B i o p s y c h o s o c i a l F o r m u l a t i o n

A P o n g P o c k e t M o d

B i o l o g i c a l : B r a i n
P s y c h o l o g i c a l : M i n d
S o c i a l : C o n n e c t i o n s

4 P s :
P r e d i s p o s i n g f a c t o r s ( P a s t )
R e n d e r i n g p t v u l n e r a b l e t o p s y c h i a t r i c d / o
P r e c i p i t a t i n g f a c t o r s ( ~ P r e s e n t )
S t r e s s o r s / d e v e l o p m e n t a l f a c t o r s t h a t m a y
t r i g g e r / w o r s e n s y m p t o m s
P e r p e t u a t i n g f a c t o r s ( ~ F u t u r e )
F a c t o r s t h a t m a i n t a i n d i s a b l i n g s y m p t o m s
P r o t e c t i v e f a c t o r s
S t r e n g t h s a n d a s s e t s t h a t p r o m o t e h e a l t h y
a d j u s t m e n t a n d d i m i n i s h t h e s e v e r i t y o f
s y m p t o m s

T h i n k : w o m b t o t o m b a n d p s y c h / m e d i c a l / d r u g s
Biological
Predisposing factors include
Genetic predispositions/Family History
Prenatal/Birth: trauma, toxins, prematurity
Early temperament: MR, milestones
Medical disorders
Neurological disorders: headinjury, seizures
Substanceuse/abuse
Precipitating factors include
Relapse: psychillness, substanceuse
Medical illness/healthproblems
Medication-related: sideeffects, drug
interactions, non-efficacy, non-adherence
Perpetuating factors include
Chronic conditions: medical, psychiatric,
substanceuse, medications
Disabilities, handicaps
Protectivefactors include
No family history
No medical illness
No substanceuse
Goodadherenceto treatment regimen
Intelligence/Insight
Additional Info
Medical records
Labs: TSH, CBC, BMP ? LP, HIV, HepB/C
Therapeutic druglevels
Urinetoxicology/drugscreen
Pregnancy test
HeadCT, MRI, EKG, EEG
Assessment instruments:
o BDI Becksdepressioninventory
o HAM-D HamiltonDeprn. Ratingscale
o BPRS Brief Psychiatric ratingscale
o PANSS (+)/(-) SyndromeScale
o YMRS YoungManiaRatingScale
o Y-BOCS Yale-BrownOCD Scale
Treatment recommendations
Ensuresafety, schedulef/uappt
Treatment site: inpt, outpt, obs
Medication: class, route, dose, frequency, ADRs
ECT/VNS
Biofeedback
Substanceabuse: residential, IOP, outpt
Education/Prognosis
Diagnosis
S/sx
Courseandprognosis
Treatment: consent, risk/benefits, sideeffects,
durationof tx until observedefficacy
Handouts
Psychological
Predisposing factors include
Personality traits
Psychological issuesandattributions
Defensemechanisms
Developmental stagetasks
Precipitating/Perpetuating/Protective
factors include
Trauma, Loss, Rejection, Abandonment,
EriksonsStages, Conflict (inter/intrapersonal)
Copingmechanisms, Problemsolvingskills,
Defensemechanisms
Transference, Distortions
Ego strength: reality testing, impulsecontrol,
insight/judgment
ExternalizationvsInternalization
PassivevsActivestance
Additional Info
Psychtesting: MMPI, IQ test, Rorschach
Treatment recommendations
Individual therapy: Supportive, Expressive,
Cognitive, Behavioral, Dialectical
Group/Family/Coupletherapy/AA/NA
Education/Prognosis
Guidelines, goalsandprognosis
Social
Predisposing/Precipitating/Perpetuating
factors include
Family/Interpersonal, Primary support group
Socioenvironmental, Cultural, Spiritual
HEADS
o Home, Education/Employment, Activities,
Drinking/Drugs, Safety/Sex
Additional Info
Collateral information
Housing
Finances
Occupation/work
Accessto resources
Legal history (probation, parole, conditional
release)
Family, support system
Treatment recommendations
Social work consult
Casemanagement
MH rehabilitation, occupational therapy
Finances
Housing/Shelter
Medical insurance
Transportation
E d u c a t i o n
J o b T r a i n i n g
C o m m u n i t y a g e n c y r e f e r r a l / S u p p o r t g r o u p
C r i s e s p h o n e n u m b e r
A d v a n c e d d i r e c t i v e
E d u c a t i o n / P r o g n o s i s
I n t r o d u c t i o n t o r e s o u r c e s

S t a g e s o f D e v e l o p m e n t :
I n f a n t
T r u s t v s M i s t r u s t
N e e d s m a x i m u m c o m f o r t w i t h
m i n i m a l u n c e r t a i n t y
t o t r u s t h i m s e l f / h e r s e l f , o t h e r s ,
a n d t h e e n v i r o n m e n t
T o d d l e r
A u t o n o m y v s S h a m e a n d
D o u b t
W o r k s t o m a s t e r p h y s i c a l
e n v i r o n m e n t w h i l e
m a i n t a i n i n g
s e l f - e s t e e m
P r e s c h o o l e r
I n i t i a t i v e v s G u i l t
B e g i n s t o i n i t i a t e , n o t i m i t a t e ,
a c t i v i t i e s ; d e v e l o p s
c o n s c i e n c e a n d s e x u a l i d e n t i t y
S c h o o l - A g e C h i l d
I n d u s t r y v s I n f e r i o r i t y
T r i e s t o d e v e l o p a s e n s e o f
s e l f - w o r t h b y r e f i n i n g s k i l l s

A d o l e s c e n t
I d e n t i t y v s R o l e C o n f u s i o n
T r i e s i n t e g r a t i n g m a n y r o l e s
( c h i l d , s i b l i n g , s t u d e n t , a t h l e t e ,
w o r k e r ) i n t o a s e l f - i m a g e
u n d e r r o l e m o d e l a n d p e e r
p r e s s u r e
Y o u n g A d u l t
I n t i m a c y v s I s o l a t i o n
L e a r n s t o m a k e p e r s o n a l
c o m m i t m e n t t o a n o t h e r a s
s p o u s e , p a r e n t o r p a r t n e r
M i d d l e - A g e A d u l t
G e n e r a t i v i t y v s S t a g n a t i o n
S e e k s s a t i s f a c t i o n t h r o u g h
p r o d u c t i v i t y i n c a r e e r , f a m i l y ,
a n d
c i v i c i n t e r e s t s
O l d e r A d u l t
I n t e g r i t y v s D e s p a i r
R e v i e w s l i f e
a c c o m p l i s h m e n t s , d e a l s w i t h
l o s s
a n d p r e p a r a t i o n f o r d e a t h