KLINISCHE PSYCHOLOGIE
Inhoudsopgave
INTRODUCTIE ....................................................................................................................................................... 5
Definities .............................................................................................................................................................. 5
Uitzonderingen................................................................................................................................................ 5
Wat is afwijkend gedrag? .................................................................................................................................... 5
Criteria voor afwijkend gedrag (Nevid) ........................................................................................................... 5
Culturele aspecten v afwijkend gedrag........................................................................................................... 6
Modellen ......................................................................................................................................................... 6
Prevalentie ...................................................................................................................................................... 7
Psychopathologie ................................................................................................................................................. 7
Normaliteit vs pathologie ............................................................................................................................... 7
Classificatie en beoordelingen van afwijkende emoties, gedachten en gedrag .................................................. 7
Classificeren ......................................................................................................................................................... 7
Classificatiesystemen (DSM-5) ........................................................................................................................ 8
Veranderingen ................................................................................................................................................ 8
Kritiek op DSM-5 ............................................................................................................................................. 8
Voor- en nadelen............................................................................................................................................. 8
Opbouw ........................................................................................................................................................... 9
Beoordelingsmethoden ........................................................................................................................................ 9
Het klinisch interview = meest gebruikt ......................................................................................................... 9
Psychologische tests ..................................................................................................................................... 10
Neuropsychologische tests ........................................................................................................................... 10
Gedragsbeoordeling ...................................................................................................................................... 10
Fysiologische beoordeelding ......................................................................................................................... 10
Classificatie van symptomen.............................................................................................................................. 10
HET BIOLOGISCH PERSPECTIEF.......................................................................................................................... 11
Het zenuwstelsel ........................................................................................................................................... 11
Onderdelen van het zenuwstelsel ................................................................................................................ 11
Evaluatie van het biologisch perspectief ...................................................................................................... 11
Biologisch georiënteerde theorieën ................................................................................................................... 12
Medicatie = psychofarmacologie .................................................................................................................. 12
Andere biologische interventies ................................................................................................................... 12
Evaluatie biologische benadering ................................................................................................................. 12
HET PSYCHOLOGISCH PERSPECTIEF .................................................................................................................. 12
Introductie.......................................................................................................................................................... 12
Psychoanalytische theorie ................................................................................................................................. 13
Inleiding ......................................................................................................................................................... 13
Achtergrond .................................................................................................................................................. 13
Visie op psychopathologie ............................................................................................................................ 13
Bewust of onbewust ..................................................................................................................................... 13
Persoonlijkheidstheorie ................................................................................................................................ 14
Ontwikkelingsfasen ....................................................................................................................................... 14
Afweermechanismen .................................................................................................................................... 15
Andere grote namen ..................................................................................................................................... 15
Kritiek ............................................................................................................................................................ 16
Psychoanalyse ............................................................................................................................................... 16
Moderne psychodynamische therapie ............................................................................................................... 18
1
,Leertheorie ......................................................................................................................................................... 18
Achtergrond .................................................................................................................................................. 18
Klassieke conditionering (zelfstudie) ............................................................................................................ 18
Verschil klassieke en operante...................................................................................................................... 19
Operante conditionering............................................................................................................................... 20
Sociaal leren .................................................................................................................................................. 20
Gedragstherapie ................................................................................................................................................ 21
Klassieke component .................................................................................................................................... 21
Operante component.................................................................................................................................... 22
Cognitieve theorie .............................................................................................................................................. 23
Inleiding ......................................................................................................................................................... 23
Ellis ................................................................................................................................................................ 23
Beck (werkt verder op Ellis) .......................................................................................................................... 24
Cognitieve therapie ............................................................................................................................................ 26
Ontwikkeling ................................................................................................................................................. 26
Diagnostiek (Ellis) .......................................................................................................................................... 26
Diagnostiek (Beck) ......................................................................................................................................... 26
Therapie (Ellis)............................................................................................................................................... 26
Therapie (Beck) ............................................................................................................................................. 26
Effect therapie............................................................................................................................................... 27
Ervaringsgerichte theorie................................................................................................................................... 27
Inleiding ......................................................................................................................................................... 27
Client-centered theory .................................................................................................................................. 27
Maslow – motivatietheorie ........................................................................................................................... 28
Laing .............................................................................................................................................................. 29
Perls ............................................................................................................................................................... 29
Ervaringsgerichte therapie................................................................................................................................. 29
Ontwikkeling ................................................................................................................................................. 29
Diagnostiek.................................................................................................................................................... 30
Therapie ........................................................................................................................................................ 30
Effect ............................................................................................................................................................. 30
Systeemtheorie .................................................................................................................................................. 31
Algemene systeemtheorie (von Bertalanffy) ................................................................................................ 31
Communicatietheoretische benadering ....................................................................................................... 32
Structurele benadering ................................................................................................................................. 33
Contextuele benadering................................................................................................................................ 34
Systeemtherpie of relatie- en gezinstherapie .................................................................................................... 35
Ontwikkeling ................................................................................................................................................. 35
Diagnostiek.................................................................................................................................................... 35
Therapie ........................................................................................................................................................ 36
Effect ............................................................................................................................................................. 38
HET SOCIAAL CULTURELE PERSPECTIEF ............................................................................................................. 38
HET BIOPSYCHOSOCIALE PERSPECTIEF .............................................................................................................. 38
Diathese-stressmodel......................................................................................................................................... 38
Theorieën kritisch bekeken ................................................................................................................................ 39
Probleem ....................................................................................................................................................... 39
KLINISCHE PSYCHOPATHOLOGIE DSM-INVALSHOEK (STOORNISSPECIFIEK) ..................................................... 40
Gedragsproblemen- en stoornissen ................................................................................................................... 40
Gedragsverslaving ......................................................................................................................................... 43
Stemmingsstoornissen ....................................................................................................................................... 46
2
, Definitie ......................................................................................................................................................... 46
Depressieve stemmingstoornis ..................................................................................................................... 46
Prementstruele stemmingsstoornis.............................................................................................................. 48
Disruptieve stemmingsregulatiestoornis (kinderen) .................................................................................... 48
Bipolaire stemmingsstoornis ........................................................................................................................ 48
Suicidaliteit .................................................................................................................................................... 49
Verlies en (gecompliceerde) rouw...................................................................................................................... 49
Wat is rouw? ................................................................................................................................................. 49
Prototypische trajecten na verlies of trauma ............................................................................................... 50
Gecompliceerde rouw ................................................................................................................................... 51
Persisterende complexe rouwstoornis in DSM-5 sectie III ........................................................................... 51
Kritiek ............................................................................................................................................................ 52
Differentiaaldiagnostiek ................................................................................................................................ 52
Risico- en beschermende factoren ............................................................................................................... 52
Rouwbegeleiding........................................................................................................................................... 52
Gecompliceerde rouw in een gezin .............................................................................................................. 54
Effectstudies .................................................................................................................................................. 54
Psychotrauma .................................................................................................................................................... 54
Meestvoorkomende trauma’s ...................................................................................................................... 54
Etiologie......................................................................................................................................................... 55
Prikkels voor een trauma .............................................................................................................................. 55
Diagnostiek.................................................................................................................................................... 55
Risicofactoren om PTSS te ontwikkelen ........................................................................................................ 55
Behandeling .................................................................................................................................................. 56
Angsstoornissen ................................................................................................................................................. 56
Kenmerken .................................................................................................................................................... 56
Criteria ........................................................................................................................................................... 57
Enkelvoudige fobie ........................................................................................................................................ 57
Biologische deel ............................................................................................................................................ 57
Functie v angst .............................................................................................................................................. 57
Soorten angststoornissen ............................................................................................................................. 57
Angst ontwikkeld zich ................................................................................................................................... 59
Onmiddelijke reacties op angst .................................................................................................................... 59
Differentiaal diagnostiek ............................................................................................................................... 59
Etiologie......................................................................................................................................................... 59
Prognose ....................................................................................................................................................... 59
Behandeling .................................................................................................................................................. 59
Somatoforme stoornissen .................................................................................................................................. 59
Algemeen ...................................................................................................................................................... 59
Geschiedenis ................................................................................................................................................. 60
Mogelijke hypothesen, hoe komt dat dan? .................................................................................................. 60
Differentiaal diagnose ................................................................................................................................... 60
Behandeling .................................................................................................................................................. 60
Somatische symptoomstoornis .......................................................................................................................... 60
Behandeling .................................................................................................................................................. 60
Chronisch vermoeidheidsydroom (cvs) .............................................................................................................. 61
Behandeling .................................................................................................................................................. 61
Munchhausen by proxy ...................................................................................................................................... 61
Behandeling .................................................................................................................................................. 61
Ziekteangststoornis ............................................................................................................................................ 61
Differentiaal diagnose ................................................................................................................................... 61
Behandeling .................................................................................................................................................. 61
3
, Dysmorfofobie.................................................................................................................................................... 62
Differentiaal diagnose ................................................................................................................................... 62
Behandeling .................................................................................................................................................. 62
Genderdysforie ................................................................................................................................................... 62
Behandeling .................................................................................................................................................. 62
Psychotische stoornissen ................................................................................................................................... 62
Positieve symptomen (psychotische episodes) ............................................................................................ 62
Negatieve symptomen (vaker bij mannen) .................................................................................................. 63
Criteria volgens DSM-5 ................................................................................................................................. 62
Etiologie......................................................................................................................................................... 63
Prevalentie .................................................................................................................................................... 63
Behandeling .................................................................................................................................................. 63
TRANSDIAGNOSTISCH PERSPECTIEF .................................................................................................................. 64
Inleiding.............................................................................................................................................................. 64
Transdiagnostische factoren ......................................................................................................................... 67
Executieve functies............................................................................................................................................. 67
Definitie (Lezak) ............................................................................................................................................ 67
Definitie (Welsh en Pennington) ................................................................................................................... 67
Definitie (klinische neuropsychologie) .......................................................................................................... 67
Algemeen ...................................................................................................................................................... 68
Verschillende executieve functies + linken ................................................................................................... 68
Relatie met psychopathologie ...................................................................................................................... 69
Assessment ................................................................................................................................................... 70
Etiologie executieve dysfuncties ................................................................................................................... 70
Behandelstrategieën ..................................................................................................................................... 71
Repetitief negatief denken = rumineren ............................................................................................................ 71
Definitie ......................................................................................................................................................... 71
Vormen van RND ........................................................................................................................................... 71
Differentiaaldiagnostiek ................................................................................................................................ 72
Repetitief Negatief Denken als TD proces .................................................................................................... 72
De rol van negatieve controle ....................................................................................................................... 73
Klinische implicaties ...................................................................................................................................... 73
Rumineren en gecompliceerde rouw ........................................................................................................... 73
Assesment ..................................................................................................................................................... 74
Behandelstrategieën ..................................................................................................................................... 74
Emotieregulatie.................................................................................................................................................. 75
Inleiding ......................................................................................................................................................... 75
Emoties = korte duur, kan snel wisselen ...................................................................................................... 75
Emotieregulatie ............................................................................................................................................. 76
Emotieregulatie als TD factor ....................................................................................................................... 77
Kernfactoren voor goede emotieregulatie ................................................................................................... 78
Behandeling .................................................................................................................................................. 79
4
Inhoudsopgave
INTRODUCTIE ....................................................................................................................................................... 5
Definities .............................................................................................................................................................. 5
Uitzonderingen................................................................................................................................................ 5
Wat is afwijkend gedrag? .................................................................................................................................... 5
Criteria voor afwijkend gedrag (Nevid) ........................................................................................................... 5
Culturele aspecten v afwijkend gedrag........................................................................................................... 6
Modellen ......................................................................................................................................................... 6
Prevalentie ...................................................................................................................................................... 7
Psychopathologie ................................................................................................................................................. 7
Normaliteit vs pathologie ............................................................................................................................... 7
Classificatie en beoordelingen van afwijkende emoties, gedachten en gedrag .................................................. 7
Classificeren ......................................................................................................................................................... 7
Classificatiesystemen (DSM-5) ........................................................................................................................ 8
Veranderingen ................................................................................................................................................ 8
Kritiek op DSM-5 ............................................................................................................................................. 8
Voor- en nadelen............................................................................................................................................. 8
Opbouw ........................................................................................................................................................... 9
Beoordelingsmethoden ........................................................................................................................................ 9
Het klinisch interview = meest gebruikt ......................................................................................................... 9
Psychologische tests ..................................................................................................................................... 10
Neuropsychologische tests ........................................................................................................................... 10
Gedragsbeoordeling ...................................................................................................................................... 10
Fysiologische beoordeelding ......................................................................................................................... 10
Classificatie van symptomen.............................................................................................................................. 10
HET BIOLOGISCH PERSPECTIEF.......................................................................................................................... 11
Het zenuwstelsel ........................................................................................................................................... 11
Onderdelen van het zenuwstelsel ................................................................................................................ 11
Evaluatie van het biologisch perspectief ...................................................................................................... 11
Biologisch georiënteerde theorieën ................................................................................................................... 12
Medicatie = psychofarmacologie .................................................................................................................. 12
Andere biologische interventies ................................................................................................................... 12
Evaluatie biologische benadering ................................................................................................................. 12
HET PSYCHOLOGISCH PERSPECTIEF .................................................................................................................. 12
Introductie.......................................................................................................................................................... 12
Psychoanalytische theorie ................................................................................................................................. 13
Inleiding ......................................................................................................................................................... 13
Achtergrond .................................................................................................................................................. 13
Visie op psychopathologie ............................................................................................................................ 13
Bewust of onbewust ..................................................................................................................................... 13
Persoonlijkheidstheorie ................................................................................................................................ 14
Ontwikkelingsfasen ....................................................................................................................................... 14
Afweermechanismen .................................................................................................................................... 15
Andere grote namen ..................................................................................................................................... 15
Kritiek ............................................................................................................................................................ 16
Psychoanalyse ............................................................................................................................................... 16
Moderne psychodynamische therapie ............................................................................................................... 18
1
,Leertheorie ......................................................................................................................................................... 18
Achtergrond .................................................................................................................................................. 18
Klassieke conditionering (zelfstudie) ............................................................................................................ 18
Verschil klassieke en operante...................................................................................................................... 19
Operante conditionering............................................................................................................................... 20
Sociaal leren .................................................................................................................................................. 20
Gedragstherapie ................................................................................................................................................ 21
Klassieke component .................................................................................................................................... 21
Operante component.................................................................................................................................... 22
Cognitieve theorie .............................................................................................................................................. 23
Inleiding ......................................................................................................................................................... 23
Ellis ................................................................................................................................................................ 23
Beck (werkt verder op Ellis) .......................................................................................................................... 24
Cognitieve therapie ............................................................................................................................................ 26
Ontwikkeling ................................................................................................................................................. 26
Diagnostiek (Ellis) .......................................................................................................................................... 26
Diagnostiek (Beck) ......................................................................................................................................... 26
Therapie (Ellis)............................................................................................................................................... 26
Therapie (Beck) ............................................................................................................................................. 26
Effect therapie............................................................................................................................................... 27
Ervaringsgerichte theorie................................................................................................................................... 27
Inleiding ......................................................................................................................................................... 27
Client-centered theory .................................................................................................................................. 27
Maslow – motivatietheorie ........................................................................................................................... 28
Laing .............................................................................................................................................................. 29
Perls ............................................................................................................................................................... 29
Ervaringsgerichte therapie................................................................................................................................. 29
Ontwikkeling ................................................................................................................................................. 29
Diagnostiek.................................................................................................................................................... 30
Therapie ........................................................................................................................................................ 30
Effect ............................................................................................................................................................. 30
Systeemtheorie .................................................................................................................................................. 31
Algemene systeemtheorie (von Bertalanffy) ................................................................................................ 31
Communicatietheoretische benadering ....................................................................................................... 32
Structurele benadering ................................................................................................................................. 33
Contextuele benadering................................................................................................................................ 34
Systeemtherpie of relatie- en gezinstherapie .................................................................................................... 35
Ontwikkeling ................................................................................................................................................. 35
Diagnostiek.................................................................................................................................................... 35
Therapie ........................................................................................................................................................ 36
Effect ............................................................................................................................................................. 38
HET SOCIAAL CULTURELE PERSPECTIEF ............................................................................................................. 38
HET BIOPSYCHOSOCIALE PERSPECTIEF .............................................................................................................. 38
Diathese-stressmodel......................................................................................................................................... 38
Theorieën kritisch bekeken ................................................................................................................................ 39
Probleem ....................................................................................................................................................... 39
KLINISCHE PSYCHOPATHOLOGIE DSM-INVALSHOEK (STOORNISSPECIFIEK) ..................................................... 40
Gedragsproblemen- en stoornissen ................................................................................................................... 40
Gedragsverslaving ......................................................................................................................................... 43
Stemmingsstoornissen ....................................................................................................................................... 46
2
, Definitie ......................................................................................................................................................... 46
Depressieve stemmingstoornis ..................................................................................................................... 46
Prementstruele stemmingsstoornis.............................................................................................................. 48
Disruptieve stemmingsregulatiestoornis (kinderen) .................................................................................... 48
Bipolaire stemmingsstoornis ........................................................................................................................ 48
Suicidaliteit .................................................................................................................................................... 49
Verlies en (gecompliceerde) rouw...................................................................................................................... 49
Wat is rouw? ................................................................................................................................................. 49
Prototypische trajecten na verlies of trauma ............................................................................................... 50
Gecompliceerde rouw ................................................................................................................................... 51
Persisterende complexe rouwstoornis in DSM-5 sectie III ........................................................................... 51
Kritiek ............................................................................................................................................................ 52
Differentiaaldiagnostiek ................................................................................................................................ 52
Risico- en beschermende factoren ............................................................................................................... 52
Rouwbegeleiding........................................................................................................................................... 52
Gecompliceerde rouw in een gezin .............................................................................................................. 54
Effectstudies .................................................................................................................................................. 54
Psychotrauma .................................................................................................................................................... 54
Meestvoorkomende trauma’s ...................................................................................................................... 54
Etiologie......................................................................................................................................................... 55
Prikkels voor een trauma .............................................................................................................................. 55
Diagnostiek.................................................................................................................................................... 55
Risicofactoren om PTSS te ontwikkelen ........................................................................................................ 55
Behandeling .................................................................................................................................................. 56
Angsstoornissen ................................................................................................................................................. 56
Kenmerken .................................................................................................................................................... 56
Criteria ........................................................................................................................................................... 57
Enkelvoudige fobie ........................................................................................................................................ 57
Biologische deel ............................................................................................................................................ 57
Functie v angst .............................................................................................................................................. 57
Soorten angststoornissen ............................................................................................................................. 57
Angst ontwikkeld zich ................................................................................................................................... 59
Onmiddelijke reacties op angst .................................................................................................................... 59
Differentiaal diagnostiek ............................................................................................................................... 59
Etiologie......................................................................................................................................................... 59
Prognose ....................................................................................................................................................... 59
Behandeling .................................................................................................................................................. 59
Somatoforme stoornissen .................................................................................................................................. 59
Algemeen ...................................................................................................................................................... 59
Geschiedenis ................................................................................................................................................. 60
Mogelijke hypothesen, hoe komt dat dan? .................................................................................................. 60
Differentiaal diagnose ................................................................................................................................... 60
Behandeling .................................................................................................................................................. 60
Somatische symptoomstoornis .......................................................................................................................... 60
Behandeling .................................................................................................................................................. 60
Chronisch vermoeidheidsydroom (cvs) .............................................................................................................. 61
Behandeling .................................................................................................................................................. 61
Munchhausen by proxy ...................................................................................................................................... 61
Behandeling .................................................................................................................................................. 61
Ziekteangststoornis ............................................................................................................................................ 61
Differentiaal diagnose ................................................................................................................................... 61
Behandeling .................................................................................................................................................. 61
3
, Dysmorfofobie.................................................................................................................................................... 62
Differentiaal diagnose ................................................................................................................................... 62
Behandeling .................................................................................................................................................. 62
Genderdysforie ................................................................................................................................................... 62
Behandeling .................................................................................................................................................. 62
Psychotische stoornissen ................................................................................................................................... 62
Positieve symptomen (psychotische episodes) ............................................................................................ 62
Negatieve symptomen (vaker bij mannen) .................................................................................................. 63
Criteria volgens DSM-5 ................................................................................................................................. 62
Etiologie......................................................................................................................................................... 63
Prevalentie .................................................................................................................................................... 63
Behandeling .................................................................................................................................................. 63
TRANSDIAGNOSTISCH PERSPECTIEF .................................................................................................................. 64
Inleiding.............................................................................................................................................................. 64
Transdiagnostische factoren ......................................................................................................................... 67
Executieve functies............................................................................................................................................. 67
Definitie (Lezak) ............................................................................................................................................ 67
Definitie (Welsh en Pennington) ................................................................................................................... 67
Definitie (klinische neuropsychologie) .......................................................................................................... 67
Algemeen ...................................................................................................................................................... 68
Verschillende executieve functies + linken ................................................................................................... 68
Relatie met psychopathologie ...................................................................................................................... 69
Assessment ................................................................................................................................................... 70
Etiologie executieve dysfuncties ................................................................................................................... 70
Behandelstrategieën ..................................................................................................................................... 71
Repetitief negatief denken = rumineren ............................................................................................................ 71
Definitie ......................................................................................................................................................... 71
Vormen van RND ........................................................................................................................................... 71
Differentiaaldiagnostiek ................................................................................................................................ 72
Repetitief Negatief Denken als TD proces .................................................................................................... 72
De rol van negatieve controle ....................................................................................................................... 73
Klinische implicaties ...................................................................................................................................... 73
Rumineren en gecompliceerde rouw ........................................................................................................... 73
Assesment ..................................................................................................................................................... 74
Behandelstrategieën ..................................................................................................................................... 74
Emotieregulatie.................................................................................................................................................. 75
Inleiding ......................................................................................................................................................... 75
Emoties = korte duur, kan snel wisselen ...................................................................................................... 75
Emotieregulatie ............................................................................................................................................. 76
Emotieregulatie als TD factor ....................................................................................................................... 77
Kernfactoren voor goede emotieregulatie ................................................................................................... 78
Behandeling .................................................................................................................................................. 79
4
