KLINISCHE PSYCHOLOGIE
HOOFDSTUK TITEL #
1
,INLEIDING IN DE KLINISCHE PSYCHOLOGIE................................................................................................... 14
1. DEFINIËRING.................................................................................................................................................... 14
1.1 De term klinisch........................................................................................................................................14
1.2 Definitie....................................................................................................................................................14
2. NORMAAL – ABNORMAAL...................................................................................................................................14
2.1 Onderscheid normaal – abnormaal.........................................................................................................14
2.2 Definitie abnormaal.................................................................................................................................15
2.2.1 Culturele aspecten van afwijkend gedrag (3)....................................................................................................15
2.3 Modellen..................................................................................................................................................15
2.3.1 Het statisch model............................................................................................................................................15
2.3.2 Het medisch model...........................................................................................................................................16
2.3.3 Het leermodel...................................................................................................................................................16
3. POPULATIE.......................................................................................................................................................16
3.1 Epidemiologisch onderzoek......................................................................................................................16
3.2 Prevalentie psychische stoornissen..........................................................................................................16
3.2.1 Demografische kenmerken...............................................................................................................................17
3.2.2 Prevalentiecijfers 2020 tijdens coronacrisis......................................................................................................17
4. TAKEN............................................................................................................................................................17
INLEIDING IN DE PSYCHOPATHOLOGIE......................................................................................................... 18
1. INLEIDING IN DE PSYCHOPATHOLOGIE....................................................................................................................18
1.1 Omschrijving en situering.........................................................................................................................18
1.2 Normaliteit versus pathologie..................................................................................................................18
1.3 Begrippen (13)..........................................................................................................................................18
2. CLASSIFICATIE...................................................................................................................................................19
2.1 Betekenis van classificatie........................................................................................................................19
2.1.1 Manieren om pathologische verschijnselen te ordenen (3)..............................................................................20
2.2 DSM & ICD................................................................................................................................................20
2.2.1 DSM: Stoornis...................................................................................................................................................20
3. KENMERKEN DSM............................................................................................................................................20
3.1 DSM-5 categorieën van psychische stoornissen......................................................................................21
3.2 Belangrijke verandering in de DSM-5.......................................................................................................21
3.3 DSM-5 blijft bron van controverse (6)......................................................................................................21
3.3.1 Voor- en nadelen van het DSM-systeem...........................................................................................................22
3.4 Opbouw DSM-5........................................................................................................................................22
3.4.1 SECTIE 1: De basics (uitleg en instructies).........................................................................................................22
3.4.2 SECTIE 3............................................................................................................................................................ 22
A. Opzet................................................................................................................................................................ 22
B. Overzicht en inhoud..........................................................................................................................................23
4. DIAGNOSTIEK – BEOORDELINGSMETHODEN............................................................................................................24
4.1 Klinisch interview......................................................................................................................................24
4.2 Psychologische tests.................................................................................................................................24
4.3 Neuropsychologische tests.......................................................................................................................24
4.4 Gedragsbeoordeling.................................................................................................................................25
4.5 Fysiologische beoordeling........................................................................................................................25
5. CLASSIFICATIE VAN SYMPTOMEN..........................................................................................................................25
5.1 Expressie en motoriek..............................................................................................................................25
5.2 Bewustzijn................................................................................................................................................26
5.3 Zelfbeleving..............................................................................................................................................26
5.4 Waarneming.............................................................................................................................................26
5.5 Denken en geheugen................................................................................................................................27
5.6 Gevoelens en verlangen...........................................................................................................................27
GESCHIEDENIS VAN DE KLINISCHE PSYCHOLOGIE.......................................................................................... 28
2
, 1. GRIEKSE OUDHEID: HIPPOCRATES........................................................................................................................28
2. VAN 700 NA CHRISTUS: ARABISCHE PSYCHIATRIE (8E TOT 16E EEUW).........................................................................28
3. MIDDELEEUWEN: EXORCISME EN HEKSENVERVOLGINGEN..........................................................................................28
4. 1600: GEKKENHUIZEN.......................................................................................................................................29
5. VANAF 1800: HERVORMINGEN...........................................................................................................................29
6. VANAF 1960: KRITIEK OP DE PSYCHIATRIE.............................................................................................................29
7. HEDENDAAGSE TRENDS......................................................................................................................................30
8. EVIDENCE-BASED MEDICINE.................................................................................................................................30
9. SLOTBESCHOUWING...........................................................................................................................................30
KLINISCH PSYCHOLOGISCHE THEORIEËN EN PSYCHOTHERAPEUTISCHE STROMINGEN...................................31
1. INTRODUCTIE...................................................................................................................................................31
1.1 Psychotherapie of counseling?.................................................................................................................31
2. PSYCHOANALYTISCHE THEORIE.............................................................................................................................32
2.1 Inleiding....................................................................................................................................................32
2.2 Achtergrond.............................................................................................................................................32
2.2.1 Visie op psychopathologie................................................................................................................................32
2.3 Bewust en onbewust................................................................................................................................33
2.4 Persoonlijkheidstheorie............................................................................................................................33
2.4.1 Es of Id.............................................................................................................................................................. 33
2.4.2 Uber-ich of superego........................................................................................................................................34
2.4.3 Ich of Ego.......................................................................................................................................................... 34
2.5 Ontwikkelingsfasen..................................................................................................................................34
2.6 Afweermechanismen................................................................................................................................35
2.7 Andere grote namen................................................................................................................................35
2.7.1 Jung.................................................................................................................................................................. 35
2.7.2 Adler................................................................................................................................................................. 36
2.7.3 Erikson.............................................................................................................................................................. 36
2.7.4 Hartman............................................................................................................................................................ 36
2.7.5 Mahler.............................................................................................................................................................. 36
2.7.6 Bowlby.............................................................................................................................................................. 36
2.8 Kritiek op psychoanalytische theorie (8)..................................................................................................36
3. BEHANDELING..................................................................................................................................................37
3.1 Ontwikkeling............................................................................................................................................37
3.1.1 Invloedrijke figuren...........................................................................................................................................37
3.1.2 Grondlegger......................................................................................................................................................37
3.1.3 Verschillen........................................................................................................................................................ 38
3.2 Diagnostiek...............................................................................................................................................38
3.2.1 Model van Kernberg.........................................................................................................................................38
3.2.2 Indicatiestelling.................................................................................................................................................38
3.2.3 Kinderen........................................................................................................................................................... 39
3.3 Therapie...................................................................................................................................................39
3.3.1 Therapeutische relatie......................................................................................................................................39
3.3.2 Basale concepten..............................................................................................................................................39
A. Vrije associatie..................................................................................................................................................39
B. Weerstand........................................................................................................................................................ 40
C. Overdracht........................................................................................................................................................40
D. Tegenoverdracht..............................................................................................................................................40
BIOLOGISCH PERSPECTIEF EN PSYCHOFARMACOLOGIE.................................................................................41
1. BIOLOGISCH PERSPECTIEF: WAT WETEN WE OVER DE HERSENEN?...............................................................................41
1.1 Hersenen als een black box......................................................................................................................41
1.2 De samenstelling van de hersenen...........................................................................................................41
1.2.1 CT Scan............................................................................................................................................................. 42
1.2.2 FMRI................................................................................................................................................................. 42
3
, 1.2.3 EEG................................................................................................................................................................... 42
1.3 Microscopisch: het neuron.......................................................................................................................42
1.3.1 Opbouw............................................................................................................................................................ 42
1.3.2 Neurotransmitters............................................................................................................................................42
1.3.3 Synaps............................................................................................................................................................... 43
2. PSYCHOFARMACOLOGIE......................................................................................................................................43
2.1 Psychofarmacon.......................................................................................................................................43
2.2 Farmacokinetiek.......................................................................................................................................44
2.2.1 Toedieningswijze (3).........................................................................................................................................44
2.2.2 Opname............................................................................................................................................................ 45
2.3 Circulatie en distributie............................................................................................................................45
2.4 Klaring (clearance)...................................................................................................................................45
2.5 Steady state..............................................................................................................................................46
2.6 Farmacodynamiek....................................................................................................................................46
2.7 Neurotransmitters (7)...............................................................................................................................46
3. FARMACOLOGIE................................................................................................................................................46
3.1 Antipsychotica..........................................................................................................................................46
3.1.1 Neveneffecten (6).............................................................................................................................................47
3.2 Antidepressiva..........................................................................................................................................47
3.2.1 Neveneffecten (5).............................................................................................................................................47
3.3 Benzodiazepines.......................................................................................................................................48
3.4 Stimulantia...............................................................................................................................................48
LEERTHEORIE EN -THERAPIE......................................................................................................................... 49
1. LEERTHEORIE....................................................................................................................................................49
1.1 Achtergrond.............................................................................................................................................49
1.2 Klassieke conditionering...........................................................................................................................49
1.2.1 Pavlov............................................................................................................................................................... 49
1.2.2 Schema van de klassieke conditionering...........................................................................................................50
1.2.3 Bekrachtiging....................................................................................................................................................50
1.2.4 Extinctie en spontaan herstel...........................................................................................................................50
1.2.5 Generalisatie en differentiatie..........................................................................................................................51
1.2.6 Hogere-orde conditionering.............................................................................................................................51
1.2.7 Inhibitie en excitatie.........................................................................................................................................51
1.2.8 Varianten (6).....................................................................................................................................................51
1.3 Operante conditionering..........................................................................................................................52
1.3.1 Verschil met klassieke conditionering (!)..........................................................................................................52
1.3.2 Thorndike......................................................................................................................................................... 52
1.3.3 Skinner.............................................................................................................................................................. 52
1.3.4 Bekrachtiging: gedrag neemt toe......................................................................................................................53
1.3.5 Bestraffing: gedrag neemt af............................................................................................................................53
1.3.6 Effect straffen versus belonen..........................................................................................................................53
1.3.7 Belangrijke begrippen.......................................................................................................................................53
1.4 Sociaal leren.............................................................................................................................................53
2. GEDRAGSTHERAPIE............................................................................................................................................54
2.1 Ontwikkeling............................................................................................................................................54
2.2 Diagnostiek...............................................................................................................................................54
2.3 Therapie...................................................................................................................................................54
2.3.1 Klassieke component........................................................................................................................................55
A. Exposure........................................................................................................................................................... 55
a) Graduele exposure.......................................................................................................................................55
b) Flooding.......................................................................................................................................................55
c) Exposure met responspreventie...................................................................................................................55
d) Cue-exposure...............................................................................................................................................56
B. Stimuluscontrole...............................................................................................................................................56
C. Contraconditionering........................................................................................................................................56
4
HOOFDSTUK TITEL #
1
,INLEIDING IN DE KLINISCHE PSYCHOLOGIE................................................................................................... 14
1. DEFINIËRING.................................................................................................................................................... 14
1.1 De term klinisch........................................................................................................................................14
1.2 Definitie....................................................................................................................................................14
2. NORMAAL – ABNORMAAL...................................................................................................................................14
2.1 Onderscheid normaal – abnormaal.........................................................................................................14
2.2 Definitie abnormaal.................................................................................................................................15
2.2.1 Culturele aspecten van afwijkend gedrag (3)....................................................................................................15
2.3 Modellen..................................................................................................................................................15
2.3.1 Het statisch model............................................................................................................................................15
2.3.2 Het medisch model...........................................................................................................................................16
2.3.3 Het leermodel...................................................................................................................................................16
3. POPULATIE.......................................................................................................................................................16
3.1 Epidemiologisch onderzoek......................................................................................................................16
3.2 Prevalentie psychische stoornissen..........................................................................................................16
3.2.1 Demografische kenmerken...............................................................................................................................17
3.2.2 Prevalentiecijfers 2020 tijdens coronacrisis......................................................................................................17
4. TAKEN............................................................................................................................................................17
INLEIDING IN DE PSYCHOPATHOLOGIE......................................................................................................... 18
1. INLEIDING IN DE PSYCHOPATHOLOGIE....................................................................................................................18
1.1 Omschrijving en situering.........................................................................................................................18
1.2 Normaliteit versus pathologie..................................................................................................................18
1.3 Begrippen (13)..........................................................................................................................................18
2. CLASSIFICATIE...................................................................................................................................................19
2.1 Betekenis van classificatie........................................................................................................................19
2.1.1 Manieren om pathologische verschijnselen te ordenen (3)..............................................................................20
2.2 DSM & ICD................................................................................................................................................20
2.2.1 DSM: Stoornis...................................................................................................................................................20
3. KENMERKEN DSM............................................................................................................................................20
3.1 DSM-5 categorieën van psychische stoornissen......................................................................................21
3.2 Belangrijke verandering in de DSM-5.......................................................................................................21
3.3 DSM-5 blijft bron van controverse (6)......................................................................................................21
3.3.1 Voor- en nadelen van het DSM-systeem...........................................................................................................22
3.4 Opbouw DSM-5........................................................................................................................................22
3.4.1 SECTIE 1: De basics (uitleg en instructies).........................................................................................................22
3.4.2 SECTIE 3............................................................................................................................................................ 22
A. Opzet................................................................................................................................................................ 22
B. Overzicht en inhoud..........................................................................................................................................23
4. DIAGNOSTIEK – BEOORDELINGSMETHODEN............................................................................................................24
4.1 Klinisch interview......................................................................................................................................24
4.2 Psychologische tests.................................................................................................................................24
4.3 Neuropsychologische tests.......................................................................................................................24
4.4 Gedragsbeoordeling.................................................................................................................................25
4.5 Fysiologische beoordeling........................................................................................................................25
5. CLASSIFICATIE VAN SYMPTOMEN..........................................................................................................................25
5.1 Expressie en motoriek..............................................................................................................................25
5.2 Bewustzijn................................................................................................................................................26
5.3 Zelfbeleving..............................................................................................................................................26
5.4 Waarneming.............................................................................................................................................26
5.5 Denken en geheugen................................................................................................................................27
5.6 Gevoelens en verlangen...........................................................................................................................27
GESCHIEDENIS VAN DE KLINISCHE PSYCHOLOGIE.......................................................................................... 28
2
, 1. GRIEKSE OUDHEID: HIPPOCRATES........................................................................................................................28
2. VAN 700 NA CHRISTUS: ARABISCHE PSYCHIATRIE (8E TOT 16E EEUW).........................................................................28
3. MIDDELEEUWEN: EXORCISME EN HEKSENVERVOLGINGEN..........................................................................................28
4. 1600: GEKKENHUIZEN.......................................................................................................................................29
5. VANAF 1800: HERVORMINGEN...........................................................................................................................29
6. VANAF 1960: KRITIEK OP DE PSYCHIATRIE.............................................................................................................29
7. HEDENDAAGSE TRENDS......................................................................................................................................30
8. EVIDENCE-BASED MEDICINE.................................................................................................................................30
9. SLOTBESCHOUWING...........................................................................................................................................30
KLINISCH PSYCHOLOGISCHE THEORIEËN EN PSYCHOTHERAPEUTISCHE STROMINGEN...................................31
1. INTRODUCTIE...................................................................................................................................................31
1.1 Psychotherapie of counseling?.................................................................................................................31
2. PSYCHOANALYTISCHE THEORIE.............................................................................................................................32
2.1 Inleiding....................................................................................................................................................32
2.2 Achtergrond.............................................................................................................................................32
2.2.1 Visie op psychopathologie................................................................................................................................32
2.3 Bewust en onbewust................................................................................................................................33
2.4 Persoonlijkheidstheorie............................................................................................................................33
2.4.1 Es of Id.............................................................................................................................................................. 33
2.4.2 Uber-ich of superego........................................................................................................................................34
2.4.3 Ich of Ego.......................................................................................................................................................... 34
2.5 Ontwikkelingsfasen..................................................................................................................................34
2.6 Afweermechanismen................................................................................................................................35
2.7 Andere grote namen................................................................................................................................35
2.7.1 Jung.................................................................................................................................................................. 35
2.7.2 Adler................................................................................................................................................................. 36
2.7.3 Erikson.............................................................................................................................................................. 36
2.7.4 Hartman............................................................................................................................................................ 36
2.7.5 Mahler.............................................................................................................................................................. 36
2.7.6 Bowlby.............................................................................................................................................................. 36
2.8 Kritiek op psychoanalytische theorie (8)..................................................................................................36
3. BEHANDELING..................................................................................................................................................37
3.1 Ontwikkeling............................................................................................................................................37
3.1.1 Invloedrijke figuren...........................................................................................................................................37
3.1.2 Grondlegger......................................................................................................................................................37
3.1.3 Verschillen........................................................................................................................................................ 38
3.2 Diagnostiek...............................................................................................................................................38
3.2.1 Model van Kernberg.........................................................................................................................................38
3.2.2 Indicatiestelling.................................................................................................................................................38
3.2.3 Kinderen........................................................................................................................................................... 39
3.3 Therapie...................................................................................................................................................39
3.3.1 Therapeutische relatie......................................................................................................................................39
3.3.2 Basale concepten..............................................................................................................................................39
A. Vrije associatie..................................................................................................................................................39
B. Weerstand........................................................................................................................................................ 40
C. Overdracht........................................................................................................................................................40
D. Tegenoverdracht..............................................................................................................................................40
BIOLOGISCH PERSPECTIEF EN PSYCHOFARMACOLOGIE.................................................................................41
1. BIOLOGISCH PERSPECTIEF: WAT WETEN WE OVER DE HERSENEN?...............................................................................41
1.1 Hersenen als een black box......................................................................................................................41
1.2 De samenstelling van de hersenen...........................................................................................................41
1.2.1 CT Scan............................................................................................................................................................. 42
1.2.2 FMRI................................................................................................................................................................. 42
3
, 1.2.3 EEG................................................................................................................................................................... 42
1.3 Microscopisch: het neuron.......................................................................................................................42
1.3.1 Opbouw............................................................................................................................................................ 42
1.3.2 Neurotransmitters............................................................................................................................................42
1.3.3 Synaps............................................................................................................................................................... 43
2. PSYCHOFARMACOLOGIE......................................................................................................................................43
2.1 Psychofarmacon.......................................................................................................................................43
2.2 Farmacokinetiek.......................................................................................................................................44
2.2.1 Toedieningswijze (3).........................................................................................................................................44
2.2.2 Opname............................................................................................................................................................ 45
2.3 Circulatie en distributie............................................................................................................................45
2.4 Klaring (clearance)...................................................................................................................................45
2.5 Steady state..............................................................................................................................................46
2.6 Farmacodynamiek....................................................................................................................................46
2.7 Neurotransmitters (7)...............................................................................................................................46
3. FARMACOLOGIE................................................................................................................................................46
3.1 Antipsychotica..........................................................................................................................................46
3.1.1 Neveneffecten (6).............................................................................................................................................47
3.2 Antidepressiva..........................................................................................................................................47
3.2.1 Neveneffecten (5).............................................................................................................................................47
3.3 Benzodiazepines.......................................................................................................................................48
3.4 Stimulantia...............................................................................................................................................48
LEERTHEORIE EN -THERAPIE......................................................................................................................... 49
1. LEERTHEORIE....................................................................................................................................................49
1.1 Achtergrond.............................................................................................................................................49
1.2 Klassieke conditionering...........................................................................................................................49
1.2.1 Pavlov............................................................................................................................................................... 49
1.2.2 Schema van de klassieke conditionering...........................................................................................................50
1.2.3 Bekrachtiging....................................................................................................................................................50
1.2.4 Extinctie en spontaan herstel...........................................................................................................................50
1.2.5 Generalisatie en differentiatie..........................................................................................................................51
1.2.6 Hogere-orde conditionering.............................................................................................................................51
1.2.7 Inhibitie en excitatie.........................................................................................................................................51
1.2.8 Varianten (6).....................................................................................................................................................51
1.3 Operante conditionering..........................................................................................................................52
1.3.1 Verschil met klassieke conditionering (!)..........................................................................................................52
1.3.2 Thorndike......................................................................................................................................................... 52
1.3.3 Skinner.............................................................................................................................................................. 52
1.3.4 Bekrachtiging: gedrag neemt toe......................................................................................................................53
1.3.5 Bestraffing: gedrag neemt af............................................................................................................................53
1.3.6 Effect straffen versus belonen..........................................................................................................................53
1.3.7 Belangrijke begrippen.......................................................................................................................................53
1.4 Sociaal leren.............................................................................................................................................53
2. GEDRAGSTHERAPIE............................................................................................................................................54
2.1 Ontwikkeling............................................................................................................................................54
2.2 Diagnostiek...............................................................................................................................................54
2.3 Therapie...................................................................................................................................................54
2.3.1 Klassieke component........................................................................................................................................55
A. Exposure........................................................................................................................................................... 55
a) Graduele exposure.......................................................................................................................................55
b) Flooding.......................................................................................................................................................55
c) Exposure met responspreventie...................................................................................................................55
d) Cue-exposure...............................................................................................................................................56
B. Stimuluscontrole...............................................................................................................................................56
C. Contraconditionering........................................................................................................................................56
4
