Q-What all information should one collect before giving diagnosis for stress and anxiety

Answer- One should collect the information under 4P. 4 Ps are –

Predisposing factor- Factors operating from early life. Determines vulnerability to develop
disorder or likelihood that person will develop certain symptoms under given stress condition
Precipitating factor –Event occurring shortly before the onset of a disorder
Perpetuating factor – factor due to which disorder is maintained or activated
Protective factor – Factors which limits the illness from an extreme progress
The 4P factor model formulation, just like the Mental State Examination (MSE), is a tool used
in psychology, psychiatry, psychological medicine or whenever it is deemed necessary and
useful. It is quick, easy-to-use and is a structured method to describe, assess and observe your
patient’s narrative into a coherent and concise record. Unlike the MSE which focuses on the
psychological functioning and mental state of your patient, the 4P factor model formulation
focuses on the collateral information of your patient and how they got to this point. This
involves the past and the present of your patient where generally the MSE is more involved in
the ‘now’. In other words, the 4P factor model formulation utilises four types of influences and
the biopsychosocial risk factors. These influences and biopsychosocial risk factors shape the
progression and development of mental health disorders for a particular patient. In a nutshell:
“The formulation asks what is wrong, how it got to that way, and what can be done about it”
(1). At the end of the 4P factor model formulation, you should have a relatively detailed
description of key aspects of your patient’s narrative, what is going on in their lives and their
risk factors. The 4P factor model formulation works hand in hand with the MSE; hence if you
do both, you would a get a clear picture about your patient’s past and current life, and about
their psychological functioning and mental state. This would allow the clinician to make a
sound diagnosis, follow-ups, formulations and patient management for recovery. This includes
the best course of action such as which therapy is needed, if medication needs to be started, if
there is a need for referrals to certain support groups or specialist and so on. These are very
useful in psychological consultation, so be sure to study and practise for a seamless and
successful consultation! Check out my other blog in psychology relating to the 4P Factor Model
formulation “The Mental State Examination and Its Purpose in Psychological Medicine”.