Brief Summary
This video provides a structured approach to psychiatric assessment and formulation, emphasizing the importance of organizing thoughts into distinct components. It covers diagnosis, formulation (using models like biopsychosocial, 4Ps, and perspectives of psychiatry), treatment recommendations, and risk assessment. The video uses an example to illustrate how to apply these principles in practice, highlighting the need to tailor the assessment to each patient's unique circumstances.
- Diagnosis: Identify the most likely diagnosis and provide a differential diagnosis.
- Formulation: Explain why the patient is presenting with their current symptoms using various models.
- Treatment: Recommend appropriate treatments, considering medications, psychological, and social interventions.
- Risk Assessment: Evaluate chronic and acute risk factors for self-harm and determine the necessary level of care.
Introduction to Psychiatric Assessment
The video introduces a structured approach to psychiatric assessment and formulation. It emphasizes organizing thoughts into distinct components: diagnosis, formulation, treatment, and risk assessment. The goal is to provide a framework for understanding the patient's condition and developing an effective treatment plan.
Components of Psychiatric Assessment
The assessment is divided into four key components. First, the diagnosis involves identifying the most likely diagnosis and providing a differential diagnosis, explaining why certain diagnoses are more or less likely. Second, the formulation aims to explain why the patient is presenting with their current symptoms. Third, the treatment section outlines recommended treatments, including medications, psychological, and social interventions. Finally, the risk assessment evaluates chronic and acute risk factors for self-harm, protective factors, and the need for a higher level of care, such as hospitalization.
Formulation Models
The formulation aims to answer why a patient is presenting with specific symptoms now, and several models can guide this process. The biopsychosocial model considers biological, psychological, and social factors. The four Ps model looks at predisposing, precipitating, perpetuating, and protective factors. The perspectives of psychiatry model uses disease, dimensional, behavior, and life story lenses. Any of these models can be used as long as the underlying question of why the patient is presenting with their current symptoms is answered.
Example Assessment
The video provides an example assessment using the biopsychosocial model. The patient's history of present illness is reviewed, followed by a structured assessment. The most likely diagnosis is Major Depressive Disorder (MDD), based on symptoms like depressed mood, anhedonia, and other criteria met over a two-week period. The formulation considers biological predisposition (family history, comorbid medical illness), psychological factors (help-seeking behaviors, coping skills), and social factors (relationship problems, housing issues, poor social support). Treatment involves initiating citalopram due to its favorable tolerability profile and low CYP inhibition, considering the patient's antidepressant naivety and coexisting coronary artery disease. The risk assessment indicates elevated chronic risk of self-harm due to depressive disorder, unhoused status, and poor social support, with a more acutely elevated risk due to recent suicidal ideation, necessitating hospitalization for safety and stabilization.
Conclusion
The video concludes by emphasizing that the presented structure is a broad overview and can be adapted based on the specific needs of each patient. The assessment is highlighted as a crucial task for psychiatrists, involving the creation of an understanding that integrates various aspects of the patient's life and experience into a cohesive story and treatment plan.
