More than 30 years ago, psychiatrist George Engel (1977) coined a word to describe a developing paradigm for patient care, the “biopsychosocial model.” The model encouraged formulating treatments that considered the mind and body of a patient as two intertwining systems influenced by yet a third system—society.
Twenty years before this paradigm, Erik Erikson (1963) created a model that describes psychological maturation across the life span. Combining these two models yields a dimensional perspective helpful for the evaluation, diagnosis, and treatment of any patient (Table 13-1).
Table 13-1. Biopsychosocial Development |Favorite Table|Download (.pdf)
Table 13-1. Biopsychosocial Development
Adolescence: 11–18 yrs
Early Adulthood: 18–34 yrs
Middle Adulthood: 35–60 yrs
Late Adulthood: 61 yrs–death
Pubertal hormonal changes
Reproductive organ development
Physical growth spurts
Initiation of sexual activity
Career choices and success
Late childbearing or “empty nest”
Caring for aging parents
Career success and/or change
Extended family and friends
Not only do women use more health care services in general than men in the United States, but more women approach their physicians with psychiatric complaints, and more women have comorbid illness than men (Andrade, 2003; Burt, 2005; Kessler, 1994). Coupled with the “almost universal recognition” that primary care is where most patients with psychiatric illness are first seen, obstetricians and gynecologists will often be the first to evaluate a woman in psychiatric distress (Goldberg, 2003). A clinical interview such as one presented in Table 13-2 can guide assessment and includes all three domains from the biopsychosocial model.
Table 13-2. Psychiatric Assessment of Women: Clinically Significant Considerations |Favorite Table|Download (.pdf)
Table 13-2. Psychiatric Assessment of Women: Clinically Significant Considerations
History of present illness and past psychiatric history
Characterize symptoms in relation to:
A specific phase of the menstrual cycle
Use of hormonal contraception
Breast feeding or weaning
Exogenous hormones and all over-the-counter medications and supplements
Ritualistic or restrictive eating patterns, binging, self-induced vomiting, and use of diet pills, laxatives, emetics, and diuretics
Alcohol and drug use
Covert use, especially of prescription medications
Family psychiatric history
History of premenstrual dysphoric disorders and postpartum mood disorders
Autoimmune illnesses (e.g., lupus, thyroiditis, or fibromyalgia) that may present with psychiatric symptoms
History of sexually transmitted disease that may affect current sexual functioning and childbearing capacity
Pregnancy, menstruation-related symptoms
Social and developmental history
Sexual preference, relationship styles, ...
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