Case formulation using pattern-based formulation methodology: clinical case 3

Instructions for Australian and New Zealand trainees in developing skills in formulation: a systematic review of local evidence

OBJECTIVE

To examine the peer-reviewed literature on psychiatric formulation.

METHODS

The term (formula*) was used to systematically search Australasian Psychiatry, Australian and New Zealand Journal of Psychiatry, British Journal of Psychiatry, BJPsych Bulletin, American Journal of Psychiatry and Academic Psychiatry. The resulting papers were reviewed.

RESULTS

Of the 42 papers located, 22 (52%) were published between 2002 and 2019; 90% papers were published in Australasian Psychiatry (15), Academic Psychiatry (12) or BJPsych Bulletin (10), journals that focus on training and clinical practice. The papers varied in their aims and recommendations and not all justified the need for formulation. Formulation was recommended as a necessity for training, a communication tool and a guide to treatment. No article provided evidence for the superiority of any type of formulation, and the role of consumers in formulation was conspicuously lacking.

CONCLUSION

There are many ways to structure formulation. However, the existing literature does not support any particular approach. More consideration needs to be given to the needs of consumers in conceptualising and practicing formulation.

Pattern-based formulation: clinical case 5

OBJECTIVE:

To demonstrate how the Pattern-based Formulation can be used to integrate biological, psychological and sociocultural factors in constructing the case formulation in a patient who developed schizophrenia and post-psychotic depression.

CONCLUSIONS:

Three new patterns are introduced and used to construct a comprehensive case formulation. This expands the suite of patterns in the pattern-based method of psychiatric case formulation, and further demonstrates its broad utility as an educational resource in psychiatry training.

Case formulation using pattern-based formulation (PBF) methodology: clinical case 4

OBJECTIVES

To provide a further example of the utility of the pattern-based model in formulation, and to introduce some further patterns.

METHODS

A case study was carried out using the Pattern-based Formulation (PBF).

RESULTS

Based on the case of a patient with a past history of trauma who developed late onset somatic symptoms, post-traumatic stress disorder and major depression, the PBF approach enabled development of a comprehensive formulation to explain the patient's current presentation. Four patterns were utilised.

CONCLUSIONS

The PBF method of using patterns as building blocks enables development of a psychobiological formulation that can accommodate considerable complexity. PBF represents a broadly applicable method that may assist psychiatry trainees and others to develop good quality formulations.

Case formulation using pattern-based formulation methodology: clinical case 3

OBJECTIVE

The objective of this study is to determine if pattern-based formulation (PBF) can accurately contribute to case formulation.

CONCLUSIONS

The application of three PBFs accurately contributed to the development of this patient's case formulation. The case formulation demonstrated here, and the patterns introduced in this paper, will serve as educational materials for teaching psychiatric case formulation.