As mental health providers, we’re often tempted to jump straight to treatment when a patient comes to us with a problem. However, skipping the crucial foundational steps can lead to misdiagnosis, inappropriate medication prescribing, and a vicious cycle of frustration for both the patient and the provider.
There’s a deceptively simple 3-step framework that, when followed correctly, is the key to providing truly effective psychiatric care. In this guide, I’ll walk you through each step and share a real-world case study to illustrate how it works in practice.
The 3-Step Psychiatric Treatment Framework
The framework consists of three essential stages:
- Assessment: Conducting a comprehensive psychiatric evaluation to gather all the necessary information.
- Diagnosis: Developing a working diagnosis and considering potential differential diagnoses.
- Treatment: Recommending evidence-based interventions, which may include medication, therapy, or a combination.
Why This Framework Matters
Following this framework in order is crucial for several reasons:
- Avoid Misdiagnosis: Jumping straight to treatment without a thorough assessment and diagnosis can lead you down the wrong path, resulting in inappropriate medication prescribing and perpetual trial-and-error.
- Improve Outcomes: Properly executing each stage ensures you have the full picture and can develop an effective, personalized treatment plan for your patient.
- Reduce Provider Stress: Adherence to this framework can help you avoid the frustration of ineffective treatments and constant medication changes.
Applying the Framework: A Case Study
Let’s see how this framework plays out with a real patient scenario. Meet Sarah, a 41-year-old female presenting with ongoing anxiety.
Assessment
During the initial psychiatric evaluation, you gather the following information from Sarah:
- She has been taking alprazolam (Xanax) 1mg 3 times daily for the past 3 years, prescribed by her primary care provider.
- She continues to experience persistent, unrelenting anxiety without specific triggers.
- She struggles with insomnia, muscle tension, and racing thoughts about daily obligations, the future, and her health.
- Her job performance and personal relationships have suffered due to the anxiety.
- Her primary care provider previously tried her on a few different antidepressants, but she did not find them helpful.
What additional information would you want to collect before moving on to the diagnosis stage?
Diagnosis
Based on the assessment information, we can start to consider potential diagnoses and differential diagnoses:
- We can rule out psychotic disorders, as there are no psychotic symptoms present.
- The prominent anxiety symptoms point to an anxiety disorder, potentially Generalized Anxiety Disorder.
- However, Sarah’s vague description of a “stressful” childhood and report of periods of “zoning out” suggest the possibility of a trauma-related disorder, such as PTSD.
Our working diagnosis is Generalized Anxiety Disorder, with PTSD as a differential diagnosis that warrants further exploration.
Treatment
Now that we have a working diagnosis, we can consider appropriate treatment options:
- Benzodiazepines like alprazolam are not recommended as long-term treatment for anxiety disorders due to the risk of dependence and other adverse effects.
- First-line evidence-based treatments include selective serotonin reuptake inhibitors (SSRIs) and trauma-focused therapy for the potential PTSD.
- We will need to slowly taper Sarah off the alprazolam while initiating an SSRI and referring her for trauma-focused cognitive behavioral therapy.
The Importance of Sticking to the Framework
If we had not followed this framework and instead jumped straight to treatment, Sarah may have continued taking ineffective and potentially harmful medications like alprazolam indefinitely. This could have led to:
- Worsening anxiety and functional impairment
- Iatrogenic benzodiazepine dependence
- Missed opportunity to properly diagnose and treat an underlying trauma disorder
By methodically working through the assessment, diagnosis, and treatment stages, we were able to provide Sarah with the most appropriate, evidence-based care – leading to improved symptoms, better functioning, and a more positive outcome.
Mastering the Psychiatric Treatment Framework
While this 3-step framework is straightforward, putting it into consistent practice can be challenging. If you’d like more in-depth guidance on accurately diagnosing and effectively treating mental health conditions, I invite you to check out my free training on [Mental Disorders Diagnosis and Treatment].
Remember, following this framework is the key to providing high-quality, stress-free psychiatric care for your patients. Take the time to get the foundations right, and you’ll see the benefits in improved outcomes and reduced provider burnout.