Formulation in psychiatry – a guide to developing competence

Abstract

Objective This paper highlights the importance of psychiatric formulation and provides guidance to those learning the art of formulation. To achieve this, we explore the guidance on formulation that has been previously published in Australasian Psychiatry, identify the key components of psychiatric formulation, and outline an approach to comprehensive formulation in routine clinical practice. Conclusion Formulation is the foundation of good psychiatric practice but presents a considerable challenge to the novice practitioner. Understanding the ingredients of formulation and a method for meaningfully putting these together will guide deliberate practice to learn the art of psychiatric formulation.

Formulation: A plea for parsimony

“…Cannabinoids predominantly act through the endogenous cannabinoid system, but animal studies suggest these compounds can also stimulate serotonin receptors. 1 This is in addition to CYP450 interactions altering the metabolism of serotonergic agents. 2 Recent cases from the United States suggest that high concentrate cannabis use can precipitate serotonin syndrome in patients taking antidepressants.…”

“…An unremarkable outpatient assessment the previous day corroborated the acuity of onset. On recovery, he disclosed oral ingestion of cannabis oil (THC 28.5 mg/mL + cannabidiol < Australasian Psychiatry 32 (1)…”

“…Dear Editor, Formulationa set of explanatory hypotheses that answer the question 'why does this patient suffer from this problem at this time'is considered an essential skill of a psychiatrist. The recent paper by Parker et al 1 highlights the various approaches to formulation and distils several themes into a comprehensive approach. However, few authors have seriously considered the utility and reliability of psychiatric formulation.…”

A guide to support trainee’s success in the psychotherapy written case submission

“…It is the only assessment of report writing skills in the current iteration of the RANZCP training program. Although report writing is a core competency expectation of psychiatrists, many trainees have limited opportunities to develop comprehensive formulations with patients 8 and prepare similar reports. 1 Several Branch Training Committees (BTCs) make a de-identified case history library of past successful submissions available to trainees.…”