Master 2 – Geneeskunde 25_26
PROBLEMEN VAN
GEESTELIJKE GEZONDHEID
EN HET ZENUWSTELSEL
, Master 2 – Geneeskunde 25_26
INHOUDSTAFEL
SCHIZOFRENIE-SPECTRUM EN ANDERE PSYCHOTISCHE STOORNISSEN ................................. 15
Symptomen .................................................................................................................................... 15
Vijf symptoomdomeinen (Afwijking in één of meer) ................................................................................................. 15
Opmerkingen ...................................................................................................................................................... 17
Impact van symptomen op functioneren .............................................................................................................. 17
Ziektebeelden in “schizofrenie en andere psychotische stoornissen” ............................................... 18
Schizofrenie........................................................................................................................................................ 18
Schizofreniforme stoornis ................................................................................................................................... 18
Kortdurende psychotische stoornis...................................................................................................................... 18
Waanstoornis ..................................................................................................................................................... 19
Psychotische stoornis door een middel ................................................................................................................ 19
Ziektebeloop .................................................................................................................................. 19
Aanvang ............................................................................................................................................................. 19
Prodromi en eerste symptomen ........................................................................................................................... 19
Opstoten ............................................................................................................................................................ 20
Partiële remissie – “Schub”.................................................................................................................................. 20
Prognose ............................................................................................................................................................ 20
Zeer belangrijke invloed van behandeling ............................................................................................................. 20
Epidemiologische gegevens ............................................................................................................ 20
Prevalentie ......................................................................................................................................................... 20
Leeftijd en geslacht ............................................................................................................................................. 20
Geografie, SES en omgeving ................................................................................................................................ 21
Mortaliteit en kosten ........................................................................................................................................... 21
Etiologie van schizofrenie ................................................................................................................ 21
Kwetsbaarheid-stress model ............................................................................................................................... 21
Rol middelengebruik ........................................................................................................................................... 22
Behandeling ................................................................................................................................... 23
Historische evolutie ............................................................................................................................................ 23
Medicamenteuze behandeling ............................................................................................................................. 24
Psychosociale behandeling ................................................................................................................................. 25
Psychotherapie en begeleiding van families .......................................................................................................... 25
Organisatie van de zorg ....................................................................................................................................... 25
DEPRESSIEVE STOORNISSEN ................................................................................................ 26
Klinische beelden ........................................................................................................................... 26
Disruptieve stemmingsregulatie stoornis ............................................................................................................. 26
(Majeur) Depressieve stoornis ............................................................................................................................. 27
Persisterende depressieve stoornis...................................................................................................................... 27
Premenstruele dysfore stemmingsstoornis .......................................................................................................... 27
Depressieve stoornis door een somatische aandoening of middel ......................................................................... 28
Diagnostiek .................................................................................................................................... 28
DiHerentiële diagnose / co-morbiditeit ............................................................................................ 28
Andere psychiatrische stoornissen ...................................................................................................................... 28
Somatische aandoeningen .................................................................................................................................. 28
Epidemiologie................................................................................................................................. 29
2
, Master 2 – Geneeskunde 25_26
Lifetime prevalentie ............................................................................................................................................ 29
Etiopathogenese ............................................................................................................................. 29
Neurobiologische factoren .................................................................................................................................. 29
Cognitieve factoren ............................................................................................................................................. 30
Levensgebeurtenissen ........................................................................................................................................ 30
Socio-economische status.................................................................................................................................. 30
Beloop van een depressieve stoornis ............................................................................................... 30
Behandeling ................................................................................................................................... 31
Psychoeducatie .................................................................................................................................................. 31
Antidepressiva .................................................................................................................................................... 31
Toekomst: antidepressiva voor subgroepen .......................................................................................................... 33
Neurobiologische niet-farmacologische behandeling ........................................................................................... 33
Psychologische behandeling ............................................................................................................................... 33
BIPOLAIRE STOORNISSEN ..................................................................................................... 34
Klinisch beeld ................................................................................................................................. 34
Epidemiologie................................................................................................................................. 35
Prevalentie ......................................................................................................................................................... 35
Geslacht, leeftijd en duurtijd ............................................................................................................................... 35
Beloop............................................................................................................................................ 35
Diagnostiek .................................................................................................................................... 36
Diberentiaal diagnostiek ..................................................................................................................................... 36
Etiopathogenese ............................................................................................................................. 37
Neurobiologische factoren .................................................................................................................................. 37
Psychologische factoren ..................................................................................................................................... 37
Risicofactoren .................................................................................................................................................... 37
Behandeling ................................................................................................................................... 37
Medicamenteuze behandeling ............................................................................................................................. 37
Psycho-educatie ................................................................................................................................................. 38
Psychotherapie ................................................................................................................................................... 38
End-stage palliatieve support therapie ................................................................................................................. 38
ANGSTSTOORNISSEN ............................................................................................................ 39
Klachten gerelateerd aan angst ............................................................................................................................ 39
Syndromen ..................................................................................................................................... 39
Paniekstoornis .................................................................................................................................................... 39
Agorafobie .......................................................................................................................................................... 40
Sociale angststoornis (SAD) ................................................................................................................................ 41
Specifieke fobie .................................................................................................................................................. 42
Gegeneraliseerde angststoornis (GAD) ................................................................................................................. 42
Separatieangststoornis ....................................................................................................................................... 43
Selectief mutisme ............................................................................................................................................... 43
Diagnostiek van angststoornissen ................................................................................................... 43
DiHerentiële diagnose ..................................................................................................................... 44
Somatische aandoeningen .................................................................................................................................. 44
Andere psychioatische stoornissen...................................................................................................................... 44
Psychoactieve stoben ......................................................................................................................................... 44
3
, Master 2 – Geneeskunde 25_26
Epidemiologie van angststoornissen ................................................................................................ 45
Beloop................................................................................................................................................................ 45
Etiopathogenese van angststoornissen ............................................................................................ 45
Neurobiologische factoren .................................................................................................................................. 45
Psychologische factoren ..................................................................................................................................... 45
Behandeling ................................................................................................................................... 45
Beloop en behandeling.................................................................................................................... 46
Forensische toepassingen ............................................................................................................... 46
OBSESSIEVE-COMPULSIEVE EN VERWANTE STOORNISSEN (DWANGSTOORNISSEN) ............... 47
Obsessieve compulsieve stoornis (OCD) .......................................................................................... 47
DSM-criteria ....................................................................................................................................................... 47
Subtypes ............................................................................................................................................................ 47
Diagnose en diberentiële diagnose ...................................................................................................................... 48
Epidemiologie en beloop ..................................................................................................................................... 48
Etiopathogenese ................................................................................................................................................. 48
Behandeling ....................................................................................................................................................... 49
Beloop................................................................................................................................................................ 49
Morfodysfore stoornis ..................................................................................................................... 49
DSM-criteria ....................................................................................................................................................... 49
Epidemiologie ..................................................................................................................................................... 49
Verzamelstoornis ............................................................................................................................ 50
DSM-criteria ....................................................................................................................................................... 50
Epidemiologie ..................................................................................................................................................... 50
Trichotillomania.............................................................................................................................. 50
DSM-criteria ....................................................................................................................................................... 50
Epidemiologie ..................................................................................................................................................... 50
Excoriatiestoornis ........................................................................................................................... 50
DSM-criteria ....................................................................................................................................................... 50
Epidemiologie ..................................................................................................................................................... 50
TRAUMA EN STRESSORGERELATEERDE STOORNISSEN ........................................................... 51
Indeling .............................................................................................................................................................. 51
Klinische beelden ........................................................................................................................... 51
Reactieve hechtingsstoornis................................................................................................................................ 51
Ontremd-sociaalcontact stoornis ........................................................................................................................ 51
Post-traumatische-stressstoornis ........................................................................................................................ 52
Acute stressstoornis ........................................................................................................................................... 53
Aanpassingsstoornissen ..................................................................................................................................... 53
Diagnostiek PTSD............................................................................................................................ 54
Etiopathogenese PTSD .................................................................................................................... 54
Traumatische gebeurtenis ................................................................................................................................... 54
Neurobiologisch model ....................................................................................................................................... 54
Epidemiologie PTSD ........................................................................................................................ 54
Ontwikkeling en beloop ....................................................................................................................................... 54
Behandeling PTSD ........................................................................................................................... 55
4
PROBLEMEN VAN
GEESTELIJKE GEZONDHEID
EN HET ZENUWSTELSEL
, Master 2 – Geneeskunde 25_26
INHOUDSTAFEL
SCHIZOFRENIE-SPECTRUM EN ANDERE PSYCHOTISCHE STOORNISSEN ................................. 15
Symptomen .................................................................................................................................... 15
Vijf symptoomdomeinen (Afwijking in één of meer) ................................................................................................. 15
Opmerkingen ...................................................................................................................................................... 17
Impact van symptomen op functioneren .............................................................................................................. 17
Ziektebeelden in “schizofrenie en andere psychotische stoornissen” ............................................... 18
Schizofrenie........................................................................................................................................................ 18
Schizofreniforme stoornis ................................................................................................................................... 18
Kortdurende psychotische stoornis...................................................................................................................... 18
Waanstoornis ..................................................................................................................................................... 19
Psychotische stoornis door een middel ................................................................................................................ 19
Ziektebeloop .................................................................................................................................. 19
Aanvang ............................................................................................................................................................. 19
Prodromi en eerste symptomen ........................................................................................................................... 19
Opstoten ............................................................................................................................................................ 20
Partiële remissie – “Schub”.................................................................................................................................. 20
Prognose ............................................................................................................................................................ 20
Zeer belangrijke invloed van behandeling ............................................................................................................. 20
Epidemiologische gegevens ............................................................................................................ 20
Prevalentie ......................................................................................................................................................... 20
Leeftijd en geslacht ............................................................................................................................................. 20
Geografie, SES en omgeving ................................................................................................................................ 21
Mortaliteit en kosten ........................................................................................................................................... 21
Etiologie van schizofrenie ................................................................................................................ 21
Kwetsbaarheid-stress model ............................................................................................................................... 21
Rol middelengebruik ........................................................................................................................................... 22
Behandeling ................................................................................................................................... 23
Historische evolutie ............................................................................................................................................ 23
Medicamenteuze behandeling ............................................................................................................................. 24
Psychosociale behandeling ................................................................................................................................. 25
Psychotherapie en begeleiding van families .......................................................................................................... 25
Organisatie van de zorg ....................................................................................................................................... 25
DEPRESSIEVE STOORNISSEN ................................................................................................ 26
Klinische beelden ........................................................................................................................... 26
Disruptieve stemmingsregulatie stoornis ............................................................................................................. 26
(Majeur) Depressieve stoornis ............................................................................................................................. 27
Persisterende depressieve stoornis...................................................................................................................... 27
Premenstruele dysfore stemmingsstoornis .......................................................................................................... 27
Depressieve stoornis door een somatische aandoening of middel ......................................................................... 28
Diagnostiek .................................................................................................................................... 28
DiHerentiële diagnose / co-morbiditeit ............................................................................................ 28
Andere psychiatrische stoornissen ...................................................................................................................... 28
Somatische aandoeningen .................................................................................................................................. 28
Epidemiologie................................................................................................................................. 29
2
, Master 2 – Geneeskunde 25_26
Lifetime prevalentie ............................................................................................................................................ 29
Etiopathogenese ............................................................................................................................. 29
Neurobiologische factoren .................................................................................................................................. 29
Cognitieve factoren ............................................................................................................................................. 30
Levensgebeurtenissen ........................................................................................................................................ 30
Socio-economische status.................................................................................................................................. 30
Beloop van een depressieve stoornis ............................................................................................... 30
Behandeling ................................................................................................................................... 31
Psychoeducatie .................................................................................................................................................. 31
Antidepressiva .................................................................................................................................................... 31
Toekomst: antidepressiva voor subgroepen .......................................................................................................... 33
Neurobiologische niet-farmacologische behandeling ........................................................................................... 33
Psychologische behandeling ............................................................................................................................... 33
BIPOLAIRE STOORNISSEN ..................................................................................................... 34
Klinisch beeld ................................................................................................................................. 34
Epidemiologie................................................................................................................................. 35
Prevalentie ......................................................................................................................................................... 35
Geslacht, leeftijd en duurtijd ............................................................................................................................... 35
Beloop............................................................................................................................................ 35
Diagnostiek .................................................................................................................................... 36
Diberentiaal diagnostiek ..................................................................................................................................... 36
Etiopathogenese ............................................................................................................................. 37
Neurobiologische factoren .................................................................................................................................. 37
Psychologische factoren ..................................................................................................................................... 37
Risicofactoren .................................................................................................................................................... 37
Behandeling ................................................................................................................................... 37
Medicamenteuze behandeling ............................................................................................................................. 37
Psycho-educatie ................................................................................................................................................. 38
Psychotherapie ................................................................................................................................................... 38
End-stage palliatieve support therapie ................................................................................................................. 38
ANGSTSTOORNISSEN ............................................................................................................ 39
Klachten gerelateerd aan angst ............................................................................................................................ 39
Syndromen ..................................................................................................................................... 39
Paniekstoornis .................................................................................................................................................... 39
Agorafobie .......................................................................................................................................................... 40
Sociale angststoornis (SAD) ................................................................................................................................ 41
Specifieke fobie .................................................................................................................................................. 42
Gegeneraliseerde angststoornis (GAD) ................................................................................................................. 42
Separatieangststoornis ....................................................................................................................................... 43
Selectief mutisme ............................................................................................................................................... 43
Diagnostiek van angststoornissen ................................................................................................... 43
DiHerentiële diagnose ..................................................................................................................... 44
Somatische aandoeningen .................................................................................................................................. 44
Andere psychioatische stoornissen...................................................................................................................... 44
Psychoactieve stoben ......................................................................................................................................... 44
3
, Master 2 – Geneeskunde 25_26
Epidemiologie van angststoornissen ................................................................................................ 45
Beloop................................................................................................................................................................ 45
Etiopathogenese van angststoornissen ............................................................................................ 45
Neurobiologische factoren .................................................................................................................................. 45
Psychologische factoren ..................................................................................................................................... 45
Behandeling ................................................................................................................................... 45
Beloop en behandeling.................................................................................................................... 46
Forensische toepassingen ............................................................................................................... 46
OBSESSIEVE-COMPULSIEVE EN VERWANTE STOORNISSEN (DWANGSTOORNISSEN) ............... 47
Obsessieve compulsieve stoornis (OCD) .......................................................................................... 47
DSM-criteria ....................................................................................................................................................... 47
Subtypes ............................................................................................................................................................ 47
Diagnose en diberentiële diagnose ...................................................................................................................... 48
Epidemiologie en beloop ..................................................................................................................................... 48
Etiopathogenese ................................................................................................................................................. 48
Behandeling ....................................................................................................................................................... 49
Beloop................................................................................................................................................................ 49
Morfodysfore stoornis ..................................................................................................................... 49
DSM-criteria ....................................................................................................................................................... 49
Epidemiologie ..................................................................................................................................................... 49
Verzamelstoornis ............................................................................................................................ 50
DSM-criteria ....................................................................................................................................................... 50
Epidemiologie ..................................................................................................................................................... 50
Trichotillomania.............................................................................................................................. 50
DSM-criteria ....................................................................................................................................................... 50
Epidemiologie ..................................................................................................................................................... 50
Excoriatiestoornis ........................................................................................................................... 50
DSM-criteria ....................................................................................................................................................... 50
Epidemiologie ..................................................................................................................................................... 50
TRAUMA EN STRESSORGERELATEERDE STOORNISSEN ........................................................... 51
Indeling .............................................................................................................................................................. 51
Klinische beelden ........................................................................................................................... 51
Reactieve hechtingsstoornis................................................................................................................................ 51
Ontremd-sociaalcontact stoornis ........................................................................................................................ 51
Post-traumatische-stressstoornis ........................................................................................................................ 52
Acute stressstoornis ........................................................................................................................................... 53
Aanpassingsstoornissen ..................................................................................................................................... 53
Diagnostiek PTSD............................................................................................................................ 54
Etiopathogenese PTSD .................................................................................................................... 54
Traumatische gebeurtenis ................................................................................................................................... 54
Neurobiologisch model ....................................................................................................................................... 54
Epidemiologie PTSD ........................................................................................................................ 54
Ontwikkeling en beloop ....................................................................................................................................... 54
Behandeling PTSD ........................................................................................................................... 55
4
