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What is formulation in psychiatry?

Gareth Owen1

  • 1Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London SE5 9RJ, UK.

Psychological Medicine
|March 6, 2023
PubMed
Summary
This summary is machine-generated.

Clinical psychiatry formulation is debated, with declining interest in teaching. This article revisits the biopsychosocial model, diagnostic hierarchy, and intersubjective meaning grasping to revive and rethink psychiatric formulation for the 21st century.

Keywords:
Formulationbiopsychosocial modeldiagnostic hierarchymedical educationphilosophy of psychiatryverstehen

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Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Medical Humanities

Background:

  • The practice of clinical formulation in psychiatry faces significant criticism and declining educational interest.
  • Historical concepts like the biopsychosocial model, diagnostic hierarchy, and 'verstehen' are foundational to formulation.
  • Contemporary challenges necessitate a re-evaluation of these core concepts.

Purpose of the Study:

  • To trace the historical development of key concepts relevant to psychiatric formulation.
  • To analyze the role of the biopsychosocial model, diagnostic hierarchy, and 'verstehen' in clinical assessment.
  • To argue for the resuscitation and rethinking of formulation practices in 21st-century psychiatry.

Main Methods:

  • Historical analysis of the biopsychosocial model.
  • Conceptual review of diagnostic hierarchy.
  • Exploration of the role of 'verstehen' (intersubjective meaning grasping) in clinical assessment.
  • Argumentative synthesis to propose recommendations for modern formulation.

Main Results:

  • The biopsychosocial model, diagnostic hierarchy, and 'verstehen' are integral to clinical formulation.
  • These concepts face valid criticisms that impact the practice of formulation.
  • A need exists to adapt and update formulation practices for contemporary clinical settings.

Conclusions:

  • Psychiatric formulation requires significant re-evaluation and revitalization.
  • Recommendations are provided for developing a 21st-century approach to formulation.
  • Integrating historical insights with modern challenges can enhance the utility of formulation in clinical psychiatry.