Comment on the patient's quality of relationships with important figures, such as grand parents, friends, significant teachers, or significant employers.Comment on the patient's experience with loss.Consider the sources of positive self image and positive role models.
Comment on any past history of trauma (child abuse, combat, rape, serious illness), as well as resiliency (how the patient coped with trauma, e.g. Consider the possible effects of substance withdrawal. Consider the influence of nicotine, alcohol and street drugs on current psychiatric symptoms. Consider possible side effects of current medications. steroids, beta blockers, pain medications, benzodiazepines, SSRI's, antipsychotics). Consider whether these medications have psychoactive effects (e.g. Identify current illnesses and any direct impact they may have on psychiatric presentation. Consider potential lasting effects of past substance use on brain functions such as cognition, affective regulation, etc. thyroid, adrenal), seizures, malignancies, or neurological illnesses. Consider any history of head injury, endocrine disorders (e.g. Note birth complications, such as prematurity, birth trauma or extended periods of hospitalization. Consider pregnancy variables: Was there in-utero exposure to nicotine, alcohol, medications or substances? Anything unusual about pregnancy?. Is there a history of close relatives who have been hospitalized for psychiatric reasons? What kind of treatments did they get, how did they respond? Consider whether any blood relatives that have had psychiatric problems, substance use problems or suicide attempts/suicides. This model generally includes the following: Biological Past Genetics: Students are encouraged to include each component in formulations. We have added prompts for the students to help them think about and organize clinical material. 
What follows is a description of the components of the bio-psycho-social-spiritual formulation. Formulations help explain "how did this patient get to this psychiatric status?" We ultimately want students to arrive at patient formulations that allow for understanding and drive formation of treatment plan. This model is used throughout our curriculum in psychiatry.
In all our teaching, we invite students to conceptualize patient problems by using a bio-psycho-social-spiritual formulation.
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