Biological formulation: do we need a new paradigm of clinical reasoning in psychiatry?

Aim: to redefine the current clinical reasoning model applied to patients with psychiatric illness and to identify semiological strategies that can establish a guide towards integrative care.

Method: directed bibliographic review and presentation of the concept of biological formulation in the clinical practice of integrative psychiatry

Results: the need to redefine the clinical reasoning model is justified, the establishment of a semiological guide —biological formulation— is defined and key questions for the detection of physiological imbalances or the integration of physical illness into the understanding of psychiatric pathology are identified. Some of these questions are: (1) what is the cause or causes of the physiological imbalance/allostatic overload/ inflammatory response in this patient? (2) What is the common root that this patient’s physical illness shares with the psychiatric symptomatology? (3) Instead of “excluding medical causes” of psychiatric illness, what is the role and how can physical illness or physiological imbalances be integrated into the understanding of psychiatric syndrome? (4) What are the vicious cycles that perpetuate the interaction between physiological imbalance/allostatic overload/ inflammatory response/physical illness and psychiatric pathology? (5) How and with what mechanisms does physical condition interfere with the psychiatric symptoms? (6) How do we proceed to correct these alterations, so that the body — and, consequently, the brain — has a greater adaptive capacity in the face of different stressors?

Conclusion: in psychiatry, traditional models are insufficient in many cases. Integrative approaches, guided by a biological formulation, that consider the understanding of the interaction between the physiological reserve, the physical conditions and the psychiatric pathology, can detect pathophysiological mechanisms that, if not considered, could be associated with inadequate responses to the clinical interventions, and, therefore, to non-pharmacological resistance to treatment.