This tutorial presentation prepared by Dr Sanil Rege from psychscene.com looks beyond the 3-stage process of interview, diagnose and treat and takes a look at the technique of psychiatric formulation and management.

Author Quotes : 

Psychiatric formulation is an art and requires an exploratory approach based on hypothesis generation.

Change the way you look at psychiatry with this novel approach!

In psychiatry, clinical practice is all about being able to formulate a case and implement a coherent management.

You now need to develop a navigational system that will guide you through the complexities that will arise in clinical practice.

Patients do not fit nicely into categories described by the DSM or ICD.

Summary :

Psychiatric history taking is not just about a mental state examination and making a diagnosis.

The hypotheses generated are then synthesised into a formulation that enables the implementation of a strategic management plan.

What may look like a categorical diagnosis may actually have alternate etiological underpinnings.

For further reading, the article Psychiatric Formulation Demystified–The Sherlock Holmes Way breaks the formulation down further with real life examples.

This presentation concludes with a look at patient needs and insight into treatment. Identifying specific factors can affect patient compliance.

Take Home Messages :

1. Relevant cognitive examination and physical examination are both important, to look at the patient holistically.
2. A good formulation and management plan start with knowing what questions to ask.
3. In patients with comorbidity, the presence or absence of a single variable can influence management to a significant extent.

Quiz