Home > Med School > MS2 > The Biopsychosocial Model of Health and Illness

The Biopsychosocial Model of Health and Illness

Tomorrow afternoon, the last 20% of my psychiatry rotation’s grade will be determined based on my ability to watch a 30 minute videotaped patient encounter, prepare a presentation, and then orally deliver the case with an accurate differential diagnosis and treatment plan.

Aside from the typical introduction (history of present illness, past psychiatric/medical history, medications, etc.), I’ll have to discuss the patient’s mental status exam (MSE) and formulate a biopsychosocial (BSP) approach to the diagnosis. I wanted to outline how the BSP approach, a theory which is rooted in the notion that the mind affects the body and vice versa, is a fantastic way to explore a psychiatric patient’s situation.

The BSP approach is just that – figuring out how a patient’s biology, psychology, and his or her social situation predispose, precipitate, perpetuate, and protect an individual in the context of illness and health. Here’s a table (credit goes to an unknown psychiatry resident) which helps me categorize facets of a patient’s history.

BiologicalPsychologicalSocial
Predisposing
  • Past psych/med hx
  • Drug use
  • Family hx
  • Genetics
  • Maladaptive defenses
  • Trauma/abuse
  • Developmental stages
  • Family dynamics
  • Limited support
  • Religious/educational conflict
Precipitating
  • New med problem
  • Relapse
  • Non-compliance
  • Grief/loss
  • New conflicts
  • New trauma
  • Impaired reality testing
  • Recent move
  • Relationship stressors
  • Unemployment
  • Legal issues
Perpetuating
  • Non-compliance
  • Chronic condition
  • Drug use
  • Trauma/abuse
  • Poor insight/judgment
  • Impulsivity
  • Passive vs active stance
  • Poverty
  • Unemployment
  • Limited resources
  • Social barriers
Protective
  • Healthy
  • Sobriety
  • Compliant
  • Good response to treatment
  • Good coping
  • Positive therapeutic alliance
  • Good insight
  • Stable support, income, housing
  • Access to resources
  • Functional

Looking over this table, it’s easy to see that we’re not dealing with the mundane “underlying problem -> symptoms -> treatment” approach to medicine. Instead, all aspects of a patient’s life are considered, and it’s the interplay between these which dictates how we should best go about diagnosing and treating.

Over the last two months, I’ve not *formally* presented the BSP in my notes, but it’s an inherent part of every diagnosis (especially psychiatric), so I should be okay in theory. 馃槈 Hope I can pull through tomorrow!

 LEGAL

My posts are not to serve as a replacement for recommendations provided by licensed physicians nor do they represent the opinions of Baylor College of Medicine or its affiliated institutions. Please read this site's Disclaimer and Terms of Use for more information.

ALSO CHECK OUT  

Second Year of Medical School in Retrospect

This is my last post as a second year medical student (MS2). 馃槸 The first …

 DROP A LINE

Your email address will not be published. Required fields are marked *