<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0001-6002</journal-id>
<journal-title><![CDATA[Acta Médica Costarricense]]></journal-title>
<abbrev-journal-title><![CDATA[Acta méd. costarric]]></abbrev-journal-title>
<issn>0001-6002</issn>
<publisher>
<publisher-name><![CDATA[Colegio de Médicos y Cirujanos de Costa Rica]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0001-60022024000200089</article-id>
<article-id pub-id-type="doi">10.51481/amc.v66i2.1396</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Formulación biológica: ¿necesitamos un nuevo paradigma de razonamiento clínico en psiquiatría?]]></article-title>
<article-title xml:lang="en"><![CDATA[Biological formulation: do we need a new clinical reasoning paradigm in psychiatry?]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Millán-González]]></surname>
<given-names><![CDATA[Ricardo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad de Costa Rica Escuela de Medicina Departamento de Psiquiatría]]></institution>
<addr-line><![CDATA[ San José]]></addr-line>
<country>Costa Rica</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>06</month>
<year>2024</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>06</month>
<year>2024</year>
</pub-date>
<volume>66</volume>
<numero>2</numero>
<fpage>89</fpage>
<lpage>94</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.sa.cr/scielo.php?script=sci_arttext&amp;pid=S0001-60022024000200089&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.sa.cr/scielo.php?script=sci_abstract&amp;pid=S0001-60022024000200089&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.sa.cr/scielo.php?script=sci_pdf&amp;pid=S0001-60022024000200089&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen Objetivo: replantear el modelo de razonamiento clínico utilizado al día de hoy durante el abordaje de los pacientes con enfermedad psiquiátrica e identificar estrategias semiológicas que puedan guiar hacia una atención integrativa. Método: revisión bibliográfica dirigida y exposición del concepto de formulación biológica en la práctica clínica de la psiquiatría integrativa. Resultados: se justifica la necesidad de un replanteamiento del modelo de razonamiento clínico, se define la necesidad de establecer una guía semiológica -formulación biológica- y se identifican las preguntas clave para la detección de los desbalances fisiológicos o la integración de la enfermedad física en la comprensión de la patología psiquiátrica. Algunas de estas preguntas son: (1) ¿cuál es la causa o las causas del desbalance fisiológico/sobrecarga alostática/respuesta inflamatoria en este paciente? (2) ¿Cuál es la raíz común que comparte la enfermedad física de este paciente con la sintomatología psiquiátrica? (3) En lugar de &#8220;excluir las causas médicas&#8221; de enfermedad psiquiátrica, ¿cuál es el rol y cómo se puede integrar la enfermedad física o desbalance fisiológico en la comprensión del síndrome psiquiátrico? (4) ¿Cuáles son los círculos viciosos que perpetúan la interacción entre el desbalance fisiológico/sobrecarga alostática/respuesta inflamatoria/enfermedad física y la patología psiquiátrica? (5) ¿Cómo y con cuáles mecanismos interfiere la condición física en la sintomatología psiquiátrica? (6) ¿Cómo se procede a corregir estas alteraciones, de modo que el organismo -y, consecuentemente, el cerebro- cuente con una mayor capacidad adaptativa ante los distintos estresores? Conclusión: en psiquiatría, los modelos tradicionales resultan insuficientes en muchos de los casos. Los abordajes integrativos, guiados por una formulación biológica, que consideren la comprensión de la interacción entre la reserva fisiológica, las condiciones físicas y la patología psiquiátrica, son capaces de detectar mecanismos fisiopatológicos que en caso de no ser considerados podrían asociarse con respuestas inadecuadas a las intervenciones clínicas, y, por lo tanto, a resistencia no farmacológica al tratamiento.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract Aim: to redefine the current clinical reasoning model applied to patients with psychiatric illness and to identify semiological strategies that can stablish a guide towards integrative care. Methos: directed bibliographic review and presentation of the concept of biological formulation in the clinical practice of integrative psychiatry. Results: the need to redefine the clinical reasoning model is justified, the establishment of a semiological guide -biological formulation- is defined and key questions for the detection of physiological imbalances or the integration of physical illness into the understanding of psychiatric pathology are identified. Some of these questions are: (1) what is the cause or causes of the physiological imbalance/allostatic overload/ inflammatory response in this patient? (2) What is the common root that this patient&#8217;s physical illness shares with the psychiatric symptomatology? (3) Instead of &#8220;excluding medical causes&#8221; of psychiatric illness, what is the role and how can physical illness or physiological imbalances be integrated into the understanding of the psychiatric syndrome? (4) What are the vicious cycles that perpetuate the interaction between physiological imbalance/allostatic overload/inflammatory response/physical illness and psychiatric pathology? (5) How and with what mechanisms does the physical condition interfere with the psychiatric symptoms? (6) How do we proceed to correct these alterations, so that the body - and, consequently, the brain- has a greater adaptive capacity in the face of different stressors? Conclusion: in psychiatry, traditional models are insufficient in many cases. Integrative approaches, guided by a biological formulation, that consider the understanding of the interaction between the physiological reserve, the physical conditions and the psychiatric pathology, are capable of detecting pathophysiological mechanisms that, if not considered, could be associated with inadequate responses to the clinical interventions, and, therefore, to non-pharmacological resistance to treatment.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Psiquiatría integrativa]]></kwd>
<kwd lng="es"><![CDATA[formulación biológica]]></kwd>
<kwd lng="es"><![CDATA[homeostasis]]></kwd>
<kwd lng="es"><![CDATA[sobrecarga alostática.]]></kwd>
<kwd lng="en"><![CDATA[Integrative psychiatry]]></kwd>
<kwd lng="en"><![CDATA[biological formulation]]></kwd>
<kwd lng="en"><![CDATA[homeostasis]]></kwd>
<kwd lng="en"><![CDATA[allostatic overload.]]></kwd>
</kwd-group>
</article-meta>
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