KLINISCHE PSYCHIATRIE
Lesmateriaal
- Ppts + lesopnames (ppts alleen zijn onvoldoende)
- Handboek (niet verplicht, wel aanbevolen voor achtergrond ed.)
Schriftelijk examen, vaak zelfs online => open vragen
Belangrijk om “de kapstok” te begrijpen waaraan verschillende ziektebeelden/aandoeningen aan opgehangen
kunnen worden.
Examen
• Donderdag 18/1/2024
• Digitaal examen
(lockdown browser & respondus monitor)
• 3-tal kennisvragen
o ”Bespreek de fysiopathogenese van……”
o “Bespreek de klinische kenmerken van…”
o “Bespreek de behandeling van…”
1
,Inhoud
Inleiding (DSM-5) ............................................................................................................................................................ 8
Inleiding ...................................................................................................................................................................... 8
Psychopathologie.................................................................................................................................................... 8
Psychiatrische stoornis ........................................................................................................................................... 8
Classificatie ................................................................................................................................................................. 9
DSM Voor- & nadelen ............................................................................................................................................. 9
DSM Geschiedenis ................................................................................................................................................ 10
Diagnostiek ............................................................................................................................................................... 10
Classificatie vs. diagnostiek................................................................................................................................... 10
Opzet DSM-5 ............................................................................................................................................................. 10
Veranderingen Deel II ........................................................................................................................................... 10
Deel III: Aandoeningen die verder onderzoek behoeven ..................................................................................... 11
Stellingen .................................................................................................................................................................. 11
DSM-5 stellingen ................................................................................................................................................... 11
Big Pharma ............................................................................................................................................................ 11
Conclusie................................................................................................................................................................... 11
Inleiding ........................................................................................................................................................................ 12
Normaliteit en psychopathologie ............................................................................................................................. 12
Gezondheid/ ziekte............................................................................................................................................... 12
Normaliteit............................................................................................................................................................ 12
Criteria normaliteit ............................................................................................................................................... 12
Probleem van subjectiviteit ...................................................................................................................................... 12
Epidemiologie ........................................................................................................................................................... 13
Onderwerpen........................................................................................................................................................ 13
Incidentie & prevalentie ....................................................................................................................................... 13
Belopen ................................................................................................................................................................. 13
Ongelijkheid in de verdeling van psychiatrische morbiditeit: .............................................................................. 13
Algemene prevalentie........................................................................................................................................... 13
Geschiedenis van de psychiatrie............................................................................................................................... 14
Hippocrates (ca. 460-366 v.C.) .............................................................................................................................. 14
Exorcisme en heksenvervolgingen (“drijftest”) (ca. Middeleeuwen) ................................................................... 14
Gekkenhuizen (14e/15e eeuw) .............................................................................................................................. 14
Vanaf 1800: hervormingen ................................................................................................................................... 14
Tweede wereldoorlog (’40-’45) ............................................................................................................................ 14
De antipsychiatrische beweging (ca. 1970) .......................................................................................................... 15
Evidence-based medicine ..................................................................................................................................... 15
Etiopathogenese ....................................................................................................................................................... 15
2
, Algemeen .............................................................................................................................................................. 15
Fysiopathogenese ................................................................................................................................................. 15
Psychopathogense ................................................................................................................................................ 18
Neurocognitieve stoornissen ........................................................................................................................................ 23
Algemeen .................................................................................................................................................................. 23
Epidemiologie ....................................................................................................................................................... 23
Het geheugen........................................................................................................................................................ 23
Ouderdom (senescentie) ...................................................................................................................................... 23
Neuropsychologische testen................................................................................................................................. 24
Dementie .................................................................................................................................................................. 24
Geheugen & veroudering ..................................................................................................................................... 24
Klinische kenmerken ............................................................................................................................................. 25
Indeling ................................................................................................................................................................. 26
Diagnostiek ........................................................................................................................................................... 29
Behandeling .......................................................................................................................................................... 30
Delirium .................................................................................................................................................................... 30
Epidemiologie ....................................................................................................................................................... 30
DSM ...................................................................................................................................................................... 30
Subtypes ............................................................................................................................................................... 30
Behandeling .......................................................................................................................................................... 31
Overzicht Delirium – Dementie – Depressie......................................................................................................... 31
Amnestische stoornissen .......................................................................................................................................... 31
Middelengerelateerde & verslavingsstoornissen ......................................................................................................... 32
Stoornissen IN het gebruik ....................................................................................................................................... 32
Misbruik van een middel ...................................................................................................................................... 32
Middelenafhankelijkheid ...................................................................................................................................... 32
Stoornissen DOOR het gebruik van middelen .......................................................................................................... 33
Intoxicatie door middel......................................................................................................................................... 33
Onthouding van een middel ................................................................................................................................. 33
Psychoactieve stoffen ............................................................................................................................................... 33
Indeling – algemeen ............................................................................................................................................. 33
Alcoholgebruik ...................................................................................................................................................... 33
Drugs ..................................................................................................................................................................... 35
Diagnostiek ............................................................................................................................................................... 35
Etiopathogenese ....................................................................................................................................................... 36
Aan middelen gebonden stoornissen ....................................................................................................................... 36
Prognose ............................................................................................................................................................... 36
Preventie & behandeling ...................................................................................................................................... 37
3
, Behandeling algemeen ............................................................................................................................................. 37
Schizofrenie & andere psychotische stoornissen ......................................................................................................... 38
Psychotische stoornissen .......................................................................................................................................... 38
Schizofrenie .............................................................................................................................................................. 38
Klinische criteria ................................................................................................................................................... 38
Kenmerken ............................................................................................................................................................ 38
Co-morbiditeit, DD en diagnostiek ....................................................................................................................... 40
Epidemiologie ....................................................................................................................................................... 40
Etiopathogenese – stresskwetsbaarheidsmodel .................................................................................................. 41
Preventie ............................................................................................................................................................... 43
Behandeling .......................................................................................................................................................... 43
Beloop ................................................................................................................................................................... 44
Schizofreniforme stoornis......................................................................................................................................... 44
Klinische criteria ................................................................................................................................................... 44
Schizoaffectieve stoornis .......................................................................................................................................... 44
Klinische criteria ................................................................................................................................................... 44
Waanstoornis............................................................................................................................................................ 45
Klinische criteria ................................................................................................................................................... 45
Varianten............................................................................................................................................................... 45
Kortdurende psychotische stoornis .......................................................................................................................... 45
Klinische criteria ................................................................................................................................................... 45
Gedeelde psychotische stoornis ............................................................................................................................... 45
Stemmingsstoornissen.................................................................................................................................................. 46
Definities episodes.................................................................................................................................................... 46
Depressieve episode............................................................................................................................................. 46
(Hypo)manische.................................................................................................................................................... 46
Gemengde ............................................................................................................................................................ 47
Kenmerken stemmingsstoornissen .......................................................................................................................... 47
Uni: depressie, dysthymie .................................................................................................................................... 47
Bi: Bipolaire stoornis type 1, 2, cyclothymie ........................................................................................................ 48
Diagnostiek en comorbiditeit ................................................................................................................................... 48
Diagnostiek ........................................................................................................................................................... 48
Differentiële diagnose & comorbiditeit ................................................................................................................ 48
Epidemiologie & etiopathogenese ........................................................................................................................... 49
Epidemiologie ....................................................................................................................................................... 49
Etiopathogenese/ fysiopathogese ........................................................................................................................ 49
Verklaringsmodel ...................................................................................................................................................... 50
Prognose depressieve stoornis – Beloop.................................................................................................................. 51
4
Lesmateriaal
- Ppts + lesopnames (ppts alleen zijn onvoldoende)
- Handboek (niet verplicht, wel aanbevolen voor achtergrond ed.)
Schriftelijk examen, vaak zelfs online => open vragen
Belangrijk om “de kapstok” te begrijpen waaraan verschillende ziektebeelden/aandoeningen aan opgehangen
kunnen worden.
Examen
• Donderdag 18/1/2024
• Digitaal examen
(lockdown browser & respondus monitor)
• 3-tal kennisvragen
o ”Bespreek de fysiopathogenese van……”
o “Bespreek de klinische kenmerken van…”
o “Bespreek de behandeling van…”
1
,Inhoud
Inleiding (DSM-5) ............................................................................................................................................................ 8
Inleiding ...................................................................................................................................................................... 8
Psychopathologie.................................................................................................................................................... 8
Psychiatrische stoornis ........................................................................................................................................... 8
Classificatie ................................................................................................................................................................. 9
DSM Voor- & nadelen ............................................................................................................................................. 9
DSM Geschiedenis ................................................................................................................................................ 10
Diagnostiek ............................................................................................................................................................... 10
Classificatie vs. diagnostiek................................................................................................................................... 10
Opzet DSM-5 ............................................................................................................................................................. 10
Veranderingen Deel II ........................................................................................................................................... 10
Deel III: Aandoeningen die verder onderzoek behoeven ..................................................................................... 11
Stellingen .................................................................................................................................................................. 11
DSM-5 stellingen ................................................................................................................................................... 11
Big Pharma ............................................................................................................................................................ 11
Conclusie................................................................................................................................................................... 11
Inleiding ........................................................................................................................................................................ 12
Normaliteit en psychopathologie ............................................................................................................................. 12
Gezondheid/ ziekte............................................................................................................................................... 12
Normaliteit............................................................................................................................................................ 12
Criteria normaliteit ............................................................................................................................................... 12
Probleem van subjectiviteit ...................................................................................................................................... 12
Epidemiologie ........................................................................................................................................................... 13
Onderwerpen........................................................................................................................................................ 13
Incidentie & prevalentie ....................................................................................................................................... 13
Belopen ................................................................................................................................................................. 13
Ongelijkheid in de verdeling van psychiatrische morbiditeit: .............................................................................. 13
Algemene prevalentie........................................................................................................................................... 13
Geschiedenis van de psychiatrie............................................................................................................................... 14
Hippocrates (ca. 460-366 v.C.) .............................................................................................................................. 14
Exorcisme en heksenvervolgingen (“drijftest”) (ca. Middeleeuwen) ................................................................... 14
Gekkenhuizen (14e/15e eeuw) .............................................................................................................................. 14
Vanaf 1800: hervormingen ................................................................................................................................... 14
Tweede wereldoorlog (’40-’45) ............................................................................................................................ 14
De antipsychiatrische beweging (ca. 1970) .......................................................................................................... 15
Evidence-based medicine ..................................................................................................................................... 15
Etiopathogenese ....................................................................................................................................................... 15
2
, Algemeen .............................................................................................................................................................. 15
Fysiopathogenese ................................................................................................................................................. 15
Psychopathogense ................................................................................................................................................ 18
Neurocognitieve stoornissen ........................................................................................................................................ 23
Algemeen .................................................................................................................................................................. 23
Epidemiologie ....................................................................................................................................................... 23
Het geheugen........................................................................................................................................................ 23
Ouderdom (senescentie) ...................................................................................................................................... 23
Neuropsychologische testen................................................................................................................................. 24
Dementie .................................................................................................................................................................. 24
Geheugen & veroudering ..................................................................................................................................... 24
Klinische kenmerken ............................................................................................................................................. 25
Indeling ................................................................................................................................................................. 26
Diagnostiek ........................................................................................................................................................... 29
Behandeling .......................................................................................................................................................... 30
Delirium .................................................................................................................................................................... 30
Epidemiologie ....................................................................................................................................................... 30
DSM ...................................................................................................................................................................... 30
Subtypes ............................................................................................................................................................... 30
Behandeling .......................................................................................................................................................... 31
Overzicht Delirium – Dementie – Depressie......................................................................................................... 31
Amnestische stoornissen .......................................................................................................................................... 31
Middelengerelateerde & verslavingsstoornissen ......................................................................................................... 32
Stoornissen IN het gebruik ....................................................................................................................................... 32
Misbruik van een middel ...................................................................................................................................... 32
Middelenafhankelijkheid ...................................................................................................................................... 32
Stoornissen DOOR het gebruik van middelen .......................................................................................................... 33
Intoxicatie door middel......................................................................................................................................... 33
Onthouding van een middel ................................................................................................................................. 33
Psychoactieve stoffen ............................................................................................................................................... 33
Indeling – algemeen ............................................................................................................................................. 33
Alcoholgebruik ...................................................................................................................................................... 33
Drugs ..................................................................................................................................................................... 35
Diagnostiek ............................................................................................................................................................... 35
Etiopathogenese ....................................................................................................................................................... 36
Aan middelen gebonden stoornissen ....................................................................................................................... 36
Prognose ............................................................................................................................................................... 36
Preventie & behandeling ...................................................................................................................................... 37
3
, Behandeling algemeen ............................................................................................................................................. 37
Schizofrenie & andere psychotische stoornissen ......................................................................................................... 38
Psychotische stoornissen .......................................................................................................................................... 38
Schizofrenie .............................................................................................................................................................. 38
Klinische criteria ................................................................................................................................................... 38
Kenmerken ............................................................................................................................................................ 38
Co-morbiditeit, DD en diagnostiek ....................................................................................................................... 40
Epidemiologie ....................................................................................................................................................... 40
Etiopathogenese – stresskwetsbaarheidsmodel .................................................................................................. 41
Preventie ............................................................................................................................................................... 43
Behandeling .......................................................................................................................................................... 43
Beloop ................................................................................................................................................................... 44
Schizofreniforme stoornis......................................................................................................................................... 44
Klinische criteria ................................................................................................................................................... 44
Schizoaffectieve stoornis .......................................................................................................................................... 44
Klinische criteria ................................................................................................................................................... 44
Waanstoornis............................................................................................................................................................ 45
Klinische criteria ................................................................................................................................................... 45
Varianten............................................................................................................................................................... 45
Kortdurende psychotische stoornis .......................................................................................................................... 45
Klinische criteria ................................................................................................................................................... 45
Gedeelde psychotische stoornis ............................................................................................................................... 45
Stemmingsstoornissen.................................................................................................................................................. 46
Definities episodes.................................................................................................................................................... 46
Depressieve episode............................................................................................................................................. 46
(Hypo)manische.................................................................................................................................................... 46
Gemengde ............................................................................................................................................................ 47
Kenmerken stemmingsstoornissen .......................................................................................................................... 47
Uni: depressie, dysthymie .................................................................................................................................... 47
Bi: Bipolaire stoornis type 1, 2, cyclothymie ........................................................................................................ 48
Diagnostiek en comorbiditeit ................................................................................................................................... 48
Diagnostiek ........................................................................................................................................................... 48
Differentiële diagnose & comorbiditeit ................................................................................................................ 48
Epidemiologie & etiopathogenese ........................................................................................................................... 49
Epidemiologie ....................................................................................................................................................... 49
Etiopathogenese/ fysiopathogese ........................................................................................................................ 49
Verklaringsmodel ...................................................................................................................................................... 50
Prognose depressieve stoornis – Beloop.................................................................................................................. 51
4
