KLINISCHE PSYCHIATRIE
1
,Inhoudsopgave
LESINHOUD ................................................................................................................................13
INLEIDING: GEBRUIK VAN DE DSM-5.............................................................................................13
MENU ............................................................................................................................................ 13
INLEIDING: PSYCHOPATHOLOGIE................................................................................................... 13
INLEIDING: PSYCHIATRISCHE STOORNIS ........................................................................................ 14
Verklaringsmodellen: .................................................................................................................. 14
Voorbeeld: bio-psycho-sociaal model.......................................................................................... 15
CLASSIFICATIE ............................................................................................................................... 16
Drie soorten classificaties ........................................................................................................... 16
.................................................................................................................................................. 16
DSM/ICD .................................................................................................................................... 17
DSM: voor- en nadelen ................................................................................................................ 18
DSM: geschiedenis ..................................................................................................................... 19
DIAGNOSTIEK ................................................................................................................................ 19
Verschillen tussen classificatie en diagnostiek ............................................................................ 19
OPZET DSM-5................................................................................................................................. 20
Veranderingen deel II .................................................................................................................. 20
Deel III: Aandoeningen die verder onderzoek behoeven ................................................................. 21
STELLINGEN .................................................................................................................................. 21
DSM-5 Stellingen ........................................................................................................................ 21
CONCLUSIE ................................................................................................................................... 22
INLEIDING ...................................................................................................................................22
NORMALITEIT + PSYCHOPATHOLOGIE ............................................................................................ 22
Normaliteit ................................................................................................................................. 22
Criteria normaliteit .................................................................................................................. 23
Probleem van de subjectiviteit ................................................................................................. 24
EPIDEMIOLOGIE ............................................................................................................................ 24
Verloop psychische stoornis........................................................................................................ 25
Acuut verloop ......................................................................................................................... 25
Intermitterend verloop............................................................................................................. 26
Statisch verloop ...................................................................................................................... 26
Progressief verloop ................................................................................................................. 26
2
, Ongelijkheden in psychiatrische morbiditeit ................................................................................. 26
Algemene prevalentie ................................................................................................................. 27
ETIOPATHOGENESE ....................................................................................................................... 27
Fysiopathogenese + Psychopathogense ....................................................................................... 27
FYSIOPATHOGENESE ..................................................................................................................... 28
Genetica .................................................................................................................................... 28
Wisselwerking tussen genen en omgevingsfacoren ................................................................... 28
Genetisch kwetsbaarheidsmodel ............................................................................................. 29
Heritabiliteit ........................................................................................................................... 30
Basisvragen genetisch onderzoek ............................................................................................ 30
Genotype x Leeftijd interactie .................................................................................................. 31
Gen-omgeving-Gen ................................................................................................................. 31
Algemene heritabiliteit in grafiek .............................................................................................. 32
Schizofrenie ........................................................................................................................... 32
Neurotransmitters ...................................................................................................................... 33
PSYCHOPATHOGENESE ................................................................................................................. 33
Psychologisch perspectief .......................................................................................................... 33
Psychische functies: Stoornis in het psychisch functioneren (symptoom benadering) ..................... 35
1: Expressie en psychomotoriek: .............................................................................................. 35
2: Bewustzijn .......................................................................................................................... 35
3: Zelfbeleving ........................................................................................................................ 36
4: Waarneming (perceptie) : ..................................................................................................... 37
5: Denken en geheugen ........................................................................................................... 38
6: Gevoelen en verlangen ........................................................................................................ 38
Psychiatrisch onderzoek ............................................................................................................. 39
Anamnese .............................................................................................................................. 39
Onderzoek .............................................................................................................................. 40
Beeldvorming ......................................................................................................................... 41
1: KLINISCHE PSYCHIATRIE: NEUROCOGNITIEVE STOORNISSEN ..................................................... 42
NEUROCOGNITIEVE STOORNISSEN ................................................................................................ 42
Epidemiologie ............................................................................................................................ 42
Algemeen - Vergrijzing van de bevolking in België ...................................................................... 43
Het geheugen ............................................................................................................................. 43
Verschillende geheugencapaciteiten ........................................................................................ 43
Ouderdom (senescentie) ............................................................................................................ 44
Neuropsychologische testen ....................................................................................................... 44
3
, Kloktest .................................................................................................................................. 45
DEMENTIE ..................................................................................................................................... 45
Geheugen en veroudering ........................................................................................................... 45
Epidemiologie – Expertisecentrum dementie Vlaanderen .............................................................. 45
Klinische Kenmerken Algemeen ................................................................................................... 46
Oriëntatieproblemen ............................................................................................................... 47
Geheugenstoornissen – inprenting ........................................................................................... 47
Geheugenstoornissen - recent geheugen.................................................................................. 48
Geheugenstoornissen - langer geheugen .................................................................................. 48
Stoornis in abstract denken en het oordeelsvermogen ............................................................... 48
Afasie (corticale functiestoornissen) ....................................................................................... 49
Apraxie (corticale functiestoornissen) ..................................................................................... 49
Agnosie (corticale functiestoornissen) ..................................................................................... 49
Gedragsveranderingen ............................................................................................................ 50
Bijkomende symptomen .......................................................................................................... 50
Indeling ...................................................................................................................................... 50
Dementie van het alzheimer-type (DAT)/ Degeneratieve oorzaken .............................................. 51
Etiopathogenese ................................................................................................................. 52
Prognose ............................................................................................................................ 52
Neuropsychologische testen: MMSE..................................................................................... 52
Vasculaire dementie ............................................................................................................... 52
Andere vormen van dementie .................................................................................................. 53
Parkinson............................................................................................................................ 53
Diagnostiek ................................................................................................................................ 53
Dementie - Depressie .............................................................................................................. 54
Behandeling ............................................................................................................................... 54
DELIRIUM ...................................................................................................................................... 55
Epidemiologie ............................................................................................................................ 55
DSM........................................................................................................................................... 55
Subtypes .................................................................................................................................... 56
Delirium-dementie-depressie ..................................................................................................... 56
Behandeling ............................................................................................................................... 56
AMNESTISCHE STOORNISSEN ........................................................................................................ 56
2: MIDDELENGERELATEERDE EN VERSLAVINGSSTOORNISSEN ......................................................57
STOORNISSEN IN HET GEBRUIK...................................................................................................... 57
Misbruik van een middel ............................................................................................................. 58
4
, Middelenafhankelijkheid ............................................................................................................. 59
STOORNISSEN DOOR HET GEBRUIK ............................................................................................... 59
Intoxicatie door een middel ......................................................................................................... 59
Onthouding van een middel......................................................................................................... 60
PSYCHOACTIEVE STOFFEN ............................................................................................................ 60
Indeling - algemeen .................................................................................................................... 61
ALCOHOLGEBRUIK ........................................................................................................................ 62
Epidemiologie ............................................................................................................................ 62
Richtlijnen alcohol ...................................................................................................................... 62
ALCOHOL ...................................................................................................................................... 62
Stoornissen door het gebruik ....................................................................................................... 62
DRUGS .......................................................................................................................................... 63
Stoornissen door het gebruik ....................................................................................................... 63
DIAGNOSTIEK ................................................................................................................................ 63
EPIOPATHOGENESE ....................................................................................................................... 64
Motivationeel systeem ................................................................................................................ 65
Controle systeem ....................................................................................................................... 65
PROGNOSE ................................................................................................................................... 66
BEHANDELING .............................................................................................................................. 66
5 Fasen die iemand doorloopt bij het stoppen of verminderen van verslavingen .............................. 67
Precontemplatie ......................................................................................................................... 67
Contemplatie ............................................................................................................................. 67
Beslissen/voorbereiden .............................................................................................................. 67
Uitvoeren ................................................................................................................................... 67
Terugvallen ................................................................................................................................. 67
Abstinentie behouden ................................................................................................................. 68
3: SCHRIZOFRENIE EN ANDERE PSYCHOTISCHE STOORNISEEN ....................................................69
INDELING ...................................................................................................................................... 69
PSYCHOTISCHE STOORNISSEN ...................................................................................................... 70
SCHIZOFRENIE .............................................................................................................................. 70
Kenmerken ................................................................................................................................. 71
Algemeen ............................................................................................................................... 71
Denkstoornissen: formeel/inhoudelijk ...................................................................................... 71
5
, Waarnemingsstoornissen ........................................................................................................ 72
Ernstig chaotisch of katatoon gedrag ........................................................................................ 73
Negatieve symptomen............................................................................................................. 73
Co-morbiditeit ............................................................................................................................ 74
Differentiële diagnostiek ............................................................................................................. 74
Diagnostiek ................................................................................................................................ 74
Epidemiologie ............................................................................................................................ 75
Etiopathogenese – Stresskwetsbaarheidsmodel ........................................................................... 75
Prodromen - De eerste verschijnselen .......................................................................................... 76
Prodromen ............................................................................................................................. 76
De psychose .............................................................................................................................. 76
Genetische factoren ................................................................................................................... 77
Neurobiologische afwijkingen ..................................................................................................... 77
Stresskwetsbaarheidsmodel ....................................................................................................... 78
Preventie .................................................................................................................................... 78
Behandeling - Algemeen ............................................................................................................. 78
Behandeling – Medicatie.......................................................................................................... 79
Psychosociale interventies ...................................................................................................... 80
Beloop – 4 fasen ......................................................................................................................... 81
SCHIZOFRENIFORME STOORNIS .................................................................................................... 81
Klinische criteria ......................................................................................................................... 81
WAANSTOORNIS ............................................................................................................................ 82
Varianten ................................................................................................................................... 83
KORTDURENDE PSYCHOTISCHE STOORNIS .................................................................................... 83
Klinische criteria ......................................................................................................................... 83
GEDEELDE PSYCHOTISCHE STOORNIS ........................................................................................... 83
Klinische criteria ......................................................................................................................... 83
4: STEMMINGSSTOORNISSEN ......................................................................................................84
INHOUD ........................................................................................................................................ 84
STEMMINGSSTOORNISSEN ............................................................................................................ 84
Symptoomcriteria (5 of meer) depressieve episode ....................................................................... 84
Symptoomcriteria manische episode........................................................................................... 85
Manisch vs. depressief ................................................................................................................ 85
Symptoomcriteria hypomane episode ......................................................................................... 85
Symptoomcriteria gemengde episode .......................................................................................... 86
6
, DEPRESSIEVE STEMMINGSSTOORNISSEN ...................................................................................... 86
Depressieve stoornis - specificaties ............................................................................................. 86
Dysthyme stoornis ...................................................................................................................... 87
BIOPOLAIRE STEMMINGSSTOORNISSEN......................................................................................... 87
Bipolaire stoornis / algemeen ...................................................................................................... 87
Cyclothyme stoornis ................................................................................................................... 88
Diagnostiek ................................................................................................................................ 88
Differentiële diagnose & comorbiditeit ......................................................................................... 89
EPIDEMIOLOGIE ............................................................................................................................ 89
ETIOPATHOGENESE / FYSIOPATHOGESE ......................................................................................... 89
PROGNOSE DEPRESSIEVE STOORNIS – BELOOP ............................................................................. 91
BEHANDELING .............................................................................................................................. 92
Algemeen ................................................................................................................................... 92
Psychotherapie........................................................................................................................... 92
Alternatieve behandelingen ......................................................................................................... 93
SUÏCIDE ........................................................................................................................................ 94
Suïcidaal proces ......................................................................................................................... 94
Ontremmende factoren .............................................................................................................. 95
Beschermende factoren .............................................................................................................. 95
Exploratie suïcidaliteit (Suicidepreventievlaanderen) .................................................................... 95
5 : ANGSTSTOORNISSEN ..............................................................................................................96
INHOUD ........................................................................................................................................ 96
INLEIDING ..................................................................................................................................... 96
Het begrip ‘angst’ ........................................................................................................................ 96
Cerebraal angstcircuit ................................................................................................................. 96
GENERIEKE BEHANDELING ............................................................................................................ 97
BESCHRIJVIN SPECIFIEKE ANGSTSTOORNISSEN ............................................................................. 97
Overzicht ................................................................................................................................... 97
Specifieke fobie .......................................................................................................................... 98
Kenmerken ............................................................................................................................. 98
Etiopathogenese : ................................................................................................................... 99
Behandeling :.......................................................................................................................... 99
Paniekstoornis............................................................................................................................ 99
Kenmerken paniekaanval ...................................................................................................... 100
7
, Agorafobie................................................................................................................................ 100
Etiopathogenese : paniekstoornis en agorafobie ..................................................................... 101
Behandeling : paniekstoornis en agorafobie ............................................................................ 102
Sociale fobie ............................................................................................................................ 102
Kenmerken ........................................................................................................................... 102
Etiopathogenese en behandeling ........................................................................................... 102
Obsessief-compulsieve stoornis (OCS/OCD) ............................................................................. 103
Etiopathogenese en behandeling ........................................................................................... 103
Gegeneraliseerde angststoornis (GAS) ....................................................................................... 104
Behandeling ......................................................................................................................... 104
Posttraumatische stressstoornis (PTSS/PTSD) ............................................................................ 105
Etiopathogenese ................................................................................................................... 106
Behandeling ......................................................................................................................... 106
Acute stressstoornis ................................................................................................................. 107
Kenmerken ........................................................................................................................... 107
6 : EETSTOORNISSEN ................................................................................................................. 108
INHOUD ...................................................................................................................................... 108
ANOREXIA NERVOSA .................................................................................................................... 108
Kenmerken ............................................................................................................................... 108
Klinische presentatie ............................................................................................................. 109
BULIMIA NERVOSA ....................................................................................................................... 109
Kenmerken ............................................................................................................................... 109
Differentiële diagnose & Comorbiditeit ...................................................................................... 110
DIAGNOSTIEK .............................................................................................................................. 110
ETIOPATHOGENESE ..................................................................................................................... 110
BEHANDELING ............................................................................................................................ 111
7: KINDER- EN JEUGDPSYCHIATRIE ............................................................................................ 112
INHOUD ...................................................................................................................................... 112
INLEIDING ................................................................................................................................... 112
Definitie psychiatrische stoornis bij kinderen en jongeren ........................................................... 112
Kinderpsychiatrische stoornissen prevalentie............................................................................. 113
ONTWIKKELINGSSTOORNISSEN ................................................................................................... 113
ADHD ...................................................................................................................................... 113
Klinische kenmerken ............................................................................................................. 113
8
, Klinisch beeld ....................................................................................................................... 113
ADHD Kernsymptomen - Bijkomende diagnostische criteria ................................................ 113
Ontwikkelingspsychopathologie – Infants & peuters ............................................................ 114
Ontwikkelingspsychopathologie – Kleuters ......................................................................... 114
Ontwikkelingspsychopathologie – Lagere schoolleeftijd ...................................................... 114
Ontwikkelingspsychopathologie - Adolescenten ................................................................. 115
Ontwikkelingpsychopathologie - Volwassenen .................................................................... 115
Ontwikkelingsverloop ........................................................................................................ 115
Classificatie ......................................................................................................................... 116
Epidemiologie/ prevalentie .................................................................................................... 116
Behandeling ......................................................................................................................... 116
ASS / Autismespectrumstoornis ................................................................................................ 118
Klinische kenmerken ............................................................................................................. 118
Screening ......................................................................................................................... 119
ASS – Classificatie ................................................................................................................ 120
Epidemiologie ....................................................................................................................... 120
Prevalentie ........................................................................................................................ 120
Etiopathogenese – psychopathogenese .................................................................................. 121
Comorbiditeit ....................................................................................................................... 122
Behandeling ......................................................................................................................... 122
GEDRAGSSTOORNISSEN .............................................................................................................. 123
Externaliserende stoornissen .................................................................................................... 123
Algemeen ............................................................................................................................. 123
Oppositionele-opstandige stoornis/ODD ................................................................................... 123
Classificatiecriteria DSM5 ..................................................................................................... 123
Normoverschrijdend-gedragsstoornis (Conduct disorder) ........................................................... 124
Classificatiecriteria DSM5 ..................................................................................................... 124
Beloop ..................................................................................................................................... 125
Epidemiologie .......................................................................................................................... 125
Etiopathogenese ...................................................................................................................... 125
Individuele risicofactoren ...................................................................................................... 125
Contextuele risicofactoren .................................................................................................... 126
Sociale risicofactoren ........................................................................................................... 126
Risicofactoren m.b.t. woonomgeving...................................................................................... 126
Ontwikkelingsmodel / Taxonomie van Moffit ........................................................................... 127
Ontwikkelingsmodel / Patterson ............................................................................................ 127
Behandeling ............................................................................................................................. 128
9
, 8: SLAAPSTOORNISSEN ............................................................................................................. 129
OVERZICHT ................................................................................................................................. 129
HET SLAAPPROCES ...................................................................................................................... 129
Algemeen ................................................................................................................................. 129
DYSSOMNIA................................................................................................................................. 130
Primaire insomnia/Primaire hypersomnia ................................................................................... 130
Narcolepsie ............................................................................................................................. 131
Slaapgebonden ademhalingsstoornis ........................................................................................ 131
Slaapstoornis gebonden aan de circadiane ritmiek ..................................................................... 131
Intrinsieke stoornis: .............................................................................................................. 131
Extrinsieke stoornis: .............................................................................................................. 132
Dyssomnia Niet Anderszins Omschreven / restcategorie ............................................................. 132
PARASOMNIA............................................................................................................................... 133
Nachtmerries ........................................................................................................................... 133
Pavor nocturnus ....................................................................................................................... 133
Slaapwandelen......................................................................................................................... 133
BEHADNELING DYSSOMNIA ......................................................................................................... 134
Insomnia/hypersomnia ............................................................................................................. 134
Narcolepsie ............................................................................................................................. 134
Andere ..................................................................................................................................... 134
BEHANDELING PARASOMNIA ....................................................................................................... 135
9: SEKSUELE STOORNISSEN ....................................................................................................... 136
INHOUD ...................................................................................................................................... 136
SEKSUELE DISFUNCTIE ................................................................................................................ 136
De seksuele respons cyclus ...................................................................................................... 136
Kenmerken ............................................................................................................................... 137
Seksuele pijnstoornissen .......................................................................................................... 137
Diagnostiek .............................................................................................................................. 137
Etiopathogenese ...................................................................................................................... 138
Behandeling ............................................................................................................................. 138
PARAFILIE .................................................................................................................................... 139
Drangstoornissen ..................................................................................................................... 139
Dwang-drang ........................................................................................................................ 139
Kenmerken ............................................................................................................................... 139
10
1
,Inhoudsopgave
LESINHOUD ................................................................................................................................13
INLEIDING: GEBRUIK VAN DE DSM-5.............................................................................................13
MENU ............................................................................................................................................ 13
INLEIDING: PSYCHOPATHOLOGIE................................................................................................... 13
INLEIDING: PSYCHIATRISCHE STOORNIS ........................................................................................ 14
Verklaringsmodellen: .................................................................................................................. 14
Voorbeeld: bio-psycho-sociaal model.......................................................................................... 15
CLASSIFICATIE ............................................................................................................................... 16
Drie soorten classificaties ........................................................................................................... 16
.................................................................................................................................................. 16
DSM/ICD .................................................................................................................................... 17
DSM: voor- en nadelen ................................................................................................................ 18
DSM: geschiedenis ..................................................................................................................... 19
DIAGNOSTIEK ................................................................................................................................ 19
Verschillen tussen classificatie en diagnostiek ............................................................................ 19
OPZET DSM-5................................................................................................................................. 20
Veranderingen deel II .................................................................................................................. 20
Deel III: Aandoeningen die verder onderzoek behoeven ................................................................. 21
STELLINGEN .................................................................................................................................. 21
DSM-5 Stellingen ........................................................................................................................ 21
CONCLUSIE ................................................................................................................................... 22
INLEIDING ...................................................................................................................................22
NORMALITEIT + PSYCHOPATHOLOGIE ............................................................................................ 22
Normaliteit ................................................................................................................................. 22
Criteria normaliteit .................................................................................................................. 23
Probleem van de subjectiviteit ................................................................................................. 24
EPIDEMIOLOGIE ............................................................................................................................ 24
Verloop psychische stoornis........................................................................................................ 25
Acuut verloop ......................................................................................................................... 25
Intermitterend verloop............................................................................................................. 26
Statisch verloop ...................................................................................................................... 26
Progressief verloop ................................................................................................................. 26
2
, Ongelijkheden in psychiatrische morbiditeit ................................................................................. 26
Algemene prevalentie ................................................................................................................. 27
ETIOPATHOGENESE ....................................................................................................................... 27
Fysiopathogenese + Psychopathogense ....................................................................................... 27
FYSIOPATHOGENESE ..................................................................................................................... 28
Genetica .................................................................................................................................... 28
Wisselwerking tussen genen en omgevingsfacoren ................................................................... 28
Genetisch kwetsbaarheidsmodel ............................................................................................. 29
Heritabiliteit ........................................................................................................................... 30
Basisvragen genetisch onderzoek ............................................................................................ 30
Genotype x Leeftijd interactie .................................................................................................. 31
Gen-omgeving-Gen ................................................................................................................. 31
Algemene heritabiliteit in grafiek .............................................................................................. 32
Schizofrenie ........................................................................................................................... 32
Neurotransmitters ...................................................................................................................... 33
PSYCHOPATHOGENESE ................................................................................................................. 33
Psychologisch perspectief .......................................................................................................... 33
Psychische functies: Stoornis in het psychisch functioneren (symptoom benadering) ..................... 35
1: Expressie en psychomotoriek: .............................................................................................. 35
2: Bewustzijn .......................................................................................................................... 35
3: Zelfbeleving ........................................................................................................................ 36
4: Waarneming (perceptie) : ..................................................................................................... 37
5: Denken en geheugen ........................................................................................................... 38
6: Gevoelen en verlangen ........................................................................................................ 38
Psychiatrisch onderzoek ............................................................................................................. 39
Anamnese .............................................................................................................................. 39
Onderzoek .............................................................................................................................. 40
Beeldvorming ......................................................................................................................... 41
1: KLINISCHE PSYCHIATRIE: NEUROCOGNITIEVE STOORNISSEN ..................................................... 42
NEUROCOGNITIEVE STOORNISSEN ................................................................................................ 42
Epidemiologie ............................................................................................................................ 42
Algemeen - Vergrijzing van de bevolking in België ...................................................................... 43
Het geheugen ............................................................................................................................. 43
Verschillende geheugencapaciteiten ........................................................................................ 43
Ouderdom (senescentie) ............................................................................................................ 44
Neuropsychologische testen ....................................................................................................... 44
3
, Kloktest .................................................................................................................................. 45
DEMENTIE ..................................................................................................................................... 45
Geheugen en veroudering ........................................................................................................... 45
Epidemiologie – Expertisecentrum dementie Vlaanderen .............................................................. 45
Klinische Kenmerken Algemeen ................................................................................................... 46
Oriëntatieproblemen ............................................................................................................... 47
Geheugenstoornissen – inprenting ........................................................................................... 47
Geheugenstoornissen - recent geheugen.................................................................................. 48
Geheugenstoornissen - langer geheugen .................................................................................. 48
Stoornis in abstract denken en het oordeelsvermogen ............................................................... 48
Afasie (corticale functiestoornissen) ....................................................................................... 49
Apraxie (corticale functiestoornissen) ..................................................................................... 49
Agnosie (corticale functiestoornissen) ..................................................................................... 49
Gedragsveranderingen ............................................................................................................ 50
Bijkomende symptomen .......................................................................................................... 50
Indeling ...................................................................................................................................... 50
Dementie van het alzheimer-type (DAT)/ Degeneratieve oorzaken .............................................. 51
Etiopathogenese ................................................................................................................. 52
Prognose ............................................................................................................................ 52
Neuropsychologische testen: MMSE..................................................................................... 52
Vasculaire dementie ............................................................................................................... 52
Andere vormen van dementie .................................................................................................. 53
Parkinson............................................................................................................................ 53
Diagnostiek ................................................................................................................................ 53
Dementie - Depressie .............................................................................................................. 54
Behandeling ............................................................................................................................... 54
DELIRIUM ...................................................................................................................................... 55
Epidemiologie ............................................................................................................................ 55
DSM........................................................................................................................................... 55
Subtypes .................................................................................................................................... 56
Delirium-dementie-depressie ..................................................................................................... 56
Behandeling ............................................................................................................................... 56
AMNESTISCHE STOORNISSEN ........................................................................................................ 56
2: MIDDELENGERELATEERDE EN VERSLAVINGSSTOORNISSEN ......................................................57
STOORNISSEN IN HET GEBRUIK...................................................................................................... 57
Misbruik van een middel ............................................................................................................. 58
4
, Middelenafhankelijkheid ............................................................................................................. 59
STOORNISSEN DOOR HET GEBRUIK ............................................................................................... 59
Intoxicatie door een middel ......................................................................................................... 59
Onthouding van een middel......................................................................................................... 60
PSYCHOACTIEVE STOFFEN ............................................................................................................ 60
Indeling - algemeen .................................................................................................................... 61
ALCOHOLGEBRUIK ........................................................................................................................ 62
Epidemiologie ............................................................................................................................ 62
Richtlijnen alcohol ...................................................................................................................... 62
ALCOHOL ...................................................................................................................................... 62
Stoornissen door het gebruik ....................................................................................................... 62
DRUGS .......................................................................................................................................... 63
Stoornissen door het gebruik ....................................................................................................... 63
DIAGNOSTIEK ................................................................................................................................ 63
EPIOPATHOGENESE ....................................................................................................................... 64
Motivationeel systeem ................................................................................................................ 65
Controle systeem ....................................................................................................................... 65
PROGNOSE ................................................................................................................................... 66
BEHANDELING .............................................................................................................................. 66
5 Fasen die iemand doorloopt bij het stoppen of verminderen van verslavingen .............................. 67
Precontemplatie ......................................................................................................................... 67
Contemplatie ............................................................................................................................. 67
Beslissen/voorbereiden .............................................................................................................. 67
Uitvoeren ................................................................................................................................... 67
Terugvallen ................................................................................................................................. 67
Abstinentie behouden ................................................................................................................. 68
3: SCHRIZOFRENIE EN ANDERE PSYCHOTISCHE STOORNISEEN ....................................................69
INDELING ...................................................................................................................................... 69
PSYCHOTISCHE STOORNISSEN ...................................................................................................... 70
SCHIZOFRENIE .............................................................................................................................. 70
Kenmerken ................................................................................................................................. 71
Algemeen ............................................................................................................................... 71
Denkstoornissen: formeel/inhoudelijk ...................................................................................... 71
5
, Waarnemingsstoornissen ........................................................................................................ 72
Ernstig chaotisch of katatoon gedrag ........................................................................................ 73
Negatieve symptomen............................................................................................................. 73
Co-morbiditeit ............................................................................................................................ 74
Differentiële diagnostiek ............................................................................................................. 74
Diagnostiek ................................................................................................................................ 74
Epidemiologie ............................................................................................................................ 75
Etiopathogenese – Stresskwetsbaarheidsmodel ........................................................................... 75
Prodromen - De eerste verschijnselen .......................................................................................... 76
Prodromen ............................................................................................................................. 76
De psychose .............................................................................................................................. 76
Genetische factoren ................................................................................................................... 77
Neurobiologische afwijkingen ..................................................................................................... 77
Stresskwetsbaarheidsmodel ....................................................................................................... 78
Preventie .................................................................................................................................... 78
Behandeling - Algemeen ............................................................................................................. 78
Behandeling – Medicatie.......................................................................................................... 79
Psychosociale interventies ...................................................................................................... 80
Beloop – 4 fasen ......................................................................................................................... 81
SCHIZOFRENIFORME STOORNIS .................................................................................................... 81
Klinische criteria ......................................................................................................................... 81
WAANSTOORNIS ............................................................................................................................ 82
Varianten ................................................................................................................................... 83
KORTDURENDE PSYCHOTISCHE STOORNIS .................................................................................... 83
Klinische criteria ......................................................................................................................... 83
GEDEELDE PSYCHOTISCHE STOORNIS ........................................................................................... 83
Klinische criteria ......................................................................................................................... 83
4: STEMMINGSSTOORNISSEN ......................................................................................................84
INHOUD ........................................................................................................................................ 84
STEMMINGSSTOORNISSEN ............................................................................................................ 84
Symptoomcriteria (5 of meer) depressieve episode ....................................................................... 84
Symptoomcriteria manische episode........................................................................................... 85
Manisch vs. depressief ................................................................................................................ 85
Symptoomcriteria hypomane episode ......................................................................................... 85
Symptoomcriteria gemengde episode .......................................................................................... 86
6
, DEPRESSIEVE STEMMINGSSTOORNISSEN ...................................................................................... 86
Depressieve stoornis - specificaties ............................................................................................. 86
Dysthyme stoornis ...................................................................................................................... 87
BIOPOLAIRE STEMMINGSSTOORNISSEN......................................................................................... 87
Bipolaire stoornis / algemeen ...................................................................................................... 87
Cyclothyme stoornis ................................................................................................................... 88
Diagnostiek ................................................................................................................................ 88
Differentiële diagnose & comorbiditeit ......................................................................................... 89
EPIDEMIOLOGIE ............................................................................................................................ 89
ETIOPATHOGENESE / FYSIOPATHOGESE ......................................................................................... 89
PROGNOSE DEPRESSIEVE STOORNIS – BELOOP ............................................................................. 91
BEHANDELING .............................................................................................................................. 92
Algemeen ................................................................................................................................... 92
Psychotherapie........................................................................................................................... 92
Alternatieve behandelingen ......................................................................................................... 93
SUÏCIDE ........................................................................................................................................ 94
Suïcidaal proces ......................................................................................................................... 94
Ontremmende factoren .............................................................................................................. 95
Beschermende factoren .............................................................................................................. 95
Exploratie suïcidaliteit (Suicidepreventievlaanderen) .................................................................... 95
5 : ANGSTSTOORNISSEN ..............................................................................................................96
INHOUD ........................................................................................................................................ 96
INLEIDING ..................................................................................................................................... 96
Het begrip ‘angst’ ........................................................................................................................ 96
Cerebraal angstcircuit ................................................................................................................. 96
GENERIEKE BEHANDELING ............................................................................................................ 97
BESCHRIJVIN SPECIFIEKE ANGSTSTOORNISSEN ............................................................................. 97
Overzicht ................................................................................................................................... 97
Specifieke fobie .......................................................................................................................... 98
Kenmerken ............................................................................................................................. 98
Etiopathogenese : ................................................................................................................... 99
Behandeling :.......................................................................................................................... 99
Paniekstoornis............................................................................................................................ 99
Kenmerken paniekaanval ...................................................................................................... 100
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, Agorafobie................................................................................................................................ 100
Etiopathogenese : paniekstoornis en agorafobie ..................................................................... 101
Behandeling : paniekstoornis en agorafobie ............................................................................ 102
Sociale fobie ............................................................................................................................ 102
Kenmerken ........................................................................................................................... 102
Etiopathogenese en behandeling ........................................................................................... 102
Obsessief-compulsieve stoornis (OCS/OCD) ............................................................................. 103
Etiopathogenese en behandeling ........................................................................................... 103
Gegeneraliseerde angststoornis (GAS) ....................................................................................... 104
Behandeling ......................................................................................................................... 104
Posttraumatische stressstoornis (PTSS/PTSD) ............................................................................ 105
Etiopathogenese ................................................................................................................... 106
Behandeling ......................................................................................................................... 106
Acute stressstoornis ................................................................................................................. 107
Kenmerken ........................................................................................................................... 107
6 : EETSTOORNISSEN ................................................................................................................. 108
INHOUD ...................................................................................................................................... 108
ANOREXIA NERVOSA .................................................................................................................... 108
Kenmerken ............................................................................................................................... 108
Klinische presentatie ............................................................................................................. 109
BULIMIA NERVOSA ....................................................................................................................... 109
Kenmerken ............................................................................................................................... 109
Differentiële diagnose & Comorbiditeit ...................................................................................... 110
DIAGNOSTIEK .............................................................................................................................. 110
ETIOPATHOGENESE ..................................................................................................................... 110
BEHANDELING ............................................................................................................................ 111
7: KINDER- EN JEUGDPSYCHIATRIE ............................................................................................ 112
INHOUD ...................................................................................................................................... 112
INLEIDING ................................................................................................................................... 112
Definitie psychiatrische stoornis bij kinderen en jongeren ........................................................... 112
Kinderpsychiatrische stoornissen prevalentie............................................................................. 113
ONTWIKKELINGSSTOORNISSEN ................................................................................................... 113
ADHD ...................................................................................................................................... 113
Klinische kenmerken ............................................................................................................. 113
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, Klinisch beeld ....................................................................................................................... 113
ADHD Kernsymptomen - Bijkomende diagnostische criteria ................................................ 113
Ontwikkelingspsychopathologie – Infants & peuters ............................................................ 114
Ontwikkelingspsychopathologie – Kleuters ......................................................................... 114
Ontwikkelingspsychopathologie – Lagere schoolleeftijd ...................................................... 114
Ontwikkelingspsychopathologie - Adolescenten ................................................................. 115
Ontwikkelingpsychopathologie - Volwassenen .................................................................... 115
Ontwikkelingsverloop ........................................................................................................ 115
Classificatie ......................................................................................................................... 116
Epidemiologie/ prevalentie .................................................................................................... 116
Behandeling ......................................................................................................................... 116
ASS / Autismespectrumstoornis ................................................................................................ 118
Klinische kenmerken ............................................................................................................. 118
Screening ......................................................................................................................... 119
ASS – Classificatie ................................................................................................................ 120
Epidemiologie ....................................................................................................................... 120
Prevalentie ........................................................................................................................ 120
Etiopathogenese – psychopathogenese .................................................................................. 121
Comorbiditeit ....................................................................................................................... 122
Behandeling ......................................................................................................................... 122
GEDRAGSSTOORNISSEN .............................................................................................................. 123
Externaliserende stoornissen .................................................................................................... 123
Algemeen ............................................................................................................................. 123
Oppositionele-opstandige stoornis/ODD ................................................................................... 123
Classificatiecriteria DSM5 ..................................................................................................... 123
Normoverschrijdend-gedragsstoornis (Conduct disorder) ........................................................... 124
Classificatiecriteria DSM5 ..................................................................................................... 124
Beloop ..................................................................................................................................... 125
Epidemiologie .......................................................................................................................... 125
Etiopathogenese ...................................................................................................................... 125
Individuele risicofactoren ...................................................................................................... 125
Contextuele risicofactoren .................................................................................................... 126
Sociale risicofactoren ........................................................................................................... 126
Risicofactoren m.b.t. woonomgeving...................................................................................... 126
Ontwikkelingsmodel / Taxonomie van Moffit ........................................................................... 127
Ontwikkelingsmodel / Patterson ............................................................................................ 127
Behandeling ............................................................................................................................. 128
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, 8: SLAAPSTOORNISSEN ............................................................................................................. 129
OVERZICHT ................................................................................................................................. 129
HET SLAAPPROCES ...................................................................................................................... 129
Algemeen ................................................................................................................................. 129
DYSSOMNIA................................................................................................................................. 130
Primaire insomnia/Primaire hypersomnia ................................................................................... 130
Narcolepsie ............................................................................................................................. 131
Slaapgebonden ademhalingsstoornis ........................................................................................ 131
Slaapstoornis gebonden aan de circadiane ritmiek ..................................................................... 131
Intrinsieke stoornis: .............................................................................................................. 131
Extrinsieke stoornis: .............................................................................................................. 132
Dyssomnia Niet Anderszins Omschreven / restcategorie ............................................................. 132
PARASOMNIA............................................................................................................................... 133
Nachtmerries ........................................................................................................................... 133
Pavor nocturnus ....................................................................................................................... 133
Slaapwandelen......................................................................................................................... 133
BEHADNELING DYSSOMNIA ......................................................................................................... 134
Insomnia/hypersomnia ............................................................................................................. 134
Narcolepsie ............................................................................................................................. 134
Andere ..................................................................................................................................... 134
BEHANDELING PARASOMNIA ....................................................................................................... 135
9: SEKSUELE STOORNISSEN ....................................................................................................... 136
INHOUD ...................................................................................................................................... 136
SEKSUELE DISFUNCTIE ................................................................................................................ 136
De seksuele respons cyclus ...................................................................................................... 136
Kenmerken ............................................................................................................................... 137
Seksuele pijnstoornissen .......................................................................................................... 137
Diagnostiek .............................................................................................................................. 137
Etiopathogenese ...................................................................................................................... 138
Behandeling ............................................................................................................................. 138
PARAFILIE .................................................................................................................................... 139
Drangstoornissen ..................................................................................................................... 139
Dwang-drang ........................................................................................................................ 139
Kenmerken ............................................................................................................................... 139
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