The basic framework of the biopsychosocial formulation focuses on identifying the 4Ps: predisposing, precipitating, perpetuating, and protecting elements within the three main domains

The basic framework of the biopsychosocial formulation focuses on identifying the 4Ps: predisposing, precipitating, perpetuating, and protecting elements within the three main domains—biological, psychological, and social(Owen, 2023). By utilizing this formulation model for the case study, the identified factors are as follows:

Predisposing factors: family history of mental illness, diagnoses of anxiety and depression, history of substance abuse, estrangement from biological family, and possible childhood trauma.

Precipitating factors: recent affair, pending divorce, financial stress, failed business endeavors, fleeting suicidal thoughts, and reported feelings of guilt.

Perpetuating factors: partial response to current medication, ongoing financial stress, ongoing marital problems, parental responsibilities, and ongoing feelings of guilt.

Protecting factors: overall physical health, adherence to medication and treatment with an outpatient physician, developed career path, high education level, and family support from the husband who brought him to the ER.

Although more information is required for an accurate diagnosis and to develop a thorough treatment plan, given the limited details presented in the case study, it appears that the diagnoses of major depressive disorder and generalized anxiety disorder are appropriate. It is worth noting that Oliver’s report of feeling “ having a lucky streak and on top of the world” along with feeling “ amazing” within a week of starting Lexapro, accompanied by high-risk behaviors such as new business endeavor, making investments with his children’s education fund and having an affair raises the suspicions of bipolar II disorder. However, further information is required to make the diagnosis. When contemplating a holistic treatment plan, it may be appropriate to consider the use of a mood stabilizer in light of Oliver’s reported mood swings. Various forms of therapy, such as cognitive-behavioral therapy, marital counseling, family therapy, and interpersonal therapy, may prove beneficial in addressing Oliver’s stress and feelings of guilt. Refraining from consuming alcohol and substances to mitigate the worsening of symptoms is encouraged. Furthermore, self-management practices, including structured daily activities, physical activity, and symptom monitoring, can be helpful (Shelton & Bobo, 2022).

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Formulation

By investigating the relationship between biological, psychological, and social variables and their effects on Oliver’s mental health, Hammen (2020) concludes that these factors are very much interconnected. The biopsychosocial model (APA, 2022) considers that aspect.

Biological

Growing substance use history and treatment for depression using escitalopram medication (APA, 2022) suggest a possible biological vulnerability to becoming addicted. The evident sleep disturbances (depicted by an undulating state of mind), as well as the mood swings, at the same time, can be indications of bipolar disorder (Grande et al., 2018). Other types of mood disorders, like genetic testing, might be developed in the future (McIntyre et al., 2020).

Psychological

Childhood poverty, lack of parental care, and various job search difficulties (APA, 2022) might be attributable. The symptoms consist of overturning of a euphoric state (involvement in amateur or business venture, affair) with feelings of guilt, suicidal ideation, and feelings of low self-worth being included in this package of behaviors. CBT to achieve thinking pattern transformation (Beck, 2019) and counseling “to dig into the past” and learn coping tools will be helpful in healing.

Social

He might not have socialized well as he did not share a good relationship with his mother, and if his father had left when he was only 5, he could have been socially confused. The marital cause intensifies strain on his supportive husband relationship, which can ultimately result in the breakdown of the family. Therapy and spouses’ group mechanisms for bipolar disorder or depression are also crucial.

Potential Diagnosis

Oliver’s signs point to bipolar disorder (APA, 2022).

Treatment Plan

A holistic approach is, in fact, necessary, tackling all elements of the biopsychosocial model (APA, 2022). This could involve a review of medication by a psychiatrist, CBT, individual therapy, marital therapy, and support group participation.

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