Klinische psychiatrie
Inhoud
1. Inleiding (DSM-5) ....................................................................................................................................... 7
1.1 Inleiding ............................................................................................................................................... 7
1.1.1 Psychopathologie/psychiatrische stoornis ...................................................................................... 7
1.2 Classificatie ......................................................................................................................................... 8
1.3 Diagnostiek .......................................................................................................................................... 9
1.4 Opzet DSM-5 ...................................................................................................................................... 10
1.4.1 Deel I ........................................................................................................................................... 10
1.4.2 Deel II .......................................................................................................................................... 10
1.4.3 Deel III ......................................................................................................................................... 10
1.5 Stellingen ........................................................................................................................................... 10
1.6 Conclusie .......................................................................................................................................... 11
2. Inleiding (inleidende begrippen)................................................................................................................ 12
2.1 Inleiding ............................................................................................................................................. 12
2.1.1 Normaliteit en psychopathologie .................................................................................................. 12
2.1.2 Probleem van de subjectiviteit ...................................................................................................... 13
2.1.3 Epidemiologie .............................................................................................................................. 13
2.1.4 Algemene prevalentie................................................................................................................... 14
2.2 Etiopathogenese ................................................................................................................................ 14
2.3 Fysiopathogenese .............................................................................................................................. 14
2.3.1 Genetica ...................................................................................................................................... 14
2.3.2 Epidemiologische studies ............................................................................................................ 16
2.3.3 Neurotransmitters ....................................................................................................................... 17
2.4 Psychopathogenese ........................................................................................................................... 17
2.4.1 Psychologisch perspectief............................................................................................................ 17
2.4.2 Psychische functies ..................................................................................................................... 18
2.4.3 Het psychiatrisch onderzoek ........................................................................................................ 21
2.4.4 Beeldvorming............................................................................................................................... 21
3. Neurocognitieve stoornissen .................................................................................................................... 22
3.1 Inleiding ............................................................................................................................................. 22
3.1.1 Epidemiologie .............................................................................................................................. 22
3.1.2 Het geheugen............................................................................................................................... 22
3.1.3 Ouderdom (senescentie) .............................................................................................................. 22
3.1.4 MMSE .......................................................................................................................................... 23
3.2 Dementie ........................................................................................................................................... 23
, 3.2.1 Epidemiologie .............................................................................................................................. 23
3.2.2 Klinische kenmerken .................................................................................................................... 24
3.2.3 Indeling ....................................................................................................................................... 25
3.2.4 Dementie van het alzheimer-type (DAT) ........................................................................................ 26
3.2.5 Vasculaire dementie .................................................................................................................... 27
3.2.6 Diagnostiek.................................................................................................................................. 27
3.2.7 Behandeling................................................................................................................................. 28
3.3 Delirium ............................................................................................................................................. 28
3.3.1 Epidemiologie .............................................................................................................................. 28
3.3.2 DSM ............................................................................................................................................ 28
3.3.3 Subtypes ..................................................................................................................................... 29
3.3.4 Behandeling................................................................................................................................. 29
3.4 Amnetische stoornissen ..................................................................................................................... 29
4. Middelengerelateerde stoornissen ........................................................................................................... 30
4.1 Inleiding ............................................................................................................................................. 30
4.2 Stoornissen in het gebruik ................................................................................................................... 30
4.2.1 Misbruik van een middel ............................................................................................................... 30
4.2.2 Middelenafhankelijkheid .............................................................................................................. 30
4.2.3 Intoxicatie door een middel .......................................................................................................... 31
4.2.4 Onthouding van een middel .......................................................................................................... 31
4.3 Psychoactieve stoffen ........................................................................................................................ 31
4.3.1 Indeling – algemeen ..................................................................................................................... 31
4.3.2 Alcoholgebruik – epidemiologie .................................................................................................... 32
4.3.3 Alcoholgebruik – richtlijnen alcohol .............................................................................................. 32
4.3.4 Alcohol – stoornissen door het gebruik.......................................................................................... 32
4.3.5 Drugs – stoornissen door het gebruik ............................................................................................ 33
4.4 Middelen gerelateerde en verslavingsstoornissen ................................................................................ 33
4.4.1 Diagnostiek.................................................................................................................................. 33
4.4.2 Etiopathogenese .......................................................................................................................... 34
4.4.3 Prognose ..................................................................................................................................... 35
4.4.4 Behandeling................................................................................................................................. 35
5. Schizofrenie en andere psychotische stoornissen ..................................................................................... 36
5.1 Psychotische stoornissen ................................................................................................................... 36
5.2 Schizofrenie ....................................................................................................................................... 36
5.2.1 Klinische criteria .......................................................................................................................... 36
5.2.2 Kenmerken .................................................................................................................................. 36
5.2.3 Co-morbiditeit ............................................................................................................................. 38
5.2.4 Differentiële diagnostiek ........................................................................................................... 38
5.2.5 Diagnostiek.................................................................................................................................. 38
, 5.2.6 Epidemiologie .............................................................................................................................. 38
5.2.7 Etiopathogenese – stresskwetsbaarheidsmodel............................................................................ 39
5.2.8 Prodromen – Eerste verschijnselen ............................................................................................... 39
5.2.9 De psychose ................................................................................................................................ 39
5.2.10 Genetische factor ...................................................................................................................... 39
5.2.11Neurobiologische afwijkingen...................................................................................................... 40
5.2.12 Stresskwetsbaarheidsmodel ...................................................................................................... 40
5.2.13 Preventie ................................................................................................................................... 40
5.2.14 Behandeling ............................................................................................................................... 41
5.3 Schizofreniforme stoornis ................................................................................................................... 42
5.4 Schizoaffectieve stoornis .................................................................................................................... 42
5.5 Waanstoornis ..................................................................................................................................... 43
5.6 Kortdurende psychotische stoornis ..................................................................................................... 43
5.7 Gedeelde psychotische stoornis ......................................................................................................... 43
6. Stemmingsstoornissen ............................................................................................................................ 44
6.1 Symptoomcriteria............................................................................................................................... 44
6.1.1 Depressieve episode (5 of meer) ................................................................................................... 44
6.1.2 Manische episode ........................................................................................................................ 44
6.1.3 Hypomane episode ...................................................................................................................... 44
6.1.4 Gemengde episode ...................................................................................................................... 45
6.2 Depressieve stemmingsstoornissen.................................................................................................... 45
6.2.1 Depressieve stoornis - specificaties ............................................................................................. 45
6.2.2 Dysthyme stoornis ....................................................................................................................... 45
6.2.3 Andere ......................................................................................................................................... 45
6.3 Bipolaire stemmingsstoornissen ......................................................................................................... 46
6.3.1 Bipolaire stoornis – algemeen ....................................................................................................... 46
6.3.2 Cyclothyme stoornis .................................................................................................................... 46
6.3.3 Andere ......................................................................................................................................... 46
6.4 Diagnostiek ........................................................................................................................................ 46
6.5 Differentiële diagnose & comorbiditeit ................................................................................................ 47
6.6 Epidemiologie .................................................................................................................................... 47
6.7 Etiopathogenese / fysiopathogese ...................................................................................................... 47
6.8 Stress, HPA en depressie .................................................................................................................... 48
6.9 Etiopathogenese /psychopathogenese ............................................................................................... 48
6.10 Verklaringsmodel ............................................................................................................................. 49
6.11 Prognose depressieve stoornis – Beloop............................................................................................ 49
6.12 Behandeling ..................................................................................................................................... 49
6.13 Suïcide ............................................................................................................................................. 50
6.13.1 Prevalentie................................................................................................................................. 50
, 6.13.2 Proces ....................................................................................................................................... 51
7. Angst- en eetstoornissen.......................................................................................................................... 52
7.1 Inleiding ............................................................................................................................................. 52
7.1.1 Begrip Angst................................................................................................................................. 52
7.1.2 Cerebraal angstcircuit .................................................................................................................. 52
7.2 Generieke behandeling ....................................................................................................................... 52
7.3 Beschrijving specifieke angststoornissen ............................................................................................ 52
7.3.1 Specifieke fobie ........................................................................................................................... 52
7.3.2 Paniekstoornis ............................................................................................................................. 53
7.3.3 Agorafobie ................................................................................................................................... 54
7.3.4 Paniekstoornis en agorafobie – Etiopathogenese en behandeling................................................... 54
7.3.5 Sociale fobie ................................................................................................................................ 54
7.3.6 Obsessieve-compulsieve stoornis (OCS) ...................................................................................... 55
7.3.7 Gegeneraliseerde angststoornis (GAS) .......................................................................................... 55
7.3.8 Posttraumatische stresstoornis .................................................................................................... 56
7.3.9 Acute stresstoornis ...................................................................................................................... 57
7.3.10 Angststoornis door somatische aandoeningen en middelen ........................................................ 57
7.4 Eetstoornissen ................................................................................................................................... 58
7.4.1 Anorexia Nervosa ......................................................................................................................... 58
7.4.2 Bulimia Nervosa........................................................................................................................... 58
7.4.3 Diagnostiek.................................................................................................................................. 59
7.4.4 Etiopathogenese .......................................................................................................................... 59
7.4.5 Behandeling................................................................................................................................. 60
8. Ontwikkelings- en gedragsstoornissen...................................................................................................... 61
8.1 Inleiding (specificiteit) ........................................................................................................................ 61
8.1.1 Specificiteit Kinder- en jeugdpsychiatrie ....................................................................................... 61
8.1.2 Definitie psychiatrische stoornis bij kinderen en jongeren .............................................................. 61
8.1.3 Prevalentie .................................................................................................................................. 61
8.2 Ontwikkelingsstoornissen................................................................................................................... 61
8.2.1 ADHD .......................................................................................................................................... 61
8.2.2 Autismespectrumstoornis ............................................................................................................ 64
8.3 Gedragsstoornissen – Externaliserende stoornissen ............................................................................ 66
8.3.1 Algemeen .................................................................................................................................... 66
8.3.2 Oppositionele-opstandige stoornis - Oppositional defiant disorder/ODD ....................................... 67
8.3.3 Normoverschrijdend-gedragsstoornis - Conduct disorder ............................................................. 67
8.3.4 Epidemiologie .............................................................................................................................. 68
8.3.5 Etiopathogenese .......................................................................................................................... 68
8.5.6 Behandeling................................................................................................................................. 69
9. Slaapstoornissen ..................................................................................................................................... 70
Inhoud
1. Inleiding (DSM-5) ....................................................................................................................................... 7
1.1 Inleiding ............................................................................................................................................... 7
1.1.1 Psychopathologie/psychiatrische stoornis ...................................................................................... 7
1.2 Classificatie ......................................................................................................................................... 8
1.3 Diagnostiek .......................................................................................................................................... 9
1.4 Opzet DSM-5 ...................................................................................................................................... 10
1.4.1 Deel I ........................................................................................................................................... 10
1.4.2 Deel II .......................................................................................................................................... 10
1.4.3 Deel III ......................................................................................................................................... 10
1.5 Stellingen ........................................................................................................................................... 10
1.6 Conclusie .......................................................................................................................................... 11
2. Inleiding (inleidende begrippen)................................................................................................................ 12
2.1 Inleiding ............................................................................................................................................. 12
2.1.1 Normaliteit en psychopathologie .................................................................................................. 12
2.1.2 Probleem van de subjectiviteit ...................................................................................................... 13
2.1.3 Epidemiologie .............................................................................................................................. 13
2.1.4 Algemene prevalentie................................................................................................................... 14
2.2 Etiopathogenese ................................................................................................................................ 14
2.3 Fysiopathogenese .............................................................................................................................. 14
2.3.1 Genetica ...................................................................................................................................... 14
2.3.2 Epidemiologische studies ............................................................................................................ 16
2.3.3 Neurotransmitters ....................................................................................................................... 17
2.4 Psychopathogenese ........................................................................................................................... 17
2.4.1 Psychologisch perspectief............................................................................................................ 17
2.4.2 Psychische functies ..................................................................................................................... 18
2.4.3 Het psychiatrisch onderzoek ........................................................................................................ 21
2.4.4 Beeldvorming............................................................................................................................... 21
3. Neurocognitieve stoornissen .................................................................................................................... 22
3.1 Inleiding ............................................................................................................................................. 22
3.1.1 Epidemiologie .............................................................................................................................. 22
3.1.2 Het geheugen............................................................................................................................... 22
3.1.3 Ouderdom (senescentie) .............................................................................................................. 22
3.1.4 MMSE .......................................................................................................................................... 23
3.2 Dementie ........................................................................................................................................... 23
, 3.2.1 Epidemiologie .............................................................................................................................. 23
3.2.2 Klinische kenmerken .................................................................................................................... 24
3.2.3 Indeling ....................................................................................................................................... 25
3.2.4 Dementie van het alzheimer-type (DAT) ........................................................................................ 26
3.2.5 Vasculaire dementie .................................................................................................................... 27
3.2.6 Diagnostiek.................................................................................................................................. 27
3.2.7 Behandeling................................................................................................................................. 28
3.3 Delirium ............................................................................................................................................. 28
3.3.1 Epidemiologie .............................................................................................................................. 28
3.3.2 DSM ............................................................................................................................................ 28
3.3.3 Subtypes ..................................................................................................................................... 29
3.3.4 Behandeling................................................................................................................................. 29
3.4 Amnetische stoornissen ..................................................................................................................... 29
4. Middelengerelateerde stoornissen ........................................................................................................... 30
4.1 Inleiding ............................................................................................................................................. 30
4.2 Stoornissen in het gebruik ................................................................................................................... 30
4.2.1 Misbruik van een middel ............................................................................................................... 30
4.2.2 Middelenafhankelijkheid .............................................................................................................. 30
4.2.3 Intoxicatie door een middel .......................................................................................................... 31
4.2.4 Onthouding van een middel .......................................................................................................... 31
4.3 Psychoactieve stoffen ........................................................................................................................ 31
4.3.1 Indeling – algemeen ..................................................................................................................... 31
4.3.2 Alcoholgebruik – epidemiologie .................................................................................................... 32
4.3.3 Alcoholgebruik – richtlijnen alcohol .............................................................................................. 32
4.3.4 Alcohol – stoornissen door het gebruik.......................................................................................... 32
4.3.5 Drugs – stoornissen door het gebruik ............................................................................................ 33
4.4 Middelen gerelateerde en verslavingsstoornissen ................................................................................ 33
4.4.1 Diagnostiek.................................................................................................................................. 33
4.4.2 Etiopathogenese .......................................................................................................................... 34
4.4.3 Prognose ..................................................................................................................................... 35
4.4.4 Behandeling................................................................................................................................. 35
5. Schizofrenie en andere psychotische stoornissen ..................................................................................... 36
5.1 Psychotische stoornissen ................................................................................................................... 36
5.2 Schizofrenie ....................................................................................................................................... 36
5.2.1 Klinische criteria .......................................................................................................................... 36
5.2.2 Kenmerken .................................................................................................................................. 36
5.2.3 Co-morbiditeit ............................................................................................................................. 38
5.2.4 Differentiële diagnostiek ........................................................................................................... 38
5.2.5 Diagnostiek.................................................................................................................................. 38
, 5.2.6 Epidemiologie .............................................................................................................................. 38
5.2.7 Etiopathogenese – stresskwetsbaarheidsmodel............................................................................ 39
5.2.8 Prodromen – Eerste verschijnselen ............................................................................................... 39
5.2.9 De psychose ................................................................................................................................ 39
5.2.10 Genetische factor ...................................................................................................................... 39
5.2.11Neurobiologische afwijkingen...................................................................................................... 40
5.2.12 Stresskwetsbaarheidsmodel ...................................................................................................... 40
5.2.13 Preventie ................................................................................................................................... 40
5.2.14 Behandeling ............................................................................................................................... 41
5.3 Schizofreniforme stoornis ................................................................................................................... 42
5.4 Schizoaffectieve stoornis .................................................................................................................... 42
5.5 Waanstoornis ..................................................................................................................................... 43
5.6 Kortdurende psychotische stoornis ..................................................................................................... 43
5.7 Gedeelde psychotische stoornis ......................................................................................................... 43
6. Stemmingsstoornissen ............................................................................................................................ 44
6.1 Symptoomcriteria............................................................................................................................... 44
6.1.1 Depressieve episode (5 of meer) ................................................................................................... 44
6.1.2 Manische episode ........................................................................................................................ 44
6.1.3 Hypomane episode ...................................................................................................................... 44
6.1.4 Gemengde episode ...................................................................................................................... 45
6.2 Depressieve stemmingsstoornissen.................................................................................................... 45
6.2.1 Depressieve stoornis - specificaties ............................................................................................. 45
6.2.2 Dysthyme stoornis ....................................................................................................................... 45
6.2.3 Andere ......................................................................................................................................... 45
6.3 Bipolaire stemmingsstoornissen ......................................................................................................... 46
6.3.1 Bipolaire stoornis – algemeen ....................................................................................................... 46
6.3.2 Cyclothyme stoornis .................................................................................................................... 46
6.3.3 Andere ......................................................................................................................................... 46
6.4 Diagnostiek ........................................................................................................................................ 46
6.5 Differentiële diagnose & comorbiditeit ................................................................................................ 47
6.6 Epidemiologie .................................................................................................................................... 47
6.7 Etiopathogenese / fysiopathogese ...................................................................................................... 47
6.8 Stress, HPA en depressie .................................................................................................................... 48
6.9 Etiopathogenese /psychopathogenese ............................................................................................... 48
6.10 Verklaringsmodel ............................................................................................................................. 49
6.11 Prognose depressieve stoornis – Beloop............................................................................................ 49
6.12 Behandeling ..................................................................................................................................... 49
6.13 Suïcide ............................................................................................................................................. 50
6.13.1 Prevalentie................................................................................................................................. 50
, 6.13.2 Proces ....................................................................................................................................... 51
7. Angst- en eetstoornissen.......................................................................................................................... 52
7.1 Inleiding ............................................................................................................................................. 52
7.1.1 Begrip Angst................................................................................................................................. 52
7.1.2 Cerebraal angstcircuit .................................................................................................................. 52
7.2 Generieke behandeling ....................................................................................................................... 52
7.3 Beschrijving specifieke angststoornissen ............................................................................................ 52
7.3.1 Specifieke fobie ........................................................................................................................... 52
7.3.2 Paniekstoornis ............................................................................................................................. 53
7.3.3 Agorafobie ................................................................................................................................... 54
7.3.4 Paniekstoornis en agorafobie – Etiopathogenese en behandeling................................................... 54
7.3.5 Sociale fobie ................................................................................................................................ 54
7.3.6 Obsessieve-compulsieve stoornis (OCS) ...................................................................................... 55
7.3.7 Gegeneraliseerde angststoornis (GAS) .......................................................................................... 55
7.3.8 Posttraumatische stresstoornis .................................................................................................... 56
7.3.9 Acute stresstoornis ...................................................................................................................... 57
7.3.10 Angststoornis door somatische aandoeningen en middelen ........................................................ 57
7.4 Eetstoornissen ................................................................................................................................... 58
7.4.1 Anorexia Nervosa ......................................................................................................................... 58
7.4.2 Bulimia Nervosa........................................................................................................................... 58
7.4.3 Diagnostiek.................................................................................................................................. 59
7.4.4 Etiopathogenese .......................................................................................................................... 59
7.4.5 Behandeling................................................................................................................................. 60
8. Ontwikkelings- en gedragsstoornissen...................................................................................................... 61
8.1 Inleiding (specificiteit) ........................................................................................................................ 61
8.1.1 Specificiteit Kinder- en jeugdpsychiatrie ....................................................................................... 61
8.1.2 Definitie psychiatrische stoornis bij kinderen en jongeren .............................................................. 61
8.1.3 Prevalentie .................................................................................................................................. 61
8.2 Ontwikkelingsstoornissen................................................................................................................... 61
8.2.1 ADHD .......................................................................................................................................... 61
8.2.2 Autismespectrumstoornis ............................................................................................................ 64
8.3 Gedragsstoornissen – Externaliserende stoornissen ............................................................................ 66
8.3.1 Algemeen .................................................................................................................................... 66
8.3.2 Oppositionele-opstandige stoornis - Oppositional defiant disorder/ODD ....................................... 67
8.3.3 Normoverschrijdend-gedragsstoornis - Conduct disorder ............................................................. 67
8.3.4 Epidemiologie .............................................................................................................................. 68
8.3.5 Etiopathogenese .......................................................................................................................... 68
8.5.6 Behandeling................................................................................................................................. 69
9. Slaapstoornissen ..................................................................................................................................... 70
