Probleem 6
Leerdoelen:
- Wat zijn de kenmerken van stemmingsstoornissen?
o Welke subtypes zijn er?
- Hoe ontstaat een stemmingsstoornis?
- Hoe behandel je een stemmingsstoornis?
Bronnen: vd Molen, Franken
Stemmingsstoornissen
Stemmingsstoornis: extreme of langdurige ontstemming met de aanwezigheid van andere
symptomen.
Stemming: de continue aanwezige grondtoon. Het is je gemoedstoestand, humeur, affect,
sentiment, emotie en gevoel.
Emotie/affect: momentane, kortdurende opwellingen of reacties
Je hebt vier soorten stemmingsklachten:
1. Depressieve episode
- Er is sprake van een depressieve episode als iemand gedurende een onafgebroken periode
van minstens twee weken symptomen vertoont die betrekking hebben op een
depressieve stemming of op het verlies van interesse en plezier.
2. Manische episode
- Van een manische episode is sprake wanneer iemand gedurende een aaneengesloten
periode van minstens een week voortdurend een overdreven uitgelaten of juist uiterst
prikkelbare stemming heeft.
3. Gemengde episode
- Als iemand vrijwel dagelijks, gedurende een aaneengesloten periode van minstens een
week, zowel voldoet aan de diagnostische eisen voor een depressieve episode als die
voor een manische episode, wordt gesproken van een gemengde episode.
4. Hypomane episode
- De hypomane episode is een mildere vorm van de manische episode en kenmerkt zich
door een constant uitgelaten of prikkelbare stemming, die duidelijk afwijkt van de
gewoonlijke stemming van de persoon en op zijn minst vier aaneengesloten dagen duurt.
Deze perioden of symptomen zijn nodig om te diagnosticeren welke stemmingsstoornis
iemand heeft.
Er wordt ook onderscheid gemaakt in verschillende typen stemmingsstoornissen:
- Depressieve stoornis
- Bipolaire I stoornis
- Biploaire II stoornis
, Depressieve stoornis (Unipolaire stoornis)
Major Depressive Disorder - Diagnostic criteria
A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change
from previous functioning: at least one of the symptoms is either (1) depressed mood or (2) loss of interest or
pleasure. Note: Do not include symptoms that are clearly attributable to another medical condition.
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad,
empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can
be irritable mood.)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as
indicated by either subjective account or observation).
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a
month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make
expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings
of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day
(not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account
or as observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation with-out a specific plan, or a
suicide attempt or a specific plan for committing suicide.
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas
of functioning.
C. The episode is not attributable to the physiological effects of a substance or to another medical condition.
Note: Criteria A-C represent a major depressive episode.
Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural disaster, a serious medical
illness or disability) may include the feelings of intense sad-ness, rumination about the loss, insomnia, poor appetite, and
weight loss noted in Criterion A, which may resemble a depressive episode. Although such symptoms may be
understand-able or considered appropriate to the loss, the presence of a major depressive episode in addition to the
normal response to a significant loss should also be carefully considered. This decision inevitably requires the exercise of
clinical judgment based on the individual’s history and the cultural norms for the expression of distress in the context of
loss.
D. The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia,
schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and
other psychotic disorders.
E. There has never been a manic episode or a hypomanie episode.
Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance-induced or are
attributable to the physiological effects of another medical condition.
Specify episode: Single
Recurrent
Specify severity / course: Mild / Moderate / Severe
With psychotic features In partial / full remission Unspecified
In recording the name of a diagnosis, terms should be listed in the following order: major depressive disorder, single or
recurrent episode, severity/psychotic/remission specifiers, followed by as many of the following specifiers that apply to
the current episode. Specify:
With anxious distress With mixed features With melancholic features With atypical features With mood-congruent
psychotic features With mood-incongruent psychotic features With catatonia
With peripartum onset With seasonal pattern (recurrent episode only)
Leerdoelen:
- Wat zijn de kenmerken van stemmingsstoornissen?
o Welke subtypes zijn er?
- Hoe ontstaat een stemmingsstoornis?
- Hoe behandel je een stemmingsstoornis?
Bronnen: vd Molen, Franken
Stemmingsstoornissen
Stemmingsstoornis: extreme of langdurige ontstemming met de aanwezigheid van andere
symptomen.
Stemming: de continue aanwezige grondtoon. Het is je gemoedstoestand, humeur, affect,
sentiment, emotie en gevoel.
Emotie/affect: momentane, kortdurende opwellingen of reacties
Je hebt vier soorten stemmingsklachten:
1. Depressieve episode
- Er is sprake van een depressieve episode als iemand gedurende een onafgebroken periode
van minstens twee weken symptomen vertoont die betrekking hebben op een
depressieve stemming of op het verlies van interesse en plezier.
2. Manische episode
- Van een manische episode is sprake wanneer iemand gedurende een aaneengesloten
periode van minstens een week voortdurend een overdreven uitgelaten of juist uiterst
prikkelbare stemming heeft.
3. Gemengde episode
- Als iemand vrijwel dagelijks, gedurende een aaneengesloten periode van minstens een
week, zowel voldoet aan de diagnostische eisen voor een depressieve episode als die
voor een manische episode, wordt gesproken van een gemengde episode.
4. Hypomane episode
- De hypomane episode is een mildere vorm van de manische episode en kenmerkt zich
door een constant uitgelaten of prikkelbare stemming, die duidelijk afwijkt van de
gewoonlijke stemming van de persoon en op zijn minst vier aaneengesloten dagen duurt.
Deze perioden of symptomen zijn nodig om te diagnosticeren welke stemmingsstoornis
iemand heeft.
Er wordt ook onderscheid gemaakt in verschillende typen stemmingsstoornissen:
- Depressieve stoornis
- Bipolaire I stoornis
- Biploaire II stoornis
, Depressieve stoornis (Unipolaire stoornis)
Major Depressive Disorder - Diagnostic criteria
A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change
from previous functioning: at least one of the symptoms is either (1) depressed mood or (2) loss of interest or
pleasure. Note: Do not include symptoms that are clearly attributable to another medical condition.
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad,
empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can
be irritable mood.)
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as
indicated by either subjective account or observation).
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a
month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make
expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings
of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day
(not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account
or as observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation with-out a specific plan, or a
suicide attempt or a specific plan for committing suicide.
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas
of functioning.
C. The episode is not attributable to the physiological effects of a substance or to another medical condition.
Note: Criteria A-C represent a major depressive episode.
Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural disaster, a serious medical
illness or disability) may include the feelings of intense sad-ness, rumination about the loss, insomnia, poor appetite, and
weight loss noted in Criterion A, which may resemble a depressive episode. Although such symptoms may be
understand-able or considered appropriate to the loss, the presence of a major depressive episode in addition to the
normal response to a significant loss should also be carefully considered. This decision inevitably requires the exercise of
clinical judgment based on the individual’s history and the cultural norms for the expression of distress in the context of
loss.
D. The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia,
schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and
other psychotic disorders.
E. There has never been a manic episode or a hypomanie episode.
Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance-induced or are
attributable to the physiological effects of another medical condition.
Specify episode: Single
Recurrent
Specify severity / course: Mild / Moderate / Severe
With psychotic features In partial / full remission Unspecified
In recording the name of a diagnosis, terms should be listed in the following order: major depressive disorder, single or
recurrent episode, severity/psychotic/remission specifiers, followed by as many of the following specifiers that apply to
the current episode. Specify:
With anxious distress With mixed features With melancholic features With atypical features With mood-congruent
psychotic features With mood-incongruent psychotic features With catatonia
With peripartum onset With seasonal pattern (recurrent episode only)
