Pattern-based formulation: a methodology for psychiatric case formulation

Abstract

Objective: Psychiatric formulation is often considered a challenging task, particularly for trainees and students in psychiatry. The process of arriving at a good psychiatric formulation involves identifying major issues of the patient, and developing an explanatory system, which can be derived using known theoretical models in psychiatry. A good explanatory system should provide a high degree of coherence by linking the most relevant data, justification for the proposed management plan, and its feasibility. Unfortunately, the literature on ‘how’ to develop psychiatric formulation is limited, and for the trainees, psychiatric formulation remains a challenging task. Method: Based on the clinical reasoning strategy known as pattern recognition, a methodology for psychiatric case formulation has been proposed. The methodology uses a repository of templates, which are derived from major theoretical models in psychiatry. Developing a formulation involves a process of selecting, prioritising and combining templates according to the elicited set of main issues or psychopathology. The pattern resulting from the combination of different templates provides a degree of uniqueness to the explanatory system. Conclusion: It is expected that this methodology will help trainees and students to develop a broader understanding and skills in psychiatric formulation.