1 Introduction in psychiatric nosology
1.1 Signs of mental illness (overview)
Psychiatric diseases are characterised by disturbances in one or more mental
functions:
➔ Cognitive domain = perception and cognition
- Consciousness (alert? More sleepy/non responsive?)
- Concentration/attention (ADD, ADHD, depression, bipolar)
- Memory (short term, long term, orientation in time, space, persons)
- Cognition
→ cognitive distortion = rational thinking, but towards negative ideas
(depression)
→ delusions = unrealistic persecution (schizophrenia, depression,
manic)(think they can fly, are Michael Jackson)
- Perception (hallucinations = visual (drugs, dementia), auditory (stemmen die
negatieve zaken zegt of dingen laat doen), tactile, olfactory)
- Obsessive thoughts (OCD, 5 x tshirt aandoen anders sterft mijn vrouw, weet
dat het idee absurd is <-> delusions)
➔ Affective domain = emotions
- Mood changes (low mood, high mood, mood instability (bipolar), anhedonia/not
being able to enjoy things (depression)) Anhedonia <-> sad mood, because they
will still be responsive to positive enjoyable things. Difference in anticipatory
anhedonia, means you are not looking forward to it anymore, and consummatory
anhedonia, during the enjoyable activity you are not enjoying it anymore.
➔ Conative domain = motivation & behavior (“to want, to strive”)
- Hyperactivity, aggressive behaviour, addiction
- Eating disorder (also emotions and cognitive), impulsive behaviour (gokken),
sexual inappropriate behaviour, compulsive behaviour (OCD)
➔ Somatic domain = body function (sleeping, eating)
- Panic attack, sleeping disturbance, eating disturbance (depression), motor
dysfunction (severe schizo), sexual dysfunction, fatigue, pain
1.2 From signs to diagnosis
Diagnostic and Statistical Manual of Mental Disorders (DSM-5) → DSM-5 diagnose = “if
you have X symptoms out of the following list, during at least Y days, then the
diagnose is….” NOT based on blood tests, neuroimaging,…
,A syndrome diagnosis in the DSM-5 has following:
- Core symptoms (zeker 1 van deze nodig!)
- Complementary symptoms
Advantages DSM-5 diagnostic system = flexibility → not all patients with the same
disorder show identical symptoms, and without this flexibility there would be almost as
many diagnoses as patients, making research and communication impossible.
Disadvantages DSM-5 diagnostic system = this same flexibility is also a limitation,
because psychiatric disorders are clinically heterogeneous, meaning their underlying
neurobiology is also heterogeneous. As a result, there is no single, uniform
neurobiological disturbance underlying one disorder such as depression or schizophrenia
(geen 1 enkele hersenverandering die leidt tot depression).
➔ different symptoms = same diagnose BUT same diagnose = other neurobiology
Conclusion: A DSM diagnosis is an attempt to impose structure on the underlying complex
world of (pathological) mental phenomena. However, a DSM diagnosis does not describe
a real entity in the outside world, the etiology of the disorder, the brain dysfunctions
associated with it, the life history behind the disorder, or the significance (impact) of the
disorder for the patient, their family, or the wider context. Despite its limitations, the DSM
remains a necessary, albeit imperfect, system for psychiatric practice and research.
Consequently, studying mental disorders should be complemented by investigating the
neurobiology of core psychological functions (e.g., memory, emotion regulation), as both
approaches are complementary: the DSM-5 facilitates clinical recognition and
communication, while functional neurobiological research helps to understand the
underlying brain mechanisms.
1.3 Diseases in DSM-5
Autism spectrum disorders and ADHD ➔ 70-80% genetically heritable
Psychosis (delusions, hallucinations) ➔ schizophrenia
Bipolar disease = mood instability, has a genetic overlap with schizophrenia + more
genetic heritable then depression.
Depression (mood dysregulation), panic disorder (anxiety, is focused on panic attacks,
not studied very much + lowest heritability of the psychiatric disorders).
All psychiatric disorders involve brain dysfunction, though some changes are visible with
imaging or post-mortem studies, while others are not yet detectable. Traditional
distinctions like organic (detectable changes) vs. functional (no detectable changes in
brain) are increasingly outdated, as every disorder has a neurobiological basis. Similarly,
syndromal disorders (arising in previously healthy individuals) and lifelong disorders
(starting early in life, e.g., personality disorders) are less sharply separated than once
thought, since even “lifelong” conditions can change over time (less stable).
1.1 Signs of mental illness (overview)
Psychiatric diseases are characterised by disturbances in one or more mental
functions:
➔ Cognitive domain = perception and cognition
- Consciousness (alert? More sleepy/non responsive?)
- Concentration/attention (ADD, ADHD, depression, bipolar)
- Memory (short term, long term, orientation in time, space, persons)
- Cognition
→ cognitive distortion = rational thinking, but towards negative ideas
(depression)
→ delusions = unrealistic persecution (schizophrenia, depression,
manic)(think they can fly, are Michael Jackson)
- Perception (hallucinations = visual (drugs, dementia), auditory (stemmen die
negatieve zaken zegt of dingen laat doen), tactile, olfactory)
- Obsessive thoughts (OCD, 5 x tshirt aandoen anders sterft mijn vrouw, weet
dat het idee absurd is <-> delusions)
➔ Affective domain = emotions
- Mood changes (low mood, high mood, mood instability (bipolar), anhedonia/not
being able to enjoy things (depression)) Anhedonia <-> sad mood, because they
will still be responsive to positive enjoyable things. Difference in anticipatory
anhedonia, means you are not looking forward to it anymore, and consummatory
anhedonia, during the enjoyable activity you are not enjoying it anymore.
➔ Conative domain = motivation & behavior (“to want, to strive”)
- Hyperactivity, aggressive behaviour, addiction
- Eating disorder (also emotions and cognitive), impulsive behaviour (gokken),
sexual inappropriate behaviour, compulsive behaviour (OCD)
➔ Somatic domain = body function (sleeping, eating)
- Panic attack, sleeping disturbance, eating disturbance (depression), motor
dysfunction (severe schizo), sexual dysfunction, fatigue, pain
1.2 From signs to diagnosis
Diagnostic and Statistical Manual of Mental Disorders (DSM-5) → DSM-5 diagnose = “if
you have X symptoms out of the following list, during at least Y days, then the
diagnose is….” NOT based on blood tests, neuroimaging,…
,A syndrome diagnosis in the DSM-5 has following:
- Core symptoms (zeker 1 van deze nodig!)
- Complementary symptoms
Advantages DSM-5 diagnostic system = flexibility → not all patients with the same
disorder show identical symptoms, and without this flexibility there would be almost as
many diagnoses as patients, making research and communication impossible.
Disadvantages DSM-5 diagnostic system = this same flexibility is also a limitation,
because psychiatric disorders are clinically heterogeneous, meaning their underlying
neurobiology is also heterogeneous. As a result, there is no single, uniform
neurobiological disturbance underlying one disorder such as depression or schizophrenia
(geen 1 enkele hersenverandering die leidt tot depression).
➔ different symptoms = same diagnose BUT same diagnose = other neurobiology
Conclusion: A DSM diagnosis is an attempt to impose structure on the underlying complex
world of (pathological) mental phenomena. However, a DSM diagnosis does not describe
a real entity in the outside world, the etiology of the disorder, the brain dysfunctions
associated with it, the life history behind the disorder, or the significance (impact) of the
disorder for the patient, their family, or the wider context. Despite its limitations, the DSM
remains a necessary, albeit imperfect, system for psychiatric practice and research.
Consequently, studying mental disorders should be complemented by investigating the
neurobiology of core psychological functions (e.g., memory, emotion regulation), as both
approaches are complementary: the DSM-5 facilitates clinical recognition and
communication, while functional neurobiological research helps to understand the
underlying brain mechanisms.
1.3 Diseases in DSM-5
Autism spectrum disorders and ADHD ➔ 70-80% genetically heritable
Psychosis (delusions, hallucinations) ➔ schizophrenia
Bipolar disease = mood instability, has a genetic overlap with schizophrenia + more
genetic heritable then depression.
Depression (mood dysregulation), panic disorder (anxiety, is focused on panic attacks,
not studied very much + lowest heritability of the psychiatric disorders).
All psychiatric disorders involve brain dysfunction, though some changes are visible with
imaging or post-mortem studies, while others are not yet detectable. Traditional
distinctions like organic (detectable changes) vs. functional (no detectable changes in
brain) are increasingly outdated, as every disorder has a neurobiological basis. Similarly,
syndromal disorders (arising in previously healthy individuals) and lifelong disorders
(starting early in life, e.g., personality disorders) are less sharply separated than once
thought, since even “lifelong” conditions can change over time (less stable).
