Download PDF
Semin Neurol 2022; 42(02): 080-087
DOI: 10.1055/s-0041-1742145
Review Article

Using the Biopsychosocial Model to Guide Patient-Centered Neurological Treatments

Aneeta Saxena  ‡   *
1   Epilepsy Division, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
2   Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Sara Paredes-Echeverri  ‡   *
2   Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Rosa Michaelis 
3   Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
4   Department of Neurology, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
,
Stoyan Popkirov 
3   Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
,
David L. Perez 
2   Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
5   Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
› Author Affiliations Funding D.L.P. was funded by the Sidney R. Baer Jr. Foundation.
› Further Information
    Permissions and Reprints

Abstract

The biopsychosocial model was defined by George L. Engel to propose a holistic approach to patient care. Through this model, physicians can understand patients in their context to aid the development of tailored, individualized treatment plans that consider relevant biological, psychological, and social–cultural–spiritual factors impacting health and longitudinal care. In this article, we advocate for the use of the biopsychosocial model in neurology practice across outpatient and inpatient clinical settings. To do so, we first present the history of the biopsychosocial model, and its relationships to precision medicine and deep phenotyping. Then, we bring the neurologist up-to-date information on the components of the biopsychosocial clinical formulation, including predisposing, precipitating, perpetuating, and protective factors. We conclude by detailing illustrative neurological case examples using the biopsychosocial model, emphasizing the importance of considering relevant psychological and social factors to aid the delivery of patient-centered clinical care in neurology.

Keywords

biopsychosocial - neurology - education - behavioral neurology - neuropsychiatry

* Both contributed equally as first authors.




Publication History

Article published online:
03 February 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Engel GL. The need for a new medical model: a challenge for biomedicine. Science 1977; 196 (4286): 129-136
    CrossrefPubMedGoogle Scholar
  • 2 Engel GL. The need for a new medical model: a challenge for biomedicine. Psychodyn Psychiatry 2012; 40 (03) 377-396
    CrossrefPubMedGoogle Scholar
  • 3 Sadler JZ, Hulgus YF. Knowing, valuing, acting: clues to revising the biopsychosocial model. Compr Psychiatry 1990; 31 (03) 185-195
    CrossrefPubMedGoogle Scholar
  • 4 Grinker Sr RR. A struggle for eclecticism. Am J Psychiatry 1964; 121: 451-457
    CrossrefPubMedGoogle Scholar
  • 5 Engel GL. The clinical application of the biopsychosocial model. Am J Psychiatry 1980; 137 (05) 535-544
    CrossrefPubMedGoogle Scholar
  • 6 Adler RH. Engel's biopsychosocial model is still relevant today. J Psychosom Res 2009; 67 (06) 607-611
    CrossrefPubMedGoogle Scholar
  • 7 Wade DT, Halligan PW. The biopsychosocial model of illness: a model whose time has come. Clin Rehabil 2017; 31 (08) 995-1004
    CrossrefPubMedGoogle Scholar
  • 8 Asadi-Pooya AA, Brigo F, Kozlowska K. et al. Social aspects of life in patients with functional seizures: closing the gap in the biopsychosocial formulation. Epilepsy Behav 2021; 117: 107903
    CrossrefPubMedGoogle Scholar
  • 9 Dhand A, Luke DA, Lang CE, Lee JM. Social networks and neurological illness. Nat Rev Neurol 2016; 12 (10) 605-612
    CrossrefPubMedGoogle Scholar
  • 10 Perez DL, Keshavan MS, Scharf JM, Boes AD, Price BH. Bridging the great divide: What can neurology learn from psychiatry?. J Neuropsychiatry Clin Neurosci 2018; 30 (04) 271-278
    CrossrefPubMedGoogle Scholar
  • 11 Keshavan MS, Price BH, Martin JB. The convergence of neurology and psychiatry: the importance of cross-disciplinary education. JAMA 2020; 324 (06) 554-555
    CrossrefPubMedGoogle Scholar
  • 12 Martin JB. The integration of neurology, psychiatry, and neuroscience in the 21st century. Am J Psychiatry 2002; 159 (05) 695-704
    CrossrefPubMedGoogle Scholar
  • 13 Parimbelli E, Marini S, Sacchi L, Bellazzi R. Patient similarity for precision medicine: a systematic review. J Biomed Inform 2018; 83: 87-96
    CrossrefPubMedGoogle Scholar
  • 14 Bird TD. Thoughts on the relationship of the human genome project to neurology. Arch Neurol 2001; 58 (11) 1764-1765
    CrossrefPubMedGoogle Scholar
  • 15 Morganti S, Tarantino P, Ferraro E, D'Amico P, Duso BA, Curigliano G. Next generation sequencing (NGS): a revolutionary technology in pharmacogenomics and personalized medicine in cancer. Adv Exp Med Biol 2019; 1168: 9-30
    CrossrefPubMedGoogle Scholar
  • 16 Paré PD. Genetic testing for respiratory disease: are we there yet?. Can Respir J 2012; 19 (04) 246-248
    CrossrefPubMedGoogle Scholar
  • 17 Kline EM, Houser MC, Herrick MK. et al. Genetic and environmental factors in Parkinson's disease converge on immune function and inflammation. Mov Disord 2021; 36 (01) 25-36
    CrossrefPubMedGoogle Scholar
  • 18 Dobson R, Giovannoni G. Multiple sclerosis - a review. Eur J Neurol 2019; 26 (01) 27-40
    Google Scholar
  • 19 Waung MW, Taylor A, Qualmann KJ, Burish MJ. Family history of cluster headache: a systematic review. JAMA Neurol 2020; 77 (07) 887-896
    CrossrefPubMedGoogle Scholar
  • 20 Ashley EA. The precision medicine initiative: a new national effort. JAMA 2015; 313 (21) 2119-2120
    CrossrefPubMedGoogle Scholar
  • 21 Hawgood S, Hook-Barnard IG, O'Brien TC, Yamamoto KR. Precision medicine: beyond the inflection point. Sci Transl Med 2015; 7 (300) 300ps17
    CrossrefPubMedGoogle Scholar
  • 22 EpiPM Consortium. A roadmap for precision medicine in the epilepsies. Lancet Neurol 2015; 14 (12) 1219-1228
    CrossrefPubMedGoogle Scholar
  • 23 Kearney H, Byrne S, Cavalleri GL, Delanty N. Tackling epilepsy with high-definition precision medicine: a review. JAMA Neurol 2019; 76 (09) 1109-1116
    CrossrefPubMedGoogle Scholar
  • 24 Chitnis T, Prat A. A roadmap to precision medicine for multiple sclerosis. Mult Scler 2020; 26 (05) 522-532
    CrossrefPubMedGoogle Scholar
  • 25 Delude CM. Deep phenotyping: the details of disease. Nature 2015; 527 (7576): S14-S15
    CrossrefPubMedGoogle Scholar
  • 26 Gibbs RM, Lipnick S, Bateman JW. et al. Toward precision medicine for neurological and neuropsychiatric disorders. Cell Stem Cell 2018; 23 (01) 21-24
    CrossrefPubMedGoogle Scholar
  • 27 Robinson PN. Deep phenotyping for precision medicine. Hum Mutat 2012; 33 (05) 777-780
    CrossrefPubMedGoogle Scholar
  • 28 Dorsey ER, Omberg L, Waddell E. et al. Deep phenotyping of Parkinson's disease. J Parkinsons Dis 2020; 10 (03) 855-873
    CrossrefPubMedGoogle Scholar
  • 29 Isaacson RS, Ganzer CA, Hristov H. et al. The clinical practice of risk reduction for Alzheimer's disease: a precision medicine approach. Alzheimers Dement 2018; 14 (12) 1663-1673
    CrossrefPubMedGoogle Scholar
  • 30 Krivanek TJ, Gale SA, McFeeley BM, Nicastri CM, Daffner KR. Promoting successful cognitive aging: a ten-year update. J Alzheimers Dis 2021; 81 (03) 871-920
    CrossrefPubMedGoogle Scholar
  • 31 Winters NC, Hanson G, Stoyanova V. The case formulation in child and adolescent psychiatry. Child Adolesc Psychiatr Clin N Am 2007; 16 (01) 111-132 , ix
    CrossrefPubMedGoogle Scholar
  • 32 Yang Z, Wu H, Lee PH. et al. Investigating shared genetic basis across Tourette syndrome and comorbid neurodevelopmental disorders along the impulsivity-compulsivity spectrum. Biol Psychiatry 2021; 90 (05) 317-327
    CrossrefPubMedGoogle Scholar
  • 33 Fisher CM. Transient global amnesia. Precipitating activities and other observations. Arch Neurol 1982; 39 (10) 605-608
    CrossrefPubMedGoogle Scholar
  • 34 Szaflarski M, Wolfe JD, Tobias JGS, Mohamed I, Szaflarski JP. Poverty, insurance, and region as predictors of epilepsy treatment among US adults. Epilepsy Behav 2020; 107: 107050
    CrossrefPubMedGoogle Scholar
  • 35 Kivipelto M, Mangialasche F, Ngandu T. Lifestyle interventions to prevent cognitive impairment, dementia and Alzheimer disease. Nat Rev Neurol 2018; 14 (11) 653-666
    CrossrefPubMedGoogle Scholar
  • 36 Josephson CB, Engbers JDT, Jette N. et al. Prediction tools for psychiatric adverse effects after levetiracetam prescription. JAMA Neurol 2019; 76 (04) 440-446
    CrossrefPubMedGoogle Scholar
  • 37 Kinrys G, Worthington JJ, Wygant L, Nery F, Reese H, Pollack MH. Levetiracetam as adjunctive therapy for refractory anxiety disorders. J Clin Psychiatry 2007; 68 (07) 1010-1013
    CrossrefPubMedGoogle Scholar
  • 38 Scott BR, Uomoto JM, Barry ES. Impact of pre-existing migraine and other co-morbid or co-occurring conditions on presentation and clinical course following deployment-related concussion. Headache 2020; 60 (03) 526-541
    CrossrefPubMedGoogle Scholar
  • 39 Chen CL, Lin MY, Huda MH, Tsai PS. Effects of cognitive behavioral therapy for adults with post-concussion syndrome: a systematic review and meta-analysis of randomized controlled trials. J Psychosom Res 2020; 136: 110190
    CrossrefPubMedGoogle Scholar
  • 40 Kaufmann AM, Price AV. A history of the Jannetta procedure. J Neurosurg 2019; 132 (02) 639-646
    CrossrefPubMedGoogle Scholar
  • 41 Frucht L, Perez DL, Callahan J. et al. Functional dystonia: differentiation from primary dystonia and multidisciplinary treatments. Front Neurol 2021; 11: 605262
    CrossrefPubMedGoogle Scholar
  • 42 Baslet G, Bajestan SN, Aybek S. et al. Evidence-based practice for the clinical assessment of psychogenic nonepileptic seizures: a report from the American Neuropsychiatric Association Committee on Research. J Neuropsychiatry Clin Neurosci 2021; 33 (01) 27-42
    CrossrefPubMedGoogle Scholar
  • 43 Espay AJ, Aybek S, Carson A. et al. Current concepts in diagnosis and treatment of functional neurological disorders. JAMA Neurol 2018; 75 (09) 1132-1141
    CrossrefPubMedGoogle Scholar
  • 44 Perez DL, Aybek S, Popkirov S. et al; (On behalf of the American Neuropsychiatric Association Committee for Research. A review and expert opinion on the neuropsychiatric assessment of motor functional neurological disorders. J Neuropsychiatry Clin Neurosci 2021; 33 (01) 14-26
    CrossrefPubMedGoogle Scholar