Formulation

Question 1

What is the main purpose of formulation

Answer 1

• Integrating the different factors in patients life to explain their current presentation
• Use these factors to assess risk
• Using these to inform management plan

Question 2

What are the 4 Ps & the subsets

Answer 2

Predisposing,
Precipitating
perpetuating
protective

Subset
- biological
-psychological
- social / cultural / spiritual

Question 3

Give examples of the different predisposing factors

Answer 3

Predisposing
Biological :
- genetic , brain trauma, illness, drugs, pain

Psychological
- personality, coping strategies (conscious and unconscious), self esteem, cognition

Social / Cultural / Spiritual
-socioeconomic status
- ethnicity /stigma
- intergenerational trauma

Question 4

Give examples of the different precipitating/ perpetuating factors

Answer 4

Bio
- med, physical trauma, drug/alcohol, acute illness, pain

Psychological
- stage of life
loss and grief
treatment
stressors

Social
- relationships
-work
-finances
- connections

Question 5

Give examples of the different protective factors (also included in risk formulation)

Answer 5

Bio
- good physical health

Psych
- Engagement in treatment
- insight
- adherence to treatment
- Resilience and coping skills
- intelligence
* Hope

Social
- Connectedness and belonging
* Family, whānau, pets, significant others as partners in care and safety planning
* Living with others
* Social supports including peer support
* Access to culturally appropriate services
* Spirituality / religious beliefs
* Having a job/routines

Question 6

What is the template for formulating risk

Answer 6

“This person is at risk of… (elements and presenting behaviours) when they are
experiencing…. (precipitating) that are perpetuated by ………. .

They have a history of …….. (risk events, context, dates).

Their predisposing factors are……

Their protective factors are…”

Question 7

What is the basic structure of formulation and example

Answer 7

1. Brief introductory statement
   ○ Name, age, sex, marital and social status ?
   ○ + main symptoms/syndrome for presentation:
   * severity, impairment, response to treatment
   ○ Eg. “This x yo woman presents with a two-week history of acute psychosis, of hearing voices, commanding her to hurt herself and others and persecutory delusions of
   being followed by enemies.”
2. Highlight important aspects of history which have potential explanatory power
   - What is the severity = impact on lifestyle and family
   
   • Premorbid personality
   • What is the context -environment stress impinging on symptoms
     “Eg. This in the context of
3. Make links (provide explanation)
   
   • Why this person, why now and why in this matter
   • How do these factors relate to each other (4 PS)
     Eg
     “In terms of previous psychiatric hx - dx of …, treatment ‘
     - drug /alcohol
     - fam hx
     Regarding her background - family structure, main support and relationships
4. Safety formulation