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Igda > Idiographic Diagnostic Formulation

Igda > Idiographic Diagnostic Formulation

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8 .1
8.1
The diagnostic process involves more than
The diagnostic process involves more than
simply identifying a disorder or distinguish-
simply identifying a disorder or distinguish-
ing one disorder from another. It should
ing one disorder from another. It should
lead to a thorough, contextualised and in-
lead to a thorough, contextualised and in-
teractive understanding of a clinical condi-
teractive understanding of a clinical condi-
tion and of the wholeness of the person
tion and of the wholeness of the person
who presents for evaluation and care.
who presents for evaluation and care.
8.2
8.2
This comprehensive concept of diagnosis is
This comprehensive concept of diagnosis is
implemented through the articulation of
implemented through the articulation of
two diagnostic levels. The first is a stand-
two diagnostic levels. The first is a stand-
ardised multi-axial diagnostic formulation,
ardised multi-axial diagnostic formulation,
which describes the patient\u2019s illness and
which describes the patient\u2019s illness and
clinical condition through standardised
clinical condition through standardised
typologies and scales (see IGDA Work-
typologies and scales (see IGDA Work-
group, WPA, 2003, this suppl.). The second
group, WPA, 2003, this suppl.). The second
is an idiographic diagnostic formulation,
is an idiographic diagnostic formulation,
which complements the standardised for-
which complements the standardised for-
mulation with a personalised and flexible
mulation with a personalised and flexible
statement.
statement.
8.3
8.3
The preparation of the idiographic formu-
The preparation of the idiographic formu-
lation starts with the recognition of the per-
lation starts with the recognition of the per-
spectives of the clinician, the patient and
spectives of the clinician, the patient and
(whenever appropriate) the family, on what
(whenever appropriate) the family, on what
is unique, important and meaningful about
is unique, important and meaningful about
the patient. The formulation sets out these
the patient. The formulation sets out these
perspectives and identifies any discrepan-
perspectives and identifies any discrepan-
cies, permitting their resolution and inte-
cies, permitting their resolution and inte-
gration into a shared understanding of the
gration into a shared understanding of the
case at hand.
case at hand.
8.4
8.4
The clinician\u2019s perspectives should represent
The clinician\u2019s perspectives should represent
a synthesising and integrative effort to identi-
a synthesising and integrative effort to identi-
fy the essential features of the patient\u2019s clini-
fy the essential features of the patient\u2019s clini-
cal condition and the biological (e.g. genetic,
cal condition and the biological (e.g. genetic,
molecular, toxic), psychological (e.g. psycho-
molecular, toxic), psychological (e.g. psycho-
dynamic, behavioural, cognitive) and social
dynamic, behavioural, cognitive) and social
(e.g. support, cultural) factors that are
(e.g. support, cultural) factors that are
relevant to that condition.
relevant to that condition.
8.5
8.5
The perspectives of the patient and the
The perspectives of the patient and the
family should cover their understanding of
family should cover their understanding of
the clinical condition and its contributory
the clinical condition and its contributory
factors, the patient\u2019s self-image, assets and
factors, the patient\u2019s self-image, assets and
strengths, and sense of what is meaningful
strengths, and sense of what is meaningful
in life, as well as their expectations for the
in life, as well as their expectations for the
clinical care process. This information
clinical care process. This information
should be elicited through questions placed
should be elicited through questions placed
strategically throughout the clinical inter-
strategically throughout the clinical inter-
view, such as: What problem brought you
view, such as: What problem brought you
here? How do you explain what has hap-
here? How do you explain what has hap-
pened to you? What is important for you
pened to you? What is important for you
in life? What do you expect from clinical
in life? What do you expect from clinical
care? The most important factor in eliciting
care? The most important factor in eliciting
the patient\u2019s and family\u2019s perspectives is the
the patient\u2019s and family\u2019s perspectives is the
ability to listen well. Learning to listen
ability to listen well. Learning to listen
requires didactic instruction, practice and
requires didactic instruction, practice and
feedback, as well as a knowledge of the
feedback, as well as a knowledge of the
patient\u2019s cultural background.
patient\u2019s cultural background.
8.6
8.6
Integration of clinician and patient perspec-
Integration of clinician and patient perspec-
tives, essential for a therapeutic alliance,
tives, essential for a therapeutic alliance,
should be based on empathetic rapport, re-
should be based on empathetic rapport, re-
flecting mutual respect and interest, and
flecting mutual respect and interest, and
human feeling between the clinician and
human feeling between the clinician and
the patient. These two people (with the col-
the patient. These two people (with the col-
laboration of the family as needed) should
laboration of the family as needed) should
attempt to reach a joint understanding, to
attempt to reach a joint understanding, to
the maximum extent possible, of the
the maximum extent possible, of the
clinical problems and their contextual-
clinical problems and their contextual-
isation, the patient\u2019s positive factors, and
isation, the patient\u2019s positive factors, and
expectations about restoration and pro-
expectations about restoration and pro-
motion of health. Each of these elements
motion of health. Each of these elements
is outlined below. Finally, clinician, patient
is outlined below. Finally, clinician, patient
and family should jointly monitor the pro-
and family should jointly monitor the pro-
gress of care and its outcome, and agree
gress of care and its outcome, and agree
on any adjustments to be made.
on any adjustments to be made.
8.7
8.7
The first element of the idiographic
The first element of the idiographic
formulation is the identification of clinical
formulation is the identification of clinical
problems and their contextualisation.
problems and their contextualisation.
These include disorders, symptoms and
These include disorders, symptoms and
problems (based on the standardised
problems (based on the standardised
multi-axial formulation) described in
multi-axial formulation) described in
language shared by the clinician, the patient
language shared by the clinician, the patient
and the family, as well as key comple-
and the family, as well as key comple-
mentary information and the elucidation
mentary information and the elucidation
of pertinent mechanisms and contributory
of pertinent mechanisms and contributory
factors, from biological, psychological,
factors, from biological, psychological,
social and cultural perspectives. Important
social and cultural perspectives. Important
disagreements should be noted and their
disagreements should be noted and their
resolution addressed.
resolution addressed.
8.8
8.8
The second element of the idiographic for-
The second element of the idiographic for-
mulation is the description of the patient\u2019s
mulation is the description of the patient\u2019s
positive factors. These are factors pertinent
positive factors. These are factors pertinent
to the treatment of the clinical condition
to the treatment of the clinical condition
and to health promotion, such as maturity
and to health promotion, such as maturity
of personality, skills, talents, social re-
of personality, skills, talents, social re-
sources and supports, and personal and
sources and supports, and personal and
spiritual aspirations.
spiritual aspirations.
8.9
8.9
The third element of the idiographic formu-
The third element of the idiographic formu-
lation outlines expectations about the re-
lation outlines expectations about the re-
storation and promotion of health. These
storation and promotion of health. These
include specific expectations about the
include specific expectations about the
types of treatments and their results, as well
types of treatments and their results, as well
as aspirations about health status and
as aspirations about health status and
quality of life in the foreseeable future.
quality of life in the foreseeable future.
8.10
8.10
The idiographic formulation should be pre-
The idiographic formulation should be pre-
sented in natural or colloquial language to
sented in natural or colloquial language to
maximise the flexibility of its presentation.
maximise the flexibility of its presentation.
The length of a written idiographic formu-
The length of a written idiographic formu-
lation could be about a page (Fig. 8.1),
lation could be about a page (Fig. 8.1),
and that of an oral presentation about 5
and that of an oral presentation about 5
minutes. Although this length may be advi-
minutes. Although this length may be advi-
sable in general, the formulation may vary
sable in general, the formulation may vary
from a short statement to a much more ex-
from a short statement to a much more ex-
tensive one, depending on the time avail-
tensive one, depending on the time avail-
able, the purposes and format of clinical
able, the purposes and format of clinical
care, and other circumstances.
care, and other circumstances.
FURTHER READING
FURTHER READING
American Psychiatric Association (1995)
American Psychiatric Association (1995)Practice
Practice
guidelines for psychiatric evaluation of adults.
guidelines for psychiatric evaluation of adults.American
American
Journal of Psychiatry
Journal of Psychiatry,
,152
152(suppl.), 67^80.
(suppl.), 67^80.
s55
s55
BRITISH JOURNAL OF PSYCHIATRY
BRITISH JOURNAL OF PSYCHIATRY(2003), 182 (suppl. 45), s55^s57
(2003), 182 (suppl. 45), s55^s57
IGDA. 8: Idiographic (personalised) diagnostic
IGDA. 8: Idiographic (personalised) diagnostic
formulation
formulation
IGDA WORKGROUP, WPA
IGDA WORKGROUP, WPA
IGDA WORKGROUP, WPA
IGDA WORKGROUP, WPA
s56
s56
COMPREHENSIVE DIAGNOSTIC FORMULATION
COMPREHENSIVE DIAGNOSTIC FORMULATION
WPA International Guidelines for Diagnostic Assessment
WPA International Guidelines for Diagnostic Assessment
SECOND COMPONENT:
SECOND COMPONENT: IDIOGR APHIC FORMULATION
IDIOGR APHIC FORMUL ATION
I
I Clinical problems and their contextualisation
Clinical problems and their contextualisation(include disorders, symptoms and problems, based on the standardised multi-
(include disorders, symptoms and problems, based on the standardised multi-
axial formulation, in language shared by the clinician, patient and family, as well as complementary key information,
axial formulation, in language shared by the clinician, patient and family, as well as complementary key information,
mechanisms and explanations from biological, psychological, social and cultural perspectives)
mechanisms and explanations from biological, psychological, social and cultural perspectives)
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
II
II Positive factors of the patient
Positive factors of the patient(include resources pertinent to treatment and health promotion, e.g. maturity of personality,
(include resources pertinent to treatment and health promotion, e.g. maturity of personality,
abilities, talents and coping skills, social supports and resources, and personal and spiritual aspirations)
abilities, talents and coping skills, social supports and resources, and personal and spiritual aspirations)
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
III
IIIExpectations on restoration and promotion of health
Expectations on restoration and promotion of health(include specific expectations on types and outcome of treatment and
(include specific expectations on types and outcome of treatment and
aspirations on health status and quality of life for the foreseeable future)
aspirations on health status and quality of life for the foreseeable future)
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Fig. 8.1
Fig. 8.1Blank form for recording the chosen treatment plan. This form may be photocopied free of charge for use in clinical prac tice.
Blank form for recording the chosen treatment plan. This form may be photocopied free of charge for use in clinical prac tice.

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