Two type of Formulation

1- Clinical Formulation

2- Dynamic Formulation

Clinical Formulation: Name, age, sex , Presenting symptoms (main complaints), Postive Symptom in Hx , Mental state finding (brief), Probable etiology , Management.
Dynamic Formulation
Biological Psychological Social
Predisposing temperament at birth attachment style -Poverty, low socioeconomic status, teenage
factors consistent personality characteristics Family act and what is the family structure parenthood, or poor access to health care
‫ العوامل المسببه‬family psychiatric history problems with affect modulation -Childhood exposure to maternal depression,
toxic exposures in utero, birth rigid or negative cognitive style domestic violence, late adoption,
complications, or developmental Low self-image/self-esteem temperament mismatch, or marital conflicts
disorders -Immigration history, marginalization,
concussions or traumatic brain injuries discrimination, or racism?
Neurodevelopmental history -Exposure to antisocial personality/traits
Precipitating -Serious medical illness or injury Stressor that activate one or more psychological processes: • Loss of or separation from close family,
factors -Increasing use of alcohol or drugs Cognitive: core beliefs and cognitive distortions partner, or friends
‫او‬ ‫ العوامل‬-Medication non-adherence Dialectical: emotional dysregulation and dysfunction • Interpersonal trauma
‫المتراكمه‬ -Pregnancy or hormonal changes Interpersonal: grief, loss, disagreement, change/transitions • Work/academic/financial stressors
-Sleep deprivation Psychodynamic: unconscious conflicts/defenses, and unconscious • Recent immigration, loss of home, loss of a
repetition of early relationship patterns (psychic determinism) supportive service (e.g. - respite services,
appropriate school placement)
• Is the individual's current
experience/symptoms similar to a past
situation (i.e. - “history repeating itself”)? For
example, they might have had a loss,
separation etc. in the past
Perpetuating • Do they have a chronic illness, One or more perpetuating psychological processes: • Chronic marital/relationship discord, lack of
factors functional impairment caused by • Cognitive: chronic negative thoughts and reinforcing environment empathy from family/friends,
‫الدائمه‬ cognitive deficits, or a learning disorder? “cognitive errors” developmentally inappropriate expectations
“Maintaining • Lack of medication optimization • Dialectical: help-seeking and help-rejecting, chronic emotional • Chronically dangerous or hostile
factors” (suboptimal doses) dysregulation and poor distress tolerance neighbourhood, trans-generational problems
• Lack of treatment or follow up for • Interpersonal: Chronic/unresolved dysfunctional relationships, of immigration, lack of culturally competent
mental illness interpersonal conflicts, or role transitions services
• Current substance use? • Psychodynamic: recurring themes throughout one’s life, chronic • Ongoing transitions and stressors
• Chronic medical problems, chronic primitive defenses • Poor finances or working long hours
pain, or disability? • Isolation, unsafe environment
• How is patient responding to • What are their beliefs about self/others/world? What ideas have
hospitalization? they internalized?
• What are the degree of the symptoms • Are there self-destructive coping mechanisms, or traumatic re-
right now? enactments?
• Ongoing poor coping skills, limited or lack of insight?
• Personality traits (e.g. - unable to maintain consistent interpersonal
relationships in borderline personality disorder)
• How is their attachment style playing out in this particular situation?
Protective Good overall health • Do they have ability to be reflective or modulate their affect? • Positive relationships, supportive
factors Absence of family psychiatric history • Do they have ability to mentalize (see other's perspectives)? community, and/or extended family/friends?
What is their response to medications • Do they have a positive sense of self, or adaptive coping • Religious/spiritual beliefs
(good response/no response, did they mechanisms? • Good interpersonal supports
achieve remission, are they optimized on • Psychologically-minded, reflective, and capacity to change thinking • Financial/disability support
current medications)? patterns? • Has an outpatient healthcare team: GP,
• Do they have above-average • Have they previously responded well to therapy? psychiatrist, social, or case worker?
intelligence, easy temperament, • Good coping skills, good insight?
resiliency, specific talents or abilities?
• No substance use is a protective factor