Reference

Guide | Reference

21  Case Formulation Framework

Purpose. Provide a standardized, brief formulation that fits any setting. Connect symptoms to context, contributors, and leverage points.

21.1 Core Elements

• Presenting problem (patient language).
• Domain profile (0-4 ratings).
• Trajectory (improving/stable/worsening/fluctuating).
• Risk modifiers and safety concerns.
• Uncertainty and competing explanations.

21.2 The 4 Ps

• Predisposing: vulnerabilities and long-term risk factors.
• Precipitating: recent triggers and onset drivers.
• Perpetuating: factors maintaining symptoms.
• Protective: strengths, supports, and stabilizers.

21.3 Leverage Points

• Smallest changes likely to shift trajectory.
• Barriers to change and feasibility constraints.

21.4 Formulation Outputs (short)

• 3-6 bullet lines summarizing the above.

21.5 Formulation Outputs (full)

• Narrative paragraph plus domain ratings and specifiers.