2025
PRAKTISCHE
PSYCHOFARMACOLOGIE
PROF. DR. DIMITRI DE BUNDEL
ROXANNE KARLA DIDIER BOGAERT
VUB
,Inhoudsopgave
Basisbegrippen............................................................................................. 6
Overzicht cursus............................................................................................................. 6
Doelstellingen................................................................................................................. 6
Anatomie vd hersenen.................................................................................................... 7
Cerebrum..................................................................................................................... 7
Indeling:....................................................................................................................... 7
Neurotransmissie.......................................................................................................... 10
Aangrijpingspunten voor psychopharmaca...................................................................11
Ionenkanalen............................................................................................................. 12
Enzymen.................................................................................................................... 12
Carriers of transporters..............................................................................................13
Receptoren................................................................................................................ 13
Mechanismen van neuromodulatie...............................................................................13
Neurotransmitter en neuromodulator systemen...........................................................14
Middelengebruik..........................................................................................17
Aan middelen gebonden stoornissen............................................................................17
Het opponent process model.....................................................................................17
Het Koob model voor verslaving (verslavingscyclus).................................................17
Centrale stimulantia..................................................................................................... 17
Nicotine........................................................................................................................ 21
Verslavingspotentieel................................................................................................21
Middelen bij tabaksgebruik........................................................................................22
Samenvatting............................................................................................................ 22
Opioïden....................................................................................................................... 22
Endogene opioïden en opioïden receptoren...............................................................22
Tolerantie................................................................................................................... 23
Verslavingspotentieel................................................................................................23
Behandeling opioïde gebruik stoornis........................................................................23
Samenvatting............................................................................................................ 24
Cannabinoïden.............................................................................................................. 24
Farmacologisch overzicht.......................................................................................... 24
Therapeutische toepassingen....................................................................................24
Verslavingspotentieel................................................................................................25
Behandeling cannabis gebruik stoornis......................................................................25
Samenvatting............................................................................................................ 25
Alcohol (ethanol)........................................................................................................... 25
Farmacologisch overzicht.......................................................................................... 26
Verslavingspotentieel................................................................................................26
Neurotoxiciteit........................................................................................................... 26
Behandeling............................................................................................................... 26
Interacties.................................................................................................................. 27
Samenvatting............................................................................................................ 27
GHB/GBL....................................................................................................................... 28
Farmacologisch overzicht.......................................................................................... 28
Verslavingspotentieel................................................................................................28
Absences, diepe slaap, coma.....................................................................................28
Dissociatieve anesthetica............................................................................................. 28
2
, Pheniceline (PCP, "Angel Dust").................................................................................28
Ketamine (“Special K”)..............................................................................................29
Dextrometorphan (DXM)............................................................................................29
Verslavingspotentieel................................................................................................29
Samenvatting............................................................................................................ 30
Klassieke psychedelica................................................................................................. 30
Farmacologisch overzicht.......................................................................................... 30
Verslavingspotentieel................................................................................................30
Therapeutisch potentieel...........................................................................................30
Samenvatting............................................................................................................ 31
!!! Key points !!! middelen begonden stoornissen........................................................31
Behandeling ADHD.......................................................................................32
Geneesmiddelen voor behandeling van ADHD.............................................................32
DSM 5: Attention deficit hyperactivity disorder..........................................................32
Het netwerk model.................................................................................................... 32
Het “catecholamine arousal” model..........................................................................32
Behandeling............................................................................................................... 33
Verslavingspotentieel................................................................................................35
!!! Key points !!! behandeling van ADHD......................................................................36
Hypnotica & Sedativa...................................................................................36
Insomnia & andere slaapstoornissen............................................................................36
Slaap & alertheid.......................................................................................................... 36
SCN & circadiaan ritme..............................................................................................36
Hypnotica & sedativa.................................................................................................... 37
GABAA receptoren......................................................................................................... 38
Benzodiazepines........................................................................................................... 38
Werking & receptor – subtypes..................................................................................38
Indicaties................................................................................................................... 38
Neveneffecten........................................................................................................... 39
Contra – indicatie & indicatie.....................................................................................40
Flumazenil: bezo antagonist......................................................................................40
Z-drugs......................................................................................................................... 40
Neveneffecten........................................................................................................... 40
Melatonine.................................................................................................................... 41
Middelen obv planten................................................................................................... 41
Werking, neveneffecten, voorzorgen, interacties.......................................................41
Diversen....................................................................................................................... 41
Werking, neveneffecten, voorzorgen, interacties.......................................................41
Slapenloosheid: kernboodschappen.............................................................................41
Antipsychotica............................................................................................. 43
Psychotische stoornissen.............................................................................................. 43
Neurobiologische basis.............................................................................................. 43
Klassieke antipsychotica............................................................................................... 44
Atypische antipsychotica.............................................................................................. 46
Algemene indicaties v antipsychotica...........................................................................47
Algemene contra-indicaties antipsychotica..................................................................48
3
, Antipsychotica bij zwangerschap & borstvoeding.........................................................48
Antipsychotica interacties............................................................................................. 48
Depressie....................................................................................................50
Neurobiologische depressie.......................................................................................... 50
Stressrespons............................................................................................................ 50
HPA-as (Hypothalamus – Hypofyse – Bijnier – as)......................................................50
Chronische stress....................................................................................................... 51
Depressie: Hyperfrontaal – Hyperlimbisch brein........................................................51
Antidepressiva........................................................................................................... 51
Behandeling van depressie........................................................................................... 52
Antidepressiva........................................................................................................... 52
Plaatsbepaling antidepressiva......................................................................................57
Zwangerschap.............................................................................................................. 58
Examenvraag voorbeeld............................................................................................... 58
Angststoornissen.........................................................................................59
Neurobiologie............................................................................................................... 59
Hersenstructuren bij angst.........................................................................................59
Angst extinctie........................................................................................................... 59
Neurotransmitters & farmacologie.............................................................................60
Behandeling.................................................................................................................. 60
Gegeneraliseerde angststoornis (GAD).........................................................................61
Sociale angststoornis (SAD).......................................................................................... 61
Paniekstoornis (PD)....................................................................................................... 61
Specifieke fobieën........................................................................................................ 61
Obsessief compulsieve stoornis (OCD).........................................................................61
Post-traumatische stressstoornis (PTSD)......................................................................62
Bipolaire stoornissen (BD)............................................................................63
Neurobiologie............................................................................................................... 63
Etiologie..................................................................................................................... 63
Circuit dysfunctie....................................................................................................... 63
Behandeling.................................................................................................................. 64
Lithiumzouten............................................................................................................... 64
Anti-epileptica/stemmingsregulatoren..........................................................................65
Antipsychotica.............................................................................................................. 66
Antidepressiva.............................................................................................................. 66
Verwerking advies........................................................................................................ 66
Dementie.................................................................................................... 68
Pathologie Alzheimer.................................................................................................... 68
Behandeling.................................................................................................................. 68
Cholinesterase inhibitoren.........................................................................................68
Memantine................................................................................................................. 70
Ginkgo biloba Gestandardiseerd extract (EGb761)....................................................71
Aducanumab.............................................................................................................. 72
4
PRAKTISCHE
PSYCHOFARMACOLOGIE
PROF. DR. DIMITRI DE BUNDEL
ROXANNE KARLA DIDIER BOGAERT
VUB
,Inhoudsopgave
Basisbegrippen............................................................................................. 6
Overzicht cursus............................................................................................................. 6
Doelstellingen................................................................................................................. 6
Anatomie vd hersenen.................................................................................................... 7
Cerebrum..................................................................................................................... 7
Indeling:....................................................................................................................... 7
Neurotransmissie.......................................................................................................... 10
Aangrijpingspunten voor psychopharmaca...................................................................11
Ionenkanalen............................................................................................................. 12
Enzymen.................................................................................................................... 12
Carriers of transporters..............................................................................................13
Receptoren................................................................................................................ 13
Mechanismen van neuromodulatie...............................................................................13
Neurotransmitter en neuromodulator systemen...........................................................14
Middelengebruik..........................................................................................17
Aan middelen gebonden stoornissen............................................................................17
Het opponent process model.....................................................................................17
Het Koob model voor verslaving (verslavingscyclus).................................................17
Centrale stimulantia..................................................................................................... 17
Nicotine........................................................................................................................ 21
Verslavingspotentieel................................................................................................21
Middelen bij tabaksgebruik........................................................................................22
Samenvatting............................................................................................................ 22
Opioïden....................................................................................................................... 22
Endogene opioïden en opioïden receptoren...............................................................22
Tolerantie................................................................................................................... 23
Verslavingspotentieel................................................................................................23
Behandeling opioïde gebruik stoornis........................................................................23
Samenvatting............................................................................................................ 24
Cannabinoïden.............................................................................................................. 24
Farmacologisch overzicht.......................................................................................... 24
Therapeutische toepassingen....................................................................................24
Verslavingspotentieel................................................................................................25
Behandeling cannabis gebruik stoornis......................................................................25
Samenvatting............................................................................................................ 25
Alcohol (ethanol)........................................................................................................... 25
Farmacologisch overzicht.......................................................................................... 26
Verslavingspotentieel................................................................................................26
Neurotoxiciteit........................................................................................................... 26
Behandeling............................................................................................................... 26
Interacties.................................................................................................................. 27
Samenvatting............................................................................................................ 27
GHB/GBL....................................................................................................................... 28
Farmacologisch overzicht.......................................................................................... 28
Verslavingspotentieel................................................................................................28
Absences, diepe slaap, coma.....................................................................................28
Dissociatieve anesthetica............................................................................................. 28
2
, Pheniceline (PCP, "Angel Dust").................................................................................28
Ketamine (“Special K”)..............................................................................................29
Dextrometorphan (DXM)............................................................................................29
Verslavingspotentieel................................................................................................29
Samenvatting............................................................................................................ 30
Klassieke psychedelica................................................................................................. 30
Farmacologisch overzicht.......................................................................................... 30
Verslavingspotentieel................................................................................................30
Therapeutisch potentieel...........................................................................................30
Samenvatting............................................................................................................ 31
!!! Key points !!! middelen begonden stoornissen........................................................31
Behandeling ADHD.......................................................................................32
Geneesmiddelen voor behandeling van ADHD.............................................................32
DSM 5: Attention deficit hyperactivity disorder..........................................................32
Het netwerk model.................................................................................................... 32
Het “catecholamine arousal” model..........................................................................32
Behandeling............................................................................................................... 33
Verslavingspotentieel................................................................................................35
!!! Key points !!! behandeling van ADHD......................................................................36
Hypnotica & Sedativa...................................................................................36
Insomnia & andere slaapstoornissen............................................................................36
Slaap & alertheid.......................................................................................................... 36
SCN & circadiaan ritme..............................................................................................36
Hypnotica & sedativa.................................................................................................... 37
GABAA receptoren......................................................................................................... 38
Benzodiazepines........................................................................................................... 38
Werking & receptor – subtypes..................................................................................38
Indicaties................................................................................................................... 38
Neveneffecten........................................................................................................... 39
Contra – indicatie & indicatie.....................................................................................40
Flumazenil: bezo antagonist......................................................................................40
Z-drugs......................................................................................................................... 40
Neveneffecten........................................................................................................... 40
Melatonine.................................................................................................................... 41
Middelen obv planten................................................................................................... 41
Werking, neveneffecten, voorzorgen, interacties.......................................................41
Diversen....................................................................................................................... 41
Werking, neveneffecten, voorzorgen, interacties.......................................................41
Slapenloosheid: kernboodschappen.............................................................................41
Antipsychotica............................................................................................. 43
Psychotische stoornissen.............................................................................................. 43
Neurobiologische basis.............................................................................................. 43
Klassieke antipsychotica............................................................................................... 44
Atypische antipsychotica.............................................................................................. 46
Algemene indicaties v antipsychotica...........................................................................47
Algemene contra-indicaties antipsychotica..................................................................48
3
, Antipsychotica bij zwangerschap & borstvoeding.........................................................48
Antipsychotica interacties............................................................................................. 48
Depressie....................................................................................................50
Neurobiologische depressie.......................................................................................... 50
Stressrespons............................................................................................................ 50
HPA-as (Hypothalamus – Hypofyse – Bijnier – as)......................................................50
Chronische stress....................................................................................................... 51
Depressie: Hyperfrontaal – Hyperlimbisch brein........................................................51
Antidepressiva........................................................................................................... 51
Behandeling van depressie........................................................................................... 52
Antidepressiva........................................................................................................... 52
Plaatsbepaling antidepressiva......................................................................................57
Zwangerschap.............................................................................................................. 58
Examenvraag voorbeeld............................................................................................... 58
Angststoornissen.........................................................................................59
Neurobiologie............................................................................................................... 59
Hersenstructuren bij angst.........................................................................................59
Angst extinctie........................................................................................................... 59
Neurotransmitters & farmacologie.............................................................................60
Behandeling.................................................................................................................. 60
Gegeneraliseerde angststoornis (GAD).........................................................................61
Sociale angststoornis (SAD).......................................................................................... 61
Paniekstoornis (PD)....................................................................................................... 61
Specifieke fobieën........................................................................................................ 61
Obsessief compulsieve stoornis (OCD).........................................................................61
Post-traumatische stressstoornis (PTSD)......................................................................62
Bipolaire stoornissen (BD)............................................................................63
Neurobiologie............................................................................................................... 63
Etiologie..................................................................................................................... 63
Circuit dysfunctie....................................................................................................... 63
Behandeling.................................................................................................................. 64
Lithiumzouten............................................................................................................... 64
Anti-epileptica/stemmingsregulatoren..........................................................................65
Antipsychotica.............................................................................................................. 66
Antidepressiva.............................................................................................................. 66
Verwerking advies........................................................................................................ 66
Dementie.................................................................................................... 68
Pathologie Alzheimer.................................................................................................... 68
Behandeling.................................................................................................................. 68
Cholinesterase inhibitoren.........................................................................................68
Memantine................................................................................................................. 70
Ginkgo biloba Gestandardiseerd extract (EGb761)....................................................71
Aducanumab.............................................................................................................. 72
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