Georg-Elias-Mueller Institute of Psychology, University of Goettingen, Goettingen, Germany.
Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands.
J Eval Clin Pract. 2021 Jun;27(3):648-656. doi: 10.1111/jep.13540. Epub 2021 Jan 25.
Proponents of clinical case formulations argue that the causes and mechanisms contributing to and maintaining a patient's problems should be analysed and integrated into a case conceptualization, on which treatment planning ought to be based. Empirical evidence shows that an individualized treatment based on a case formulation is at least sometimes better than a standardized evidence-based treatment.
We argue that it is likely to improve decisions when two conditions hold: (a) knowing about the mechanisms underlying the patient's problems makes a difference for treatment, and (b) the case formulation is based on valid knowledge about mechanisms of psychopathology.
We propose a protocol for assessment, case formulation and treatment planning (PACT), which incorporates transdiagnostic accounts of psychopathology. PACT describes a 5-step decision making process, which aims to help clinicians to decide when to resort to evidence-based treatments and when to construct a case formulation to individualize the treatment.
We show how PACT works in practice by discussing treatment planning for a clinical case involving symptoms of social anxiety, depression and post-traumatic stress disorder.
临床病例式治疗的支持者认为，应该对导致和维持患者问题的原因和机制进行分析，并将其整合到病例概念化中，治疗计划应该以此为基础。实证证据表明，基于病例式的个体化治疗有时至少比基于标准化循证治疗要好。
我们认为，如果满足以下两个条件，决策可能会得到改善：(a)了解患者问题的潜在机制对治疗有影响，以及(b)病例式治疗基于对精神病理学机制的有效知识。
我们提出了一种评估、病例式治疗和治疗计划（PACT）的方案，该方案纳入了精神病理学的跨诊断描述。PACT 描述了一个 5 步决策过程，旨在帮助临床医生决定何时采用基于证据的治疗方法，何时构建病例式治疗以实现个体化治疗。
我们通过讨论涉及社交焦虑、抑郁和创伤后应激障碍症状的临床病例的治疗计划，展示了 PACT 在实践中的工作方式。
