Formulation
Fernanda Garcia-Costas
Child and Adolescent Consultant Psychiatrist
Plym Bridge House
Fernanda.garcia-costas@nhs.net
Includes:
• Diagnostic features
• Differential diagnosis
• Aetiological factors:
– Predisposing (increase vulnerability)
– Precipitating (trigger onset of disorder)
– Perpetuating (maintain symptoms after
precipitants have disappeared)
– Protective factors
• Prognosis
• Aetiology:
BIOLOGICAL
PRED
PPT
PERP
PSYCHOLOGICAL
SOCIAL
Biological
• Predisposing:
– Obstetric complications
– Genetic loading
– Head injuries
– Drug and alcohol misuse
– Physical illness
– Gender
– Cognition
Biological
• Precipitant:
– Non compliance
– Drug and alcohol
– Physical illness
– Head injury
Biological
• Perpetuating:
– In addition to the irreversible genetic loading and
obstetric damage
– Continued non compliance
– Drug and alcohol
– Physical illness
Psychological
• Predisposing:
– Inadequate parenting and early trauma/attachment
•
•
•
•
Poor self-esteem
Poor impulse control
Difficulties with relationships
Dysfunctional beliefs
– Evidence of maladaptive behaviour
•
•
•
Drug and alcohol
Excessive/no relationships
Offending behaviour.
Psychological
• Precipitant:
– Trauma (real or imagined) reignites dysfunctional
beliefs from previous similar experiences
– Specific psychological mechanisms adopted:
•
•
•
•
Depression: denial, turning against one self
Paranoia: projection, splitting
OCD: isolation, magical thinking/undoing
Phobia: displacement
Psychological
• Perpetuating:
– Continued ingrained maladaptive thoughts and
behaviour.
Social
• Predisposing:
– Poverty
– Divorce/parental discord
– Overcrowding
– Unemployment
– Isolation
– Any cause of stress: finances
Social
• Precipitant:
– Life event: new birth in the family, moving
house/school.
Social
• Perpetuating:
– Decreased functioning which exacerbates or
causes any of the above plus others.
Prognosis
• Short term: current episode
– Good or poor depending on likelihood of
remission.
– Determined by the natural history of the disease
(episodic/chronic) and the past psychiatric history.
• Long term: Likelihood/frequency of
recurrence
– Dependent on:
• Natural history
• Past psychiatric history
• Bio/Psycho/Social components of the aetiology.