BPSS Framework Biological: Substances

https://med.unr.
edu/psychiatry/education/resources/bio-psycho-social-spiritual-model
benzodiazepines, SSRI's, antipsychotics). Consider possible side effects

BPSS Framework of current medications.
Biological Substances:
 Consider the influence of nicotine, alcohol and street drugs on current

Past psychiatric symptoms.
Genetics:  Consider the possible effects of substance withdrawal.
 Consider whether any blood relatives that have had psychiatric

problems, substance use problems or suicide attempts/suicides. Is there a
Psychological
history of close relatives who have been hospitalized for psychiatric
reasons? What kind of treatments did they get, how did they respond? Past
History of Pregnancy and Birth:  Comment on any past history of trauma (child abuse, combat, rape,
serious illness), as well as resiliency (how the patient coped with
 Consider pregnancy variables: Was there in-utero exposure to nicotine, trauma, e.g. friends, family, religion).
alcohol, medications or substances? Anything unusual about pregnancy?  Consider the sources of positive self image and positive role models.
 Note birth complications, such as prematurity, birth trauma or extended  Comment on the patient's experience with loss.
periods of hospitalization.
 Comment on the patient's quality of relationships with important figures,
Relevant Previous Illnesses such as grand parents, friends, significant teachers, or significant
employers.
 Consider any history of head injury, endocrine disorders (e.g. thyroid,  Comment on how past medical problems, substance use or psychiatric
adrenal), seizures, malignancies, or neurological illnesses. problems impacted the patient's development and their relevance to
 Consider potential lasting effects of past substance use on brain patient today.
functions such as cognition, affective regulation, etc.
Present
Present
 Describe the recent events and experiences that precipitated the
Current Illnesses: admission or appointment.
 What are the current stressors? Do they have any symbolic meaning?
 Identify current illnesses and any direct impact they may have on
 Assess and comment on coping skills, defense mechanisms, presence or
psychiatric presentation.
absence of cognitive distortions.
Medications:  Consider current developmental demands on the person, such as
marriage, divorce, birth, children leaving home, loss, aging, etc. What
 Assess current medication regimen. Consider whether these medications stage of development is the patient at now? Is it appropriate?
have psychoactive effects (e.g. steroids, beta blockers, pain medications,  What is the developmental impact of the patient's illness?
https://med.unr.edu/psychiatry/education/resources/bio-psycho-social-spiritual-model
Bio-Psycho-Social-Spiritual Model: Examples of Kinds of Questions to ask
Social during your Interviews
 How adequate is the patient's current support system?

 What is the current status of relationships with important figures?
Biological
 What are the possible peer influences? Past
 Consider the patient's current housing arrangement.
Genetics:
 Comment on vocational/financial status.
 Comment on any relevant legal problems.  Tell me about any family history of psychiatric problems or suicide
attempts.
 Consider the role of agencies (e.g. Veteran's Administration, Child
Protective Services, Criminal Justice System) on the patient.  Tell me about any relatives that have been hospitalized for psychiatric
admissions. Tell me about any relatives that might have suffered from
 Comment on cultural influences that may impact the current situation
emotional problems. How were they treated and how did they respond
and that might impact treatment.
to these treatments?
Spiritual History of Pregnancy and Birth:
 Comment on the role of spirituality in the patient's life. Is the patient  Tell me about your mother's pregnancy with you. Do you know if she
affiliated with a spiritual community of some sort? smoked, drank, or used any medications?
 How does spirituality contribute to the patient's ability to hope, their  What have you been told about your actual birth? Were there any birth
position on suicide if relevant, or their contact with a supportive complications?
community?
Relevant Previous Illnesses:
 Tell me about any major medical problems you have had in your life.
Have you had any history of head injury, endocrine disorders (i.e.
thyroid, adrenal), seizures, malignancies or neurological illnesses?
Present
Current Illnesses:
 Can you describe your health right now? Do you have any illnesses right
now? Do you worry that you have something that has not been
diagnosed?
Medications:
 Tell me about the prescribed and non-prescribed medications that you

are taking? (Probe for medications that have psychoactive effects, such
as steroids, beta blockers, pain medications, benzodiazepines, SSRI's,
Herbal remedies). Social
Substances:  Tell me about who you tum to if you need help. Do you have friends or
family you can turn to if you need help?
 Can you tell me about your use of alcohol or take street drugs? (Probe  Tell me about who you rely on for company, support, and fun. Do you
for whether current substance use could account for patient's psychiatric have friends or family that you can rely on for company, support, and
symptoms). fun?
 Currently, describe the kind of social life that you have? How often do
Psychological you get together with people you can relate to, and do you enjoy it?
 When you were feeling better, describe the kind of social life you had.
Past How often did you get together with people you could relate to?
 Tell me about your present housing arrangement? Are you satisfied with
 How were you treated as a child? (Probe for trauma as well as evidence
it?
for family strengths).
 Tell me about your work life. Are you working? Is your work satisfying
 Can you tell me about any trauma's you might have experienced in life?
or do you need help in this area?
(Probe for military/combat, rape, violence, and serious illness).
 Tell me about your financial circumstances?
 Can you describe to me any losses you have experienced? How did you
cope with this?  To help me understand you, can you tell me about cultural/family
beliefs that might help me get a more clear sense of your life-
 Tell me about your relationships like with important figures, such as
circumstance/symptoms right now?
parents, grandparents, friends, significant teachers, or significant
employers.
 How have medical problems or psychiatric problems in your past Spiritual
influenced your life today?
 Can you describe your spiritual belief system?
Present  Can you tell me about how you get spiritual needs met?
 Can you tell me about your religious community?
 Tell me about the recent events and experiences that bring you here
today?  Can you describe your childhood experience of religion?
 How have you already tried to solve your problems? (Probe for coping
skills).
 How do you usually cope with difficult life-situations? (Probe for and
observe defense mechanisms).
 Tell me about how you are coping with marriage, divorce, birth, Bio Psycho Social Spiritual Treatment Plan
children leaving home, loss aging, etc. (The point here is to get a sense
of what is being demanded of the person at this time, developmentally). Biological
 How do current medical problems or psychiatric problems influence
your life today? Diagnostic:
To "work up" current medical and psychiatric symptoms labs (i.e. thyroid, Assessment of patient's social and financial resources, qualifications for various
metabolic panel, Urine Drug Screen, blood alcohol level, current blood level of aid programs (housing, Vocational Rehabilitation, Medicaid, GA, etc.)
medication if relevant) Imaging (i.e. MRI, chest X-ray) Other: EEG, Biopsies,
etc. Therapeutic:
Therapeutic: Assistance with housing, job training, benefits groups (may include 12 Step,
"Self-Help," Reminiscence, Clubs, etc.) Encouraging hobbies, encouraging
Treatment of current illness and associated symptoms Medications for social activities, family meetings.
underlying psychiatric disorder: antidepressant, mood stabilizer, antipsychotic,
etc. Medications related to substance use disorder: methadone, alcohol Give a statement about why these kinds of supports are or are not indicated. Are
withdrawal protocol, nicotine replacement therapy, etc. Medications for there any interventions that could decrease social barriers to treatment?
symptom relief: sleeping medication Medications for other medical problems:
antibiotics, etc. life style prescriptions such as exercise and diet changes. Give Spiritual
your rationale as to why you are or are not choosing a biological treatment for
particular problems with particular patients.
Diagnostic:
Psychological Assessment of patient's past religious and spiritual affiliations.
Diagnostic: Therapeutic:
Psychological testing: personality, IQ, other relevant tests. Behaviors and Identifying resources: Organized religious activities, Meditation/Mindfulness
personality styles noted in the interview or reported by staff. Obtain more training, Groups (may include 12 step).
information: (old records, speak with outside providers, family) with written
Give a statement about why these kinds of supports are or are not indicated.
consent
Treatment:
Individual Psychotherapy: (tailored to patient — may include behavioral
treatments such as DBT, relaxation therapy, behavioral activation, social skills
training, coping skills development or cognitive behavioral therapy or
psychodynamic therapy — be prepared to justify your choice for this patient).
Couple's Therapy/Group Therapy: (tailored to patient, many choices, may
include 12 step). Give you rationale as to why you are or are not suggesting a
type of psychotherapy. Are there any interventions that could decrease
psychological barriers to treatment?
Social
Diagnostic:

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https://med.unr.

benzodiazepines, SSRI's, antipsychotics). Consider possible side effects

 Consider the influence of nicotine, alcohol and street drugs on current

 Consider whether any blood relatives that have had psychiatric

 How adequate is the patient's current support system?

Spiritual History of Pregnancy and Birth:

 Tell me about the prescribed and non-prescribed medications that you

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