diagnóstico centrado en la persona - mezzich y kastrup

8/8/2019 diagnóstico centrado en la persona - mezzich y kastrup

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Evaluation Procedures forExperience of Illness and Health in

Person-centered Integrative Diagnosis

Evaluation Procedures forEvaluation Procedures forExperience of Illness and HealthExperience of Illness and Health inin

PersonPerson--centered Integrative Diagnosiscentered Integrative Diagnosis

Juan E. Mezzich (New York)

Marianne Kastrup (Copenhagen)

Juan E. Mezzich (New York)

Marianne Kastrup (Copenhagen)

April 2010April 2010



AgendaAgenda

Designing Person-centered Integrative

Diagnosis (PID)

Apprasing experience of illness

Appraising experience of positive health

Designing PersonDesigning Person--centered Integrativecentered Integrative

Diagnosis (PID)Diagnosis (PID)

Apprasing experience of illnessApprasing experience of illness

Appraising experience of positive healthAppraising experience of positive health



Bio-Psycho-Social Framework of HealthBio-Psycho-Social Framework of Health

Engel’s Perspective

Clinical Complexity

Ill- and Positive-Health

Ecological Epidemiology

Engel’s Perspective

Clinical Complexity

Ill- and Positive-Health

Ecological Epidemiology



Engagement,

Respect, and Empowerment

Engagement,

Respect, and Empowerment

Engagement

Respect for human dignity

Respect for human values

Respect for cultural diversity

Empowering for autonomy

Empowering for fulfillment

Engagement

Respect for human dignity

Respect for human values

Respect for cultural diversity

Empowering for autonomy

Empowering for fulfillment



Promoting Personhood

and Life Fulfillment

Promoting Personhood

and Life Fulfillment

Self-awareness and personal & cultural identity

Autonomy and sense of controlling own life

Resilience and self-efficacy

Healthy habits (eating, exercise, relaxation, etc.)

Positive emotions (cooperation, solidarity, etc)

Self-trascendence and spirituality

Fulfillment of life project

Self-awareness and personal & cultural identity

Autonomy and sense of controlling own life

Resilience and self-efficacy

Healthy habits (eating, exercise, relaxation, etc.)

Positive emotions (cooperation, solidarity, etc)

Self-trascendence and spirituality

Fulfillment of life project



Towards a Person-centeredPsychiatry and Medicine

Towards a Person-centered

Psychiatry and Medicine

of the Person

for the Person

by the Person

with the Person

of the Person

for the Person

by the Person

with the Person



The Meanings of DiagnosisThe Meanings of Diagnosis

A fundamental concept for clinical care

A name, a variable, a formulation

A process or activity

A fundamental concept for clinical care

A name, a variable, a formulation

A process or activity



The WPA International Guidelines for Diagnostic

Assessment (IGDA) as a starting point forPerson-centered Integrative Diagnosis (PID)

The WPA International Guidelines for Diagnostic

Assessment (IGDA) as a starting point forPerson-centered Integrative Diagnosis (PID)

A. Standardized Multiaxial Formulation

I. Illness

II. Disabilities/Functioning

III. Contextual Factors

IV. Quality of Life

B. Idiographic Personalized Formulation Jointl made b clinician atient and amil

A. Standardized Multiaxial Formulation

I. Illness

II. Disabilities/Functioning

III. Contextual Factors

IV. Quality of Life

B. Idiographic Personalized Formulation Jointl made b clinician atient and amil



Outline of Person-centered

Integrative Diagnosis (PID)

Outline of Person-centered

Integrative Diagnosis (PID)

Diagnosis as a formulation and a process

Broader scope of diagnosis describing ill- and positive-

health

Domain levels to include:

▫Illness & disability to wellbeing

▫Experience of illness and health

▫Contributory factors (risk & protective factors)

Descriptive tools to include standardized (categorical and

dimensional) and narrative approaches

Evaluation process to include a partnership of patient,

family/carers, and clinicians

Diagnosis as a formulation and a process

Broader scope of diagnosis describing ill- and positive-

health

Domain levels to include:

▫Illness & disability to wellbeing

▫Experience of illness and health

▫Contributory factors (risk & protective factors)

Descriptive tools to include standardized (categorical and

dimensional) and narrative approaches

Evaluation process to include a partnership of patient,

family/carers, and clinicians



erson-centered Integrative Diagnosis Domainerson-centered Integrative Diagnosis Domain

Levels Ill Health Positive Health

I. Health Status Ill-Being Well Being

a. Disorders a. Recovery

b. Disabilities b. Functioning

II. Experience of Experience of illness Experience of Health positive health

III. Contributory Risk factors Protective factorsFactors (internal & (internal &

external) external)

Levels Ill Health Positive Health

I. Health Status Ill-Being Well Being

a. Disorders a. Recovery

b. Disabilities b. Functioning

II. Experience of Experience of illness Experience of Health positive health

III. Contributory Risk factors Protective factorsFactors (internal & (internal &

external) external)



Experience of Illness Experience of HealthExperience of Illness Experience of Health

Suffering

Idioms of ill-being

Explanations and

meanings of ill-being

Experience and

preferences on carers

Suffering

Idioms of ill-being

Explanations and

meanings of ill-being

Experience and

preferences on carers

Identity & self-awareness

Self-efficacy & controlling

own life

Self-trascendence

Resilience & positive

emotions

Emotional & instrumental

social supports

Quality of life

Identity & self-awareness

Self-efficacy & controlling

own life

Self-trascendence

Resilience & positive

emotions

Emotional & instrumental

social supportsQuality of life



Descriptive Methods for Assessing

Experience of Illness and Health

Descriptive Methods for Assessing


Categories, e.g. idioms of ill-being

Dimensions, e.g. quality of life scales

Narratives, e.g. identity and self-awareness

Categories, e.g. idioms of ill-being

Dimensions, e.g. quality of life scales

Narratives, e.g. identity and self-awareness



Evaluation Process for


Evaluation Process for


Perspectives of the Patient

Perspectives of the Family and Carers

Perspectives of the Clinicians

Integration of Perspectives

Perspectives of the Patient

Perspectives of the Family and Carers

Perspectives of the Clinicians

Integration of Perspectives



Towards a

Health Experience Formulation

Towards a

Health Experience Formulation Personal history

Cultural identity

Social stressors and supports

Idioms, causes and meanings of illness

Self-efficacy & controlling own life

Resilience and positive emotions

Coherence and self-trascendenceQuality of life

Clinician-patient relationship

Health restoration /promotion experiences & plans

Personal history

Cultural identity

Social stressors and supports

Idioms, causes and meanings of illness

Self-efficacy & controlling own life

Resilience and positive emotions

Coherence and self-trascendenceQuality of life

Clinician-patient relationship

Health restoration /promotion experiences & plans

diagnóstico centrado en la persona - mezzich y kastrup

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