Leucht Stefan, König Bernhard, di Francesco Antonio, Rodolico Alessandro, Priller Josef, Böge Kerem, Strube Wolfgang, Gensichen Jochen, Bechmann Peter, ElDeeb Amr, Hasan Alkomiet, Moritz Steffen, Jäger Markus, Leucht Claudia, van Os Jim, Davis John M
Department of Psychiatry and Psychotherapy, Klinikum Rechts Der Isar, Technical University of Munich, TUM School of Medicine and Health, Ismaningerstrasse 22, 81675, Munich, Germany.
German Center for Mental Health (Partner Site Munich-Augsburg), Munich, Germany.
Eur Arch Psychiatry Clin Neurosci. 2025 Jul 1. doi: 10.1007/s00406-025-02045-5.
Lawrence Weed introduced the "Problem-Oriented Medical Records" (POMR) approach to medicine. Its core principle is that treatment should be organised around patients' specific problems. This approach gained widespread adoption in the United States during the 1970s. However, few studies have compared POMR with the traditional "source-based" method, and evidence supporting its application in mental health remains particularly limited.
We carried out a narrative review to examine whether POMR is appropriate for mental health care and which modifications are necessary for this purpose.
Psychiatry and psychotherapy address brain-mediated disorders that lack clear biological markers. Diagnoses rely on the assessment of psychopathological symptoms, which are grouped into syndromes. These symptoms and syndromes can be effectively categorized as "problems". Given that psychiatric treatment is often symptomatic in that it focuses on symptoms rather than diagnoses, POMR provides an ideal framework for organizing care. Furthermore, mental health is inherently multidimensional, encompassing biological, psychological, social, and existential domains. This complexity necessitates interdisciplinary collaboration. However, under the conventional source-based approach, professional groups often operate in parallel rather than jointly together. POMR, by contrast, facilitates seamless collaboration by aligning teams around patient-centred problems. A special aspect of mental health care is the emphasis on considering patients' individual goals and resources, rather than focusing only on their deficits.
By systematically applying POMR to psychiatric care-particularly through tightly coordinated interdisciplinary treatment-clinicians could enhance both clinical and functional outcomes, improve both patient and team satisfaction, and better align treatment with patients' unique needs. To support this approach, we propose a practical grid which we refer to as the Problem-Resources-Goals Oriented framework (PRoGO), reflecting the necessary adaptations for mental health. Clinical trials are warranted to assess the effectiveness of POMR/PRoGO in psychiatric practice and its potential to advance the field.
劳伦斯·威德将“问题导向医疗记录”（POMR）方法引入医学领域。其核心原则是治疗应围绕患者的具体问题来组织。这种方法在20世纪70年代的美国得到了广泛应用。然而，很少有研究将POMR与传统的“基于来源”方法进行比较，支持其在心理健康领域应用的证据仍然特别有限。
我们进行了一项叙述性综述，以研究POMR是否适用于心理健康护理，以及为此需要进行哪些修改。
精神病学和心理治疗针对的是缺乏明确生物学标志物的大脑介导疾病。诊断依赖于对心理病理症状的评估，这些症状被归类为综合征。这些症状和综合征可以有效地归类为“问题”。鉴于精神科治疗通常是对症治疗，即侧重于症状而非诊断，POMR为组织护理提供了一个理想的框架。此外，心理健康本质上是多维度的，涵盖生物、心理、社会和生存领域。这种复杂性需要跨学科合作。然而，在传统的基于来源的方法下，专业团队往往并行运作而非共同协作。相比之下，POMR通过围绕以患者为中心的问题调整团队，促进无缝协作。心理健康护理的一个特殊方面是强调考虑患者的个人目标和资源，而不仅仅关注他们的缺陷。
通过将POMR系统地应用于精神科护理——特别是通过紧密协调的跨学科治疗——临床医生可以提高临床和功能结局，提高患者和团队的满意度，并使治疗更好地符合患者的独特需求。为了支持这种方法，我们提出了一个实用的网格，我们称之为问题-资源-目标导向框架（PRoGO），反映了对心理健康的必要调整。有必要进行临床试验，以评估POMR/PRoGO在精神科实践中的有效性及其推动该领域发展的潜力。
