMurran, M., & Bruford , S. (2016). Case formulation quality checklist: a revision based upon clinicians' views. Journal of Forensic Practice, 18(1), 31-38.

9. Reveley , A. (1983). Why do candidates fail the MRCPsych Part II?. Bulletin of the Royal College of Psychiatrists, 7(3), 51-51.

10. Hollyman , J. A., & Hemsi , L. (1983). What do psychiatrists understand by formulation?: a survey of clinicians in a group of hospitals in London. Bulletin of the Royal College of Psychiatrists, 7(8), 140-143.

11. Components of diagnostic formulation - Opinion among psychiatrists (Sr. Reg - Senior registrar; Reg. - Registrar; SHO - Senior House Officer) Item Consultants % Sr. Reg % Reg./SHO % Total sample % History (%) 81 82 81 81 Mental status 57 64 38 52 Physical exam 10 18 13 13 Diff. diagnoses 76 64 50 65 Single diagnosis 24 36 37 31 Psychodynamics 33 45 19 31 Aetiology 43 45 56 48 Prognosis 67 55 69 65 Length of formulation 29 44 27

12. Hollyman , J. A., & Hemsi , L. (1983). What do the examiners understand by formulation?: a survey of the members of the college's board of examiners. Bulletin of the Royal College of Psychiatrists, 7(9), 165-166.

13. Components of diagnostic formulation - Opinion among examiners Item Examiners% History 78 Mental status 62 Physical exam 07 Investigations 49 Diff. diagnoses 80 Single diagnosis 11 Psychodynamics 29 Aetiology 60 Management 82 Prognosis 69 Length of formulation 51

14. Components of diagnostic formulation - Opinion among examiners and trainees Item Examiners% Trainees% Mental status 62 38 Investigations 49 13 Diff. diagnoses 80 50 Single diagnosis 11 37

15. FUNCTION OF FORMULATION

16. The basic content of the formulation Royal College of Psychiatrists (2017) Using Formulation in General Psychiatric Care: Good Practice (Occasional Paper OP103). Royal College of Psychiatrists.

17. Six principles of formulation Baird, J., Hyslop , A., Macfie , M., Stocks, R., & Van der Kleij , T. (2017). Clinical formulation: where it came from, what it is and why it matters. BJPsych Advances, 23(2), 95-103.

18. Biopsychosocial formulation

19. Levels of formulation Kuyken , W., Padesky , C. A., & Dudley, R. (2008). The science and practice of case conceptualization. Behavioural and Cognitive Psychotherapy, 36(6), 757-768.

20. INTAKE DIAGNOSIS FORMULATION

21. CONCLUSION As early as the last century , psychiatrists had recognized the importance of case formulation in psychiatry Case formulation still a confusing concepts and poorly understood by psychiatrists No formal standardization of how to teach and use it. It is a core competency skill for all trainees in the field