PSYCHOPATHOLOGIE EN PSYCHIATRIE : VOLWASSENEN
Examen bestaat uit 40 multiple choice vragen. 24 vragen over volwassenen. 16 vragen kinderpsychiatrie.
Inhoudstafel
Psychopathologie en psychiatrie: volwassenen ...................................................................................................... 1
Hoofdstuk 1: Diagnostiek (en DSM) .................................................................................................................. 18
Lessen ............................................................................................................................................................ 18
Leerstof ......................................................................................................................................................... 18
Madness (insanity) ........................................................................................................................................ 19
Thomas Sydenham UK, 1624-1689 ............................................................................................................... 19
Medisch model .............................................................................................................................................. 19
Medisch model: somatogene hypothese .................................................................................................. 20
Emil Kraeplin 1856-1926 ............................................................................................................................... 21
Nood aan classificatie neemt toe… ............................................................................................................... 22
DSM-I (1952) ................................................................................................................................................. 22
Psychofarmaca .......................................................................................................................................... 22
DSM-II (1968) ................................................................................................................................................ 23
DSM-III (1980) ............................................................................................................................................... 24
Diagnose (doel) ............................................................................................................................................. 24
Diagnose (typen) ........................................................................................................................................... 25
Struktuurdiagnose ..................................................................................................................................... 25
Struktuurdiagnose: beïnvloedende factoren ........................................................................................ 25
Casus Hans ............................................................................................................................................ 25
Classificatie (doel) ......................................................................................................................................... 28
Classificatie als Communicatie ...................................................................................................................... 28
Classificatie .................................................................................................................................................... 28
Kritiek op medisch model & DSM ................................................................................................................. 28
Anti-psychiatrie – Thomas Szasz (60-s) ..................................................................................................... 28
Robert E. Kendell, 2000 ............................................................................................................................. 29
On being sane in insane places – David Rosenhan 1973 ........................................................................... 29
Multivariate statistiek: categoriaal vs dimensionaal ................................................................................. 30
Lage betrouwbaarheid diagnosen: Classificatie ............................................................................................ 30
Consensus is geen wetenschap ..................................................................................................................... 31
Wat is een depressie (DSM-5 criteria) .......................................................................................................... 32
Depressie? ................................................................................................................................................. 33
DSM-Depressie: één vlag, vele ladingen ....................................................................................................... 34
1
, Hoofdstuk 2: Kwetsbaarheids-stressmodel............................................................................................... 34
Hoofdstuk 3: Psychotische stoornissen ............................................................................................................. 40
Casus John Nash ............................................................................................................................................ 40
Psychose ........................................................................................................................................................ 40
Gestoord realiteitsbesef? Reality testing .................................................................................................. 40
Psychotische episode .................................................................................................................................... 41
1.Wanen ........................................................................................................................................................ 41
Classificatie (niet exhaustief) .................................................................................................................... 41
Classificatie - thought interference – schneideriaanse eersterangsymptomen........................................ 42
Differentiaaldiagnose ................................................................................................................................ 42
Stoornissen van het denken .......................................................................................................................... 43
2.Hallucinaties: waarnemingsstoornissen..................................................................................................... 44
Classificatie ................................................................................................................................................ 45
unimodaal - multimodaal (poly-modaal - poly-sensorisch) ...................................................................... 45
unimodaal - multimodaal in schizophrenia spectrum disorders ............................................................... 45
Auditieve hallucinaties .............................................................................................................................. 45
Verwijzen stemmen naar schizofrenie? Nee ......................................................................................... 46
Stemmen bij gezonde individuen: verschillen met patiënten met schizofrenie ................................... 46
Visuele hallucinaties bij ouderen .............................................................................................................. 47
Syndroom van Charles Bonnet: ‘goeie hallucinaties’!! ......................................................................... 47
‘Bad hallucinations’: ouderen- parkinson, alzheimer, lewy body dementia, vascular dementia,
delirium ................................................................................................................................................. 48
Waarneminsstoornissen: illusie .................................................................................................................... 48
Waarnemingsstoornissen: metamorfopsie ............................................................................................... 49
Waarnemingsstoornissen: synesthesie (niet gezien) ................................................................................ 49
Psychose continuum: in de algemene populatie; prevalentie ...................................................................... 50
Psychotische belevingen: ‘normale variant’ ................................................................................................. 50
Hypnagoge en hypnopompe hallucinaties… tijdens het in slaap vallen en het wakker worden (niet
gezien) ....................................................................................................................................................... 50
Psychotische episode .................................................................................................................................... 51
Schizofrenie: DSM-5 ...................................................................................................................................... 51
Emil Kraeplin (1893) .................................................................................................................................. 51
Schizofrenie (-en): Eugen Bleuler (1911) ................................................................................................... 51
Fragmentatie van denkproces: Dissociatieve Identiteitsstoornis: case Carine ......................................... 52
4 A’s van Eugen Bleuler ............................................................................................................................. 52
Salience Dysregulation Syndrome ............................................................................................................. 52
Schizofrenie: symptoomdimensies ............................................................................................................... 53
2
, Kurt Schneider: first rank symptoms – symptomen eerste orde – schneideriaanse symptomen ............ 53
Negatieve symptomen: primair vs secundair!! ......................................................................................... 54
Affectieve symptomen .............................................................................................................................. 55
Gedragssymptomen .................................................................................................................................. 56
Cognitieve symptomen: verloop ............................................................................................................... 56
Casus Willy ................................................................................................................................................ 57
Subtypes: schizofrenie .............................................................................................................................. 57
Natuurlijk verloop: schizofrenie .................................................................................................................... 59
...................................................................................................................................................................... 59
Prodromale fase ........................................................................................................................................ 59
At Risk Mental State: vroegtijdige herkenning .......................................................................................... 59
Casis-cluster: vroegtijdige herkenning ...................................................................................................... 60
Risico op herval ............................................................................................................................................. 60
Casus David Helfgott ..................................................................................................................................... 61
Etiologie: risicofactoren ................................................................................................................................ 62
Risico op schizofrenie: in functie van genetische verwantschap .............................................................. 63
Zwangerschap: verwikkelingen ................................................................................................................. 63
Cannabis .................................................................................................................................................... 63
Cannabis-psychosis: persistence model .................................................................................................... 64
Cannabus & psychose: estimated RR of psychosis by level of cannabis use ............................................. 65
Expressed emotion: barometer van emoties in een familie ..................................................................... 66
Schizoaffectieve stoornis........................................................................................................................... 67
Casus Louise: waanstoornis ...................................................................................................................... 67
Waanstoornis: DSM-5 ................................................................................................................................... 68
subtype: Erotomane waan: syndroom van de clérambault ...................................................................... 68
Casus Peter ................................................................................................................................................ 69
Gedeelde psychotische stoornis: folie à deux – DSM-IV niet in DSM-5 ........................................................ 69
Schizofrenie: differentieel diagnose.............................................................................................................. 69
Hoofdstuk 4: Depressieve stemmingsstoornissen ............................................................................................ 69
IV > 5: categoriale benadering ...................................................................................................................... 69
IV > 5: dimensionele benadering................................................................................................................... 70
Stemmingsepisoden: bouwstenen ................................................................................................................ 71
Depressieve stoornis: er is nooit een hypomane of manische episode geweest (DSM-5 Criterium E) ........ 71
Symptomenclusters: depressie ..................................................................................................................... 71
Affectieve symptomen: 2 kernsymptomen .............................................................................................. 71
Lichamelijke symptomen: depressieve episode ........................................................................................ 72
Cognitieve symptomen: depressieve episode........................................................................................... 73
3
, DSM-Depressie: één vlag die vele ladingen dekt .......................................................................................... 73
9 Specifiers: depressieve stoornis en bipolaire stoornis ............................................................................... 74
‘Met angstige spanning’: depressieve stoornis ......................................................................................... 74
‘Met angstige spanning’: depressieve en bipolaire stemmingsstoornissen.............................................. 74
‘Met melancholische kenmerken’: melancholie ........................................................................................... 75
‘Met melancholische kenmerken’: vitale kenmerken -1 ........................................................................... 75
‘Met melancholische kenmerken’: vitale kenmerken -2 ........................................................................... 75
Model Gordon Parker: melancholia .......................................................................................................... 76
Depressie subtypes ................................................................................................................................... 77
Psychomotore stoornissen: model Gordon Parker ................................................................................... 77
Psychotische depressie: vaak miskend...................................................................................................... 78
Syndroom van Cotard: Jules Cotard (1840-1889) ......................................................................................... 79
Atypische depressie: met atypische kenmerken ........................................................................................... 79
Seizoensdepressie: met seizoensgebonden patroon ................................................................................ 79
Peripartale depressie: met begin peri partum (= depressie die begint in periode rond een bevalling) ....... 80
Prevalentie: peripartale depressie ............................................................................................................ 80
Maternity blues: kraamtranen .................................................................................................................. 80
Waarin verschilt PPD (postpartum depressie) van andere depressies ......................................................... 80
Postpartumpsychose: bipolaire stemmingsstoornis ..................................................................................... 81
Postpartum is risicofactor: bij individuele voorbeschiktheid ........................................................................ 82
Kahlbaum’s Katatonie ................................................................................................................................... 82
Catatonia: ≥3 of the following (symptomen van catatonie die in dsm zijn opgesomd) ................................ 83
Stupor ........................................................................................................................................................ 83
Ouderdomsdepressie: komt voor bij 60+ ...................................................................................................... 85
Ouderdomsdepressie: verschillen (jong)volwassenen .................................................................................. 85
Ouderdomsdepressie: andere stressfactoren ............................................................................................... 85
Eenzaamheid: ouderdomsdepressie - andere stressfactoren ....................................................................... 86
Ouderdomsdepressie: verschillen (jong)volwassenen .................................................................................. 86
Frailty: ouderdomsdepressie – biologische veroudering .............................................................................. 86
Frailty: Netherlands Study of Depression in Older Persons – NESDO ....................................................... 86
Ouderdomsdepressie: verschillen (jong)volwassenen .................................................................................. 87
Vasculaire depressie: Alexopoulos 1997 ....................................................................................................... 87
Differentiaaldiagnose .................................................................................................................................... 87
Depressie versus dementie ....................................................................................................................... 87
Rouw: DSM-5 ................................................................................................................................................ 88
Rouw: leidraad voor clinicus ......................................................................................................................... 88
Burn-out: werk-gerelateerde depressie (?) ................................................................................................... 88
4
Examen bestaat uit 40 multiple choice vragen. 24 vragen over volwassenen. 16 vragen kinderpsychiatrie.
Inhoudstafel
Psychopathologie en psychiatrie: volwassenen ...................................................................................................... 1
Hoofdstuk 1: Diagnostiek (en DSM) .................................................................................................................. 18
Lessen ............................................................................................................................................................ 18
Leerstof ......................................................................................................................................................... 18
Madness (insanity) ........................................................................................................................................ 19
Thomas Sydenham UK, 1624-1689 ............................................................................................................... 19
Medisch model .............................................................................................................................................. 19
Medisch model: somatogene hypothese .................................................................................................. 20
Emil Kraeplin 1856-1926 ............................................................................................................................... 21
Nood aan classificatie neemt toe… ............................................................................................................... 22
DSM-I (1952) ................................................................................................................................................. 22
Psychofarmaca .......................................................................................................................................... 22
DSM-II (1968) ................................................................................................................................................ 23
DSM-III (1980) ............................................................................................................................................... 24
Diagnose (doel) ............................................................................................................................................. 24
Diagnose (typen) ........................................................................................................................................... 25
Struktuurdiagnose ..................................................................................................................................... 25
Struktuurdiagnose: beïnvloedende factoren ........................................................................................ 25
Casus Hans ............................................................................................................................................ 25
Classificatie (doel) ......................................................................................................................................... 28
Classificatie als Communicatie ...................................................................................................................... 28
Classificatie .................................................................................................................................................... 28
Kritiek op medisch model & DSM ................................................................................................................. 28
Anti-psychiatrie – Thomas Szasz (60-s) ..................................................................................................... 28
Robert E. Kendell, 2000 ............................................................................................................................. 29
On being sane in insane places – David Rosenhan 1973 ........................................................................... 29
Multivariate statistiek: categoriaal vs dimensionaal ................................................................................. 30
Lage betrouwbaarheid diagnosen: Classificatie ............................................................................................ 30
Consensus is geen wetenschap ..................................................................................................................... 31
Wat is een depressie (DSM-5 criteria) .......................................................................................................... 32
Depressie? ................................................................................................................................................. 33
DSM-Depressie: één vlag, vele ladingen ....................................................................................................... 34
1
, Hoofdstuk 2: Kwetsbaarheids-stressmodel............................................................................................... 34
Hoofdstuk 3: Psychotische stoornissen ............................................................................................................. 40
Casus John Nash ............................................................................................................................................ 40
Psychose ........................................................................................................................................................ 40
Gestoord realiteitsbesef? Reality testing .................................................................................................. 40
Psychotische episode .................................................................................................................................... 41
1.Wanen ........................................................................................................................................................ 41
Classificatie (niet exhaustief) .................................................................................................................... 41
Classificatie - thought interference – schneideriaanse eersterangsymptomen........................................ 42
Differentiaaldiagnose ................................................................................................................................ 42
Stoornissen van het denken .......................................................................................................................... 43
2.Hallucinaties: waarnemingsstoornissen..................................................................................................... 44
Classificatie ................................................................................................................................................ 45
unimodaal - multimodaal (poly-modaal - poly-sensorisch) ...................................................................... 45
unimodaal - multimodaal in schizophrenia spectrum disorders ............................................................... 45
Auditieve hallucinaties .............................................................................................................................. 45
Verwijzen stemmen naar schizofrenie? Nee ......................................................................................... 46
Stemmen bij gezonde individuen: verschillen met patiënten met schizofrenie ................................... 46
Visuele hallucinaties bij ouderen .............................................................................................................. 47
Syndroom van Charles Bonnet: ‘goeie hallucinaties’!! ......................................................................... 47
‘Bad hallucinations’: ouderen- parkinson, alzheimer, lewy body dementia, vascular dementia,
delirium ................................................................................................................................................. 48
Waarneminsstoornissen: illusie .................................................................................................................... 48
Waarnemingsstoornissen: metamorfopsie ............................................................................................... 49
Waarnemingsstoornissen: synesthesie (niet gezien) ................................................................................ 49
Psychose continuum: in de algemene populatie; prevalentie ...................................................................... 50
Psychotische belevingen: ‘normale variant’ ................................................................................................. 50
Hypnagoge en hypnopompe hallucinaties… tijdens het in slaap vallen en het wakker worden (niet
gezien) ....................................................................................................................................................... 50
Psychotische episode .................................................................................................................................... 51
Schizofrenie: DSM-5 ...................................................................................................................................... 51
Emil Kraeplin (1893) .................................................................................................................................. 51
Schizofrenie (-en): Eugen Bleuler (1911) ................................................................................................... 51
Fragmentatie van denkproces: Dissociatieve Identiteitsstoornis: case Carine ......................................... 52
4 A’s van Eugen Bleuler ............................................................................................................................. 52
Salience Dysregulation Syndrome ............................................................................................................. 52
Schizofrenie: symptoomdimensies ............................................................................................................... 53
2
, Kurt Schneider: first rank symptoms – symptomen eerste orde – schneideriaanse symptomen ............ 53
Negatieve symptomen: primair vs secundair!! ......................................................................................... 54
Affectieve symptomen .............................................................................................................................. 55
Gedragssymptomen .................................................................................................................................. 56
Cognitieve symptomen: verloop ............................................................................................................... 56
Casus Willy ................................................................................................................................................ 57
Subtypes: schizofrenie .............................................................................................................................. 57
Natuurlijk verloop: schizofrenie .................................................................................................................... 59
...................................................................................................................................................................... 59
Prodromale fase ........................................................................................................................................ 59
At Risk Mental State: vroegtijdige herkenning .......................................................................................... 59
Casis-cluster: vroegtijdige herkenning ...................................................................................................... 60
Risico op herval ............................................................................................................................................. 60
Casus David Helfgott ..................................................................................................................................... 61
Etiologie: risicofactoren ................................................................................................................................ 62
Risico op schizofrenie: in functie van genetische verwantschap .............................................................. 63
Zwangerschap: verwikkelingen ................................................................................................................. 63
Cannabis .................................................................................................................................................... 63
Cannabis-psychosis: persistence model .................................................................................................... 64
Cannabus & psychose: estimated RR of psychosis by level of cannabis use ............................................. 65
Expressed emotion: barometer van emoties in een familie ..................................................................... 66
Schizoaffectieve stoornis........................................................................................................................... 67
Casus Louise: waanstoornis ...................................................................................................................... 67
Waanstoornis: DSM-5 ................................................................................................................................... 68
subtype: Erotomane waan: syndroom van de clérambault ...................................................................... 68
Casus Peter ................................................................................................................................................ 69
Gedeelde psychotische stoornis: folie à deux – DSM-IV niet in DSM-5 ........................................................ 69
Schizofrenie: differentieel diagnose.............................................................................................................. 69
Hoofdstuk 4: Depressieve stemmingsstoornissen ............................................................................................ 69
IV > 5: categoriale benadering ...................................................................................................................... 69
IV > 5: dimensionele benadering................................................................................................................... 70
Stemmingsepisoden: bouwstenen ................................................................................................................ 71
Depressieve stoornis: er is nooit een hypomane of manische episode geweest (DSM-5 Criterium E) ........ 71
Symptomenclusters: depressie ..................................................................................................................... 71
Affectieve symptomen: 2 kernsymptomen .............................................................................................. 71
Lichamelijke symptomen: depressieve episode ........................................................................................ 72
Cognitieve symptomen: depressieve episode........................................................................................... 73
3
, DSM-Depressie: één vlag die vele ladingen dekt .......................................................................................... 73
9 Specifiers: depressieve stoornis en bipolaire stoornis ............................................................................... 74
‘Met angstige spanning’: depressieve stoornis ......................................................................................... 74
‘Met angstige spanning’: depressieve en bipolaire stemmingsstoornissen.............................................. 74
‘Met melancholische kenmerken’: melancholie ........................................................................................... 75
‘Met melancholische kenmerken’: vitale kenmerken -1 ........................................................................... 75
‘Met melancholische kenmerken’: vitale kenmerken -2 ........................................................................... 75
Model Gordon Parker: melancholia .......................................................................................................... 76
Depressie subtypes ................................................................................................................................... 77
Psychomotore stoornissen: model Gordon Parker ................................................................................... 77
Psychotische depressie: vaak miskend...................................................................................................... 78
Syndroom van Cotard: Jules Cotard (1840-1889) ......................................................................................... 79
Atypische depressie: met atypische kenmerken ........................................................................................... 79
Seizoensdepressie: met seizoensgebonden patroon ................................................................................ 79
Peripartale depressie: met begin peri partum (= depressie die begint in periode rond een bevalling) ....... 80
Prevalentie: peripartale depressie ............................................................................................................ 80
Maternity blues: kraamtranen .................................................................................................................. 80
Waarin verschilt PPD (postpartum depressie) van andere depressies ......................................................... 80
Postpartumpsychose: bipolaire stemmingsstoornis ..................................................................................... 81
Postpartum is risicofactor: bij individuele voorbeschiktheid ........................................................................ 82
Kahlbaum’s Katatonie ................................................................................................................................... 82
Catatonia: ≥3 of the following (symptomen van catatonie die in dsm zijn opgesomd) ................................ 83
Stupor ........................................................................................................................................................ 83
Ouderdomsdepressie: komt voor bij 60+ ...................................................................................................... 85
Ouderdomsdepressie: verschillen (jong)volwassenen .................................................................................. 85
Ouderdomsdepressie: andere stressfactoren ............................................................................................... 85
Eenzaamheid: ouderdomsdepressie - andere stressfactoren ....................................................................... 86
Ouderdomsdepressie: verschillen (jong)volwassenen .................................................................................. 86
Frailty: ouderdomsdepressie – biologische veroudering .............................................................................. 86
Frailty: Netherlands Study of Depression in Older Persons – NESDO ....................................................... 86
Ouderdomsdepressie: verschillen (jong)volwassenen .................................................................................. 87
Vasculaire depressie: Alexopoulos 1997 ....................................................................................................... 87
Differentiaaldiagnose .................................................................................................................................... 87
Depressie versus dementie ....................................................................................................................... 87
Rouw: DSM-5 ................................................................................................................................................ 88
Rouw: leidraad voor clinicus ......................................................................................................................... 88
Burn-out: werk-gerelateerde depressie (?) ................................................................................................... 88
4
