P S Y CH OP A T HO LOG I E
GEESTELIJKE GEZONDHEIDSZORG
HoGent | ACADEMIEJAAR 2022 – 2023
,Inhoudsopgave
1. Psychiatrie en maatschappij....................................................................................................................... 6
2. Diagnose.................................................................................................................................................... 8
2.1 De DSM – 5.....................................................................................................................................................8
2.3 Kritische bedenkingen bij de classificatie van psychopathologie...................................................................9
Dimensionele versus categoriale classificatie..................................................................................................9
Triomf van de lobby........................................................................................................................................10
Psychiatrisering van het dagelijks leven.........................................................................................................10
2.4 Besluit...........................................................................................................................................................10
3. Verklaring (Etiologie)................................................................................................................................ 11
3.1 Biologische verklaringen...............................................................................................................................11
Invloed van geneesmiddelen en drugs...........................................................................................................11
3.2 Psychologische verklaringen.........................................................................................................................12
3.3. Sociale verklaringen.....................................................................................................................................12
4. Behandeling............................................................................................................................................. 13
4.1 Biologische behandeling...............................................................................................................................13
4.2 Psychotherapie.............................................................................................................................................14
Psychodynamische therapie...........................................................................................................................14
Cliëntgerichte therapie...................................................................................................................................15
Gedragstherapie.............................................................................................................................................15
Cognitieve therapie........................................................................................................................................16
Speltherapie...................................................................................................................................................17
4.3 Sociale psychiatrie........................................................................................................................................17
5. Verloop en preventie............................................................................................................................... 18
5.1 Epidemiologie...............................................................................................................................................18
5.2 Preventie.......................................................................................................................................................18
1. Inleiding................................................................................................................................................... 19
2. Wanen en hallucinaties............................................................................................................................ 19
3. Schizofrenie............................................................................................................................................. 22
3.1 Kenmerken....................................................................................................................................................22
Types van Schizofrenie...................................................................................................................................25
Belangrijke verschillen tussen andere stoornissen en schizofrenie...............................................................26
3.2 Verklaringen.................................................................................................................................................26
3.3 Behandeling..................................................................................................................................................29
1. Inleiding................................................................................................................................................... 32
1
,2. Waanstoornis........................................................................................................................................... 32
2.1 Kenmerken....................................................................................................................................................32
2.2 Verklaring.....................................................................................................................................................33
2.3 Behandeling..................................................................................................................................................34
3. Kortdurende psychotische stoornis........................................................................................................... 34
3.1 Kenmerken....................................................................................................................................................34
3.2 Verklaring.....................................................................................................................................................34
3.3 Behandeling..................................................................................................................................................34
4. Schizofreniforme stoornis........................................................................................................................ 34
4.1 Kenmerken....................................................................................................................................................34
4.2 Verklaring.....................................................................................................................................................35
4.3 Behandeling..................................................................................................................................................35
5. Gedeelde psychotische stoornis............................................................................................................... 35
5.1 Kenmerken....................................................................................................................................................35
5.2 Verklaring.....................................................................................................................................................35
5.3 Behandeling..................................................................................................................................................35
6. Dubbeldiagnose: psychose en toxicomanie...............................................................................................35
1. Inleiding................................................................................................................................................... 36
2. Angst en angststoornissen........................................................................................................................ 36
3. Fobieën en sociale angsten....................................................................................................................... 39
3.1 Specifieke fobie.............................................................................................................................................39
Differentiaaldiagnose.....................................................................................................................................39
Verklaring.......................................................................................................................................................40
Behandeling....................................................................................................................................................40
3.2 Sociale angsten.............................................................................................................................................40
Differentiaaldiagnose.....................................................................................................................................40
Verklaring.......................................................................................................................................................41
Behandeling....................................................................................................................................................41
4. Paniekstoornis en agorafobie................................................................................................................... 41
4.1 Kenmerken....................................................................................................................................................41
Differentiaaldiagnose.....................................................................................................................................42
4.2 Verklaring.....................................................................................................................................................42
Hyperventilatie...............................................................................................................................................43
4.3 Behandeling..................................................................................................................................................44
5. Gegeneraliseerde angststoornis............................................................................................................... 44
2
, 5.1 Kenmerken....................................................................................................................................................45
5.2 Verklaring.....................................................................................................................................................45
5.3 Behandeling..................................................................................................................................................46
1. Dwang..................................................................................................................................................... 47
2. Obsessieve- compulsieve stoornis............................................................................................................ 48
2.1 Kenmerken....................................................................................................................................................48
2.2 Verklaring.....................................................................................................................................................49
2.3 Behandeling..................................................................................................................................................49
3. Andere dwangstoornissen........................................................................................................................ 49
3.1 Kenmerken....................................................................................................................................................49
Excoriatiestoornis...........................................................................................................................................49
Trichotillomanie..............................................................................................................................................49
Morfodysfore stoornis....................................................................................................................................50
Verzamelstoornis............................................................................................................................................50
3.2 Verklaring.....................................................................................................................................................51
3.3 Behandeling..................................................................................................................................................51
1. Stress en aanpassing................................................................................................................................ 52
Factoren die de ontwikkeling van stress bepalen...............................................................................................53
Coping.............................................................................................................................................................53
Persoonlijkheid...............................................................................................................................................53
Sociale relaties................................................................................................................................................54
2. Aanpassingsstoornis................................................................................................................................. 54
Kenmerken..........................................................................................................................................................54
Verklaring...........................................................................................................................................................55
Behandeling........................................................................................................................................................55
3. Posttraumatische - stressstoornis............................................................................................................. 56
Kenmerken..........................................................................................................................................................56
Differentiaaldiagnose:....................................................................................................................................57
Verklaring...........................................................................................................................................................57
Behandeling........................................................................................................................................................57
1. Stemming en emotie................................................................................................................................ 58
2. Depressieve- stemmingsstoornis.............................................................................................................. 59
2.1 Kenmerken....................................................................................................................................................59
2.2 Verklaring.....................................................................................................................................................62
Biologische verklaring.....................................................................................................................................62
Psychologische en sociale factoren................................................................................................................63
3
, Gedragstheorie...............................................................................................................................................63
Cognitieve theorie..........................................................................................................................................63
Cognitief- gedragsmatige benadering............................................................................................................63
Besluit.............................................................................................................................................................64
2.3 Behandeling..................................................................................................................................................64
Biologische behandeling.................................................................................................................................64
Psychotherapie...............................................................................................................................................64
Cognitieve gedragstherapie............................................................................................................................65
Interpersoonlijke therapie..............................................................................................................................65
3. Bipolaire- stemmingsstoornis................................................................................................................... 66
3.1 Kenmerken....................................................................................................................................................66
Differentiaaldiagnose:....................................................................................................................................66
Nieuwe depressieve stemmingsstoornis........................................................................................................67
3.2 Verklaring.....................................................................................................................................................67
3.3 Behandeling..................................................................................................................................................68
1. Drugs en afhankelijkheid.......................................................................................................................... 69
2. Stoornissen door gebruik van alcohol....................................................................................................... 73
2.1 Kenmerken....................................................................................................................................................73
2.2 Verklaring.....................................................................................................................................................75
Biologische factoren.......................................................................................................................................75
Psychologische factoren.................................................................................................................................76
Sociale factoren..............................................................................................................................................76
2.3 Behandeling..................................................................................................................................................77
Medische behandeling...................................................................................................................................77
Psychosociale behandeling.............................................................................................................................77
Therapietrouw................................................................................................................................................78
3. Stoornissen door gebruik van alcohol....................................................................................................... 78
3.1 Kenmerken....................................................................................................................................................78
GHB.................................................................................................................................................................78
Cocaïne...........................................................................................................................................................79
Amfetamine....................................................................................................................................................80
Heroïne...........................................................................................................................................................80
Lage stimulerende middelen..........................................................................................................................81
Ter afronding..................................................................................................................................................82
3.2 Verklaring.....................................................................................................................................................82
3.3 Behandeling..................................................................................................................................................83
Opiaatverslaafden..........................................................................................................................................83
GHB- verslaafden............................................................................................................................................83
1. Normale en gestoorde persoonlijkheid..................................................................................................... 84
2. Persoonlijkheidsstoornissen..................................................................................................................... 85
4
, 2.1 Algemene kenmerken van de PHS................................................................................................................85
Cluster A: vreemd en excentriek gedrag.............................................................................................................87
Schizoïde personen.........................................................................................................................................87
Schizotypische PHS.........................................................................................................................................87
Paranoïde PHS................................................................................................................................................87
Cluster B: dramatische, emotionele of onvoorspelbare gedragingen................................................................88
Antisociale PHS...............................................................................................................................................88
Borderline PHS................................................................................................................................................89
Histrionische PHS............................................................................................................................................89
Narcistische PHS.............................................................................................................................................90
Cluster C: angst en onzekerheid.........................................................................................................................90
Vermijdende PHS............................................................................................................................................90
Afhankelijke PHS.............................................................................................................................................91
Dwangmatige PHS..........................................................................................................................................91
3. Verklaring................................................................................................................................................ 92
3.1 Biologische Factoren.....................................................................................................................................92
3.2 Psychodynamische opvattingen...................................................................................................................92
3.3 Cognitieve theorie.........................................................................................................................................92
3.4 Opvoedingsstijl.............................................................................................................................................92
3.5 Comorbiditeit................................................................................................................................................93
4. Behandeling............................................................................................................................................. 93
4.1 Psychofarmaca.............................................................................................................................................93
4.2 Psychodynamische psychotherapie..............................................................................................................93
Overdrachtsgerichte psychotherapie.............................................................................................................93
Metalliseren bevorderende therapie.............................................................................................................93
4.3 Cognitieve gedragstherapie..........................................................................................................................94
Dialectische gedragstherapie.........................................................................................................................94
Schemagerichte therapie...............................................................................................................................94
Omgaan met moeilijke mensen.....................................................................................................................94
5
GEESTELIJKE GEZONDHEIDSZORG
HoGent | ACADEMIEJAAR 2022 – 2023
,Inhoudsopgave
1. Psychiatrie en maatschappij....................................................................................................................... 6
2. Diagnose.................................................................................................................................................... 8
2.1 De DSM – 5.....................................................................................................................................................8
2.3 Kritische bedenkingen bij de classificatie van psychopathologie...................................................................9
Dimensionele versus categoriale classificatie..................................................................................................9
Triomf van de lobby........................................................................................................................................10
Psychiatrisering van het dagelijks leven.........................................................................................................10
2.4 Besluit...........................................................................................................................................................10
3. Verklaring (Etiologie)................................................................................................................................ 11
3.1 Biologische verklaringen...............................................................................................................................11
Invloed van geneesmiddelen en drugs...........................................................................................................11
3.2 Psychologische verklaringen.........................................................................................................................12
3.3. Sociale verklaringen.....................................................................................................................................12
4. Behandeling............................................................................................................................................. 13
4.1 Biologische behandeling...............................................................................................................................13
4.2 Psychotherapie.............................................................................................................................................14
Psychodynamische therapie...........................................................................................................................14
Cliëntgerichte therapie...................................................................................................................................15
Gedragstherapie.............................................................................................................................................15
Cognitieve therapie........................................................................................................................................16
Speltherapie...................................................................................................................................................17
4.3 Sociale psychiatrie........................................................................................................................................17
5. Verloop en preventie............................................................................................................................... 18
5.1 Epidemiologie...............................................................................................................................................18
5.2 Preventie.......................................................................................................................................................18
1. Inleiding................................................................................................................................................... 19
2. Wanen en hallucinaties............................................................................................................................ 19
3. Schizofrenie............................................................................................................................................. 22
3.1 Kenmerken....................................................................................................................................................22
Types van Schizofrenie...................................................................................................................................25
Belangrijke verschillen tussen andere stoornissen en schizofrenie...............................................................26
3.2 Verklaringen.................................................................................................................................................26
3.3 Behandeling..................................................................................................................................................29
1. Inleiding................................................................................................................................................... 32
1
,2. Waanstoornis........................................................................................................................................... 32
2.1 Kenmerken....................................................................................................................................................32
2.2 Verklaring.....................................................................................................................................................33
2.3 Behandeling..................................................................................................................................................34
3. Kortdurende psychotische stoornis........................................................................................................... 34
3.1 Kenmerken....................................................................................................................................................34
3.2 Verklaring.....................................................................................................................................................34
3.3 Behandeling..................................................................................................................................................34
4. Schizofreniforme stoornis........................................................................................................................ 34
4.1 Kenmerken....................................................................................................................................................34
4.2 Verklaring.....................................................................................................................................................35
4.3 Behandeling..................................................................................................................................................35
5. Gedeelde psychotische stoornis............................................................................................................... 35
5.1 Kenmerken....................................................................................................................................................35
5.2 Verklaring.....................................................................................................................................................35
5.3 Behandeling..................................................................................................................................................35
6. Dubbeldiagnose: psychose en toxicomanie...............................................................................................35
1. Inleiding................................................................................................................................................... 36
2. Angst en angststoornissen........................................................................................................................ 36
3. Fobieën en sociale angsten....................................................................................................................... 39
3.1 Specifieke fobie.............................................................................................................................................39
Differentiaaldiagnose.....................................................................................................................................39
Verklaring.......................................................................................................................................................40
Behandeling....................................................................................................................................................40
3.2 Sociale angsten.............................................................................................................................................40
Differentiaaldiagnose.....................................................................................................................................40
Verklaring.......................................................................................................................................................41
Behandeling....................................................................................................................................................41
4. Paniekstoornis en agorafobie................................................................................................................... 41
4.1 Kenmerken....................................................................................................................................................41
Differentiaaldiagnose.....................................................................................................................................42
4.2 Verklaring.....................................................................................................................................................42
Hyperventilatie...............................................................................................................................................43
4.3 Behandeling..................................................................................................................................................44
5. Gegeneraliseerde angststoornis............................................................................................................... 44
2
, 5.1 Kenmerken....................................................................................................................................................45
5.2 Verklaring.....................................................................................................................................................45
5.3 Behandeling..................................................................................................................................................46
1. Dwang..................................................................................................................................................... 47
2. Obsessieve- compulsieve stoornis............................................................................................................ 48
2.1 Kenmerken....................................................................................................................................................48
2.2 Verklaring.....................................................................................................................................................49
2.3 Behandeling..................................................................................................................................................49
3. Andere dwangstoornissen........................................................................................................................ 49
3.1 Kenmerken....................................................................................................................................................49
Excoriatiestoornis...........................................................................................................................................49
Trichotillomanie..............................................................................................................................................49
Morfodysfore stoornis....................................................................................................................................50
Verzamelstoornis............................................................................................................................................50
3.2 Verklaring.....................................................................................................................................................51
3.3 Behandeling..................................................................................................................................................51
1. Stress en aanpassing................................................................................................................................ 52
Factoren die de ontwikkeling van stress bepalen...............................................................................................53
Coping.............................................................................................................................................................53
Persoonlijkheid...............................................................................................................................................53
Sociale relaties................................................................................................................................................54
2. Aanpassingsstoornis................................................................................................................................. 54
Kenmerken..........................................................................................................................................................54
Verklaring...........................................................................................................................................................55
Behandeling........................................................................................................................................................55
3. Posttraumatische - stressstoornis............................................................................................................. 56
Kenmerken..........................................................................................................................................................56
Differentiaaldiagnose:....................................................................................................................................57
Verklaring...........................................................................................................................................................57
Behandeling........................................................................................................................................................57
1. Stemming en emotie................................................................................................................................ 58
2. Depressieve- stemmingsstoornis.............................................................................................................. 59
2.1 Kenmerken....................................................................................................................................................59
2.2 Verklaring.....................................................................................................................................................62
Biologische verklaring.....................................................................................................................................62
Psychologische en sociale factoren................................................................................................................63
3
, Gedragstheorie...............................................................................................................................................63
Cognitieve theorie..........................................................................................................................................63
Cognitief- gedragsmatige benadering............................................................................................................63
Besluit.............................................................................................................................................................64
2.3 Behandeling..................................................................................................................................................64
Biologische behandeling.................................................................................................................................64
Psychotherapie...............................................................................................................................................64
Cognitieve gedragstherapie............................................................................................................................65
Interpersoonlijke therapie..............................................................................................................................65
3. Bipolaire- stemmingsstoornis................................................................................................................... 66
3.1 Kenmerken....................................................................................................................................................66
Differentiaaldiagnose:....................................................................................................................................66
Nieuwe depressieve stemmingsstoornis........................................................................................................67
3.2 Verklaring.....................................................................................................................................................67
3.3 Behandeling..................................................................................................................................................68
1. Drugs en afhankelijkheid.......................................................................................................................... 69
2. Stoornissen door gebruik van alcohol....................................................................................................... 73
2.1 Kenmerken....................................................................................................................................................73
2.2 Verklaring.....................................................................................................................................................75
Biologische factoren.......................................................................................................................................75
Psychologische factoren.................................................................................................................................76
Sociale factoren..............................................................................................................................................76
2.3 Behandeling..................................................................................................................................................77
Medische behandeling...................................................................................................................................77
Psychosociale behandeling.............................................................................................................................77
Therapietrouw................................................................................................................................................78
3. Stoornissen door gebruik van alcohol....................................................................................................... 78
3.1 Kenmerken....................................................................................................................................................78
GHB.................................................................................................................................................................78
Cocaïne...........................................................................................................................................................79
Amfetamine....................................................................................................................................................80
Heroïne...........................................................................................................................................................80
Lage stimulerende middelen..........................................................................................................................81
Ter afronding..................................................................................................................................................82
3.2 Verklaring.....................................................................................................................................................82
3.3 Behandeling..................................................................................................................................................83
Opiaatverslaafden..........................................................................................................................................83
GHB- verslaafden............................................................................................................................................83
1. Normale en gestoorde persoonlijkheid..................................................................................................... 84
2. Persoonlijkheidsstoornissen..................................................................................................................... 85
4
, 2.1 Algemene kenmerken van de PHS................................................................................................................85
Cluster A: vreemd en excentriek gedrag.............................................................................................................87
Schizoïde personen.........................................................................................................................................87
Schizotypische PHS.........................................................................................................................................87
Paranoïde PHS................................................................................................................................................87
Cluster B: dramatische, emotionele of onvoorspelbare gedragingen................................................................88
Antisociale PHS...............................................................................................................................................88
Borderline PHS................................................................................................................................................89
Histrionische PHS............................................................................................................................................89
Narcistische PHS.............................................................................................................................................90
Cluster C: angst en onzekerheid.........................................................................................................................90
Vermijdende PHS............................................................................................................................................90
Afhankelijke PHS.............................................................................................................................................91
Dwangmatige PHS..........................................................................................................................................91
3. Verklaring................................................................................................................................................ 92
3.1 Biologische Factoren.....................................................................................................................................92
3.2 Psychodynamische opvattingen...................................................................................................................92
3.3 Cognitieve theorie.........................................................................................................................................92
3.4 Opvoedingsstijl.............................................................................................................................................92
3.5 Comorbiditeit................................................................................................................................................93
4. Behandeling............................................................................................................................................. 93
4.1 Psychofarmaca.............................................................................................................................................93
4.2 Psychodynamische psychotherapie..............................................................................................................93
Overdrachtsgerichte psychotherapie.............................................................................................................93
Metalliseren bevorderende therapie.............................................................................................................93
4.3 Cognitieve gedragstherapie..........................................................................................................................94
Dialectische gedragstherapie.........................................................................................................................94
Schemagerichte therapie...............................................................................................................................94
Omgaan met moeilijke mensen.....................................................................................................................94
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