Using the Biopsychosocial Model to Guide Patient-Centered Neurological Treatments

Saxena, Aneeta MD
Paredes-Echeverri, Sara MD
Michaelis, Rosa MD
Popkirov, Stoyan MD
Perez, David L. MD, MMSc, FAAN, FANPA

¹Epilepsy Division, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
²Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
³Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
⁴Department of Neurology, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
⁵Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

Address for correspondence Aneeta Saxena, MD, Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118 (e-mail: [email protected]

Conflict of Interest D.L.P. has received honoraria for continuing medical education lectures in functional neurological disorder and is on the editorial board of Epilepsy & Behavior. All other authors do not report any relevant disclosures or conflicts of interest.

^*Both contributed equally as first authors.

Seminars in Neurology 42(2):p 80-87, April 2022. | DOI: 10.1055/s-0041-1742145

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.