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.

Biological Psychological Social
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. πŸ˜‰ Hope I can pull through tomorrow!

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