Towards a Health Experience Formulation for Person-centered Integrative Diagnosis

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Juan Mezzich


As diagnosis is a crucial element of sound clinical care, a Person-centered Integrative Diagnosis (PID) model is being developed to facilitate the implementation of person-centered medicine. The conceptual bases and structural model of the PID call for an evaluation of the experience of illness and health as one of three key domain levels. A major aspect of this level involves a broad concept of culture with an emphasis on its experiential base. In line with this, a significant operational precedent would be the Cultural Formulation proposed for and then included in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). This Formulation was considered one of the few significant innovations in DSM-IV, but was published there in a marginal and very schematic fashion. A few years ago, a more elaborate guide was published to assist in the preparation of Cultural Formulations. Elements of this guide are presented here to provide a rounded outline of this procedure on which prospectively to build a Health Experience Formulation. New elements needed for the new Formulation are identified and discussed, including the experiential cultural framework of positive health and the patient’s values, needs, concerns and expectations. Also discussed is a semi-structured narrative approach as suitable for the new Formulation and its strategic development through a broad global engagement with the support of the International College of Person-centered Medicine. Of special significance is that through the Health Experience Formulation the patient’s experience, culture and values would be brought for the first time into the core of clinical diagnosis.

Article Details

Fourth Geneva Conference on Person-centered Medicine: Person-centered integrative diagnosis (PID)
Author Biography

Juan Mezzich, Mount Sinai School of Medicine, New York University

Born in Lima, Peru, of Yugoslavian and Peruvian ancestries. Medical graduate of Cayetano Heredia Peruvian University and president of the University Student Association.Psychiatric residency training, M.Sc. in Academic Psychiatry, and M.A. and Ph.D. in Mathematical and Statistical Psychology, all at Ohio State University, and diplomate of the American Board of Psychiatry and Neurology.Professorial positions in psychiatry, sequentially at Stanford University, California, the University of Pittsburgh, Pennsylvania, and the Mount Sinai School of Medicine of New York University. Currently also Attending Psychiatrist at Mount Sinai Hospital and  Bronx VA Medical Center, New York.Doctor Honoris Causa at Athens University (Greece), Cordoba University (Argentina), Cayetano Heredia University (Peru), and Cluj-Napoca University, Timisoara University and Oradea University (Romania). Honorary Professorship at Cayetano Heredia Peruvian University and University of Belgrade (Serbia), World Psychiatric Association Honorary Fellow, Simon Bolivar Award of the American Psychiatric Association, Past-President of the American Society of Hispanic Psychiatry, honorary member/fellow of several national psychiatric associations, and visiting professor and lecturer at academic institutions over 80 countries across all continents.Earlier academic and international work: Secretary & Chair (1983-1996) and Honorary Chair (2008-) of the WPA Section on Classification and Diagnostic Assessment; member of the ICD-10 Work Group and the DSM-IV Task Force; chair of the US National Institute of Mental Health Group on Culture, Diagnosis and Care; consultant on the development of the Chinese Classification of Mental Disorders (3rd Ed.), the Japanese Modification of ICD-10, the Third Cuban Glossary of Psychiatry, and the Latin American Guide for Psychiatric Diagnosis (GLADP); and director of the 1993-2003 WPA International Guidelines for Diagnostic Assessment (IGDA).Author/coauthor of over 200 scientific journal articles and book chapters (including sections on diagnosis,   epidemiology, and culture in Kaplan & Sadock's and Tasman et al’s Textbooks of Psychiatry), and of 25 books and monographs, including Conceptual Bases of Psychiatry for the Person (in press), Conceptual Explorations on Person-centered Medicine (2010), Psychiatric Diagnosis: Challenges and Prospects (2009), Cultural Formulation: A Reader for Psychiatric Diagnosis (2008), Psychiatry and Sexual Health: An Integrative Approach (2006), Philosophical & Methodological Bases of Psychiatric Diagnosis (2005), Guía Latinoamericana de Diagnóstico Psiquiátrico (GLADP) (APAL, 2004), WPA International Guidelines for Diagnostic Assessment (IGDA) (2003), Cultural Psychiatry: International Perspectives (2001), Culture and Psychiatric Diagnosis: A DSM-IV Perspective (1996), Psychiatric Epidemiology (1994). Editor, Psychopathology, (2002-2010), Deputy Editor-in-Chief, Int’l J Person Centered Medicine, (2010- ), Associate Editor, Int’l J of Integrated Care, (2009- ), and editorial board member of 15 other medical journals in the Americas, Europe, Asia, and Africa.WPA Secretary General (1996-2002), Vice-President and President-Elect (2002-2005), President (2005-2008), and Council Member (2008- ). President of the International Network for Person-centered Medicine (2009- ).Current Work: 1) Person-centered Psychiatry and Medicine: Organization of the 2008, 2009, 2010 and 2011 Geneva Conferences on Person-centered Medicine, and Conferences in London (2007), Paris (2008), and Uppsala (2008) on Psychiatry for the Person; thematic publication of several monographs and journal editorials & papers, and initiating the International Network for Person-centered Medicine in collaboration with the World Medical Association, the World Health Organization and 25 other international medical and health bodies, 2) International diagnostic systems, particularly ICD-11, Person-centered Integrative Diagnosis, and Latin American Guide for Psychiatric Diagnosis, through monographs, journal papers, and conferences, 3) Culture-informed clinical concepts and procedures, including the Cultural Formulation, the Personal Health Scale, the Multi-ethnic Bicultural Scale, and the Multicultural Quality of Life Index through publications, conferences and research projects.


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