Psychiatrie
2020-2021
1
,Inhoudsopgave
1 INLEIDING TOT DE PSYCHIATRIE............................................................................................................. 5
1.1 DEFINITIE................................................................................................................................................. 5
1.2 DIAGNOSE EN CLASSIFICATIE ........................................................................................................................ 6
1.3 ETIOGENESE ............................................................................................................................................. 7
1.4 PSYCHOLOGIE VAN NORMAAL EN PATHOLOGISCH PSYCHISCHE FUNCTIONEREN ....................................................... 8
1.5 EPIDEMIOLOGIE ........................................................................................................................................ 9
1.6 GEVOLGEN ............................................................................................................................................. 10
1.7 BEHANDELING ........................................................................................................................................ 10
2 SEMIOLOGIE ........................................................................................................................................ 11
2.1 PSYCHIATRISCH CONSULT .......................................................................................................................... 11
2.2 COGNITIEVE FUNCTISTOORNIS .................................................................................................................... 12
2.3 AFFECTIEVE FUNCTIESTOORNIS ................................................................................................................... 13
2.4 CONATIEVE FUNCTIESTOORNISEN ................................................................................................................ 13
3 BEHANDELMODALITEITEN ................................................................................................................... 15
3.1 GEESTELIJKE GEZONDHEIDSZORG ................................................................................................................ 15
3.2 FARMACOTHERAPIE ................................................................................................................................. 16
3.3 PSYCHOTHERAPIE .................................................................................................................................... 17
3.4 ZIEKENHUISPSYCHIATRIE ........................................................................................................................... 20
4 PSYCHOSE SPECTRUM STOORNISSEN................................................................................................... 22
4.1 EPIDEMIOLOGIE ...................................................................................................................................... 22
4.2 ETIOPATHOGENESE .................................................................................................................................. 22
4.3 KLINIEK ................................................................................................................................................. 24
4.4 CLASSIFICATIE PSYCHOTISCHE STOORNISSEN .................................................................................................. 26
4.5 BEHANDELING ........................................................................................................................................ 28
5 DEPRESSIEVE STEMMINGSSTOORNISSEN ............................................................................................. 31
5.1 EPIDEMIOLOGIE ...................................................................................................................................... 31
5.2 DEPRESSIEVE STOORNIS ............................................................................................................................ 33
5.3 SUÏCIDE ................................................................................................................................................. 34
5.4 ETIOLOGIE ............................................................................................................................................. 36
5.5 CLASSIFICATIE DEPRESSIEVE STEMMINGSSTOORNISSEN (DMS-5) ...................................................................... 37
5.6 BEHANDELING ........................................................................................................................................ 38
6 BIPOLAIRE STEMMINGSSTOORNISSEN ................................................................................................. 41
6.1 EPIDEMIOLOGIE ...................................................................................................................................... 41
6.2 ETIOLOGIE ............................................................................................................................................. 42
6.3 KLINIEK ................................................................................................................................................. 43
6.4 DIAGNOSE ............................................................................................................................................. 45
6.5 BEHANDELING ........................................................................................................................................ 47
7 ANGSTSTOORNISSEN ........................................................................................................................... 51
7.1 EMOTIES ............................................................................................................................................... 51
7.2 ANGSTSTOORNISSEN DEFINITIE ................................................................................................................... 52
7.3 EPIDEMIOLOGIE ...................................................................................................................................... 54
7.4 ETIOLOGIE ............................................................................................................................................. 55
7.5 BEHANDELING ........................................................................................................................................ 56
8 DWANGSTOORNISSEN ......................................................................................................................... 60
8.1 OBSESSIEVE-COMPULSIEVE STOORNIS (OCD)................................................................................................ 60
9 EETSTOORNISSEN ................................................................................................................................ 61
9.1 SYNDROMEN .......................................................................................................................................... 61
2
, 9.2 EPIDEMIOLOGIE ...................................................................................................................................... 62
9.3 ETIOPATHOGENESE .................................................................................................................................. 63
9.4 DIAGNOSTIEK ......................................................................................................................................... 64
9.5 BEHANDELING ........................................................................................................................................ 65
9.6 SAMENVATTING ...................................................................................................................................... 65
10 SLAAPSTOORNISSEN ............................................................................................................................ 66
10.1 KLINIEK ................................................................................................................................................. 66
10.2 INSOMNIA.............................................................................................................................................. 67
10.3 HYPERSOMNIE ........................................................................................................................................ 68
10.4 NARCOLEPSIE ......................................................................................................................................... 69
10.5 PARASOMNIE ......................................................................................................................................... 71
11 PERSOONLIJKHEIDSSTOORNISSEN ....................................................................................................... 74
11.1 INLEIDING .............................................................................................................................................. 74
11.2 SYNDROMEN .......................................................................................................................................... 74
11.3 EPIDEMIOLOGIE ...................................................................................................................................... 78
11.4 ETIOPATHOGENESE .................................................................................................................................. 79
11.5 DIAGNOSTIEK ......................................................................................................................................... 80
11.6 BEHANDELING ........................................................................................................................................ 80
11.7 SAMENVATTING ...................................................................................................................................... 83
12 SOMATISCHE SYMPTOOMSTOORNIS ................................................................................................... 84
12.1 INLEIDING SOMATISATIE ............................................................................................................................ 84
12.2 ETIOPATHOLOGIE .................................................................................................................................... 85
12.3 BELEID .................................................................................................................................................. 87
12.4 NAGEBOOTSTE STOORNIS .......................................................................................................................... 88
13 AANPASSINGSSTOORNISSEN ............................................................................................................... 90
14 PSYCHOTRAUMA GERELATEERDE STOORNIS ....................................................................................... 92
14.1 ACUTE STRESSSTOORNIS (ASS) .................................................................................................................. 92
14.2 POSTTRAUMATISCHE STRESSSTOORNIS (PTSS) .............................................................................................. 92
14.3 ETIOPATHOGENESE .................................................................................................................................. 93
14.4 BEHANDELING ........................................................................................................................................ 94
15 OUDERENPSYCHIATRIE ........................................................................................................................ 95
15.1 DE GERIATRISCHE PATIËNT......................................................................................................................... 95
15.2 DELIRIUM .............................................................................................................................................. 96
15.3 NEUROCOGNITIEVE STOORNISSEN ............................................................................................................... 98
15.4 APATHIE ................................................................................................................................................ 99
15.5 DEPRESSIE ........................................................................................................................................... 100
15.6 ALGEMENE PRINCIPES BEHANDELING OUDERENPSYCHIATRIE ........................................................................... 100
16 KINDER- EN JEUGDPSYCHIATRIE ........................................................................................................ 101
16.1 INLEIDING ............................................................................................................................................ 101
16.2 KINDERPSYCHIATERISCH ONDERZOEK ......................................................................................................... 102
16.3 ONTWIKKELINGSSTOORNISSEN: ADHD...................................................................................................... 102
16.4 ONTWIKKELINGSSTOORNIS: ASS .............................................................................................................. 105
16.5 ANDERE ONTWIKKELINGSSTOORNISSEN ...................................................................................................... 107
16.6 EXTERNALISERENDE STOORNISSEN: GEDRAGSSTOORNIS ................................................................................. 107
16.7 INTERNALISERENDE STOORNISSEN: ANGSTSTOORNISSEN ................................................................................ 110
16.8 INTERNALISERENDE STOORNISSEN: DEPRESSIE ............................................................................................. 111
16.9 EETSTOORNISSEN .................................................................................................................................. 113
17 MIDDELEN MISBRUIK ........................................................................................................................ 115
17.1 SYNDROMEN ........................................................................................................................................ 115
3
, 17.2 DIAGNOSTIEK ....................................................................................................................................... 117
17.3 ETIOPATHOGENESE ................................................................................................................................ 118
17.4 BEHANDELING ...................................................................................................................................... 121
18 ONTWIKKELINGSSTOORNISSEN BIJ VOLWASSENEN ........................................................................... 124
18.1 ADHDH ............................................................................................................................................. 124
18.2 AUTISMESPECTRUMSTOORNISSEN............................................................................................................. 125
19 FORENSISCHE PSYCHIATRIE ............................................................................................................... 127
19.1 ALGEMEEN........................................................................................................................................... 127
19.2 DWANGOPNAME................................................................................................................................... 127
19.3 OMSTANDIGHEDEN MEDISCH VERSLAG ...................................................................................................... 128
- OPGESTELD (IN MOEDERTAAL VAN PATIËNT) DOOR EEN ARTS, BEVOEGD OM DE GENEESKUNDE UIT TE OEFENEN ............ 128
O GEEN BAND MET PATIËNT OF DE AANVRAGER ................................................................................................... 128
O GEEN (AANGETROUWDE) FAMILIE IS VAN DE PATIËNT OF DE AANVRAGER ............................................................... 128
O NIET VERBONDEN IS OP OM HET EVEN WELKE MANIER AAN DE INSTELLING WAAR DE PATIËNT VERBLIJFT....................... 128
19.4 ONBEKWAAMHEIDSVERKLARING ............................................................................................................... 128
19.5 INTERNERING........................................................................................................................................ 129
19.6 PARAFILIE ............................................................................................................................................ 131
19.7 SEKSUELE DELIQUENTEN ......................................................................................................................... 131
19.8 AGRESSIE ............................................................................................................................................. 132
19.9 PERIODIEKE EXPLOSIEVE STOORNIS ............................................................................................................ 132
19.10 PSYCHOPATHIE ..................................................................................................................................... 133
20 EXTRA: FARMACO.............................................................................................................................. 134
4
2020-2021
1
,Inhoudsopgave
1 INLEIDING TOT DE PSYCHIATRIE............................................................................................................. 5
1.1 DEFINITIE................................................................................................................................................. 5
1.2 DIAGNOSE EN CLASSIFICATIE ........................................................................................................................ 6
1.3 ETIOGENESE ............................................................................................................................................. 7
1.4 PSYCHOLOGIE VAN NORMAAL EN PATHOLOGISCH PSYCHISCHE FUNCTIONEREN ....................................................... 8
1.5 EPIDEMIOLOGIE ........................................................................................................................................ 9
1.6 GEVOLGEN ............................................................................................................................................. 10
1.7 BEHANDELING ........................................................................................................................................ 10
2 SEMIOLOGIE ........................................................................................................................................ 11
2.1 PSYCHIATRISCH CONSULT .......................................................................................................................... 11
2.2 COGNITIEVE FUNCTISTOORNIS .................................................................................................................... 12
2.3 AFFECTIEVE FUNCTIESTOORNIS ................................................................................................................... 13
2.4 CONATIEVE FUNCTIESTOORNISEN ................................................................................................................ 13
3 BEHANDELMODALITEITEN ................................................................................................................... 15
3.1 GEESTELIJKE GEZONDHEIDSZORG ................................................................................................................ 15
3.2 FARMACOTHERAPIE ................................................................................................................................. 16
3.3 PSYCHOTHERAPIE .................................................................................................................................... 17
3.4 ZIEKENHUISPSYCHIATRIE ........................................................................................................................... 20
4 PSYCHOSE SPECTRUM STOORNISSEN................................................................................................... 22
4.1 EPIDEMIOLOGIE ...................................................................................................................................... 22
4.2 ETIOPATHOGENESE .................................................................................................................................. 22
4.3 KLINIEK ................................................................................................................................................. 24
4.4 CLASSIFICATIE PSYCHOTISCHE STOORNISSEN .................................................................................................. 26
4.5 BEHANDELING ........................................................................................................................................ 28
5 DEPRESSIEVE STEMMINGSSTOORNISSEN ............................................................................................. 31
5.1 EPIDEMIOLOGIE ...................................................................................................................................... 31
5.2 DEPRESSIEVE STOORNIS ............................................................................................................................ 33
5.3 SUÏCIDE ................................................................................................................................................. 34
5.4 ETIOLOGIE ............................................................................................................................................. 36
5.5 CLASSIFICATIE DEPRESSIEVE STEMMINGSSTOORNISSEN (DMS-5) ...................................................................... 37
5.6 BEHANDELING ........................................................................................................................................ 38
6 BIPOLAIRE STEMMINGSSTOORNISSEN ................................................................................................. 41
6.1 EPIDEMIOLOGIE ...................................................................................................................................... 41
6.2 ETIOLOGIE ............................................................................................................................................. 42
6.3 KLINIEK ................................................................................................................................................. 43
6.4 DIAGNOSE ............................................................................................................................................. 45
6.5 BEHANDELING ........................................................................................................................................ 47
7 ANGSTSTOORNISSEN ........................................................................................................................... 51
7.1 EMOTIES ............................................................................................................................................... 51
7.2 ANGSTSTOORNISSEN DEFINITIE ................................................................................................................... 52
7.3 EPIDEMIOLOGIE ...................................................................................................................................... 54
7.4 ETIOLOGIE ............................................................................................................................................. 55
7.5 BEHANDELING ........................................................................................................................................ 56
8 DWANGSTOORNISSEN ......................................................................................................................... 60
8.1 OBSESSIEVE-COMPULSIEVE STOORNIS (OCD)................................................................................................ 60
9 EETSTOORNISSEN ................................................................................................................................ 61
9.1 SYNDROMEN .......................................................................................................................................... 61
2
, 9.2 EPIDEMIOLOGIE ...................................................................................................................................... 62
9.3 ETIOPATHOGENESE .................................................................................................................................. 63
9.4 DIAGNOSTIEK ......................................................................................................................................... 64
9.5 BEHANDELING ........................................................................................................................................ 65
9.6 SAMENVATTING ...................................................................................................................................... 65
10 SLAAPSTOORNISSEN ............................................................................................................................ 66
10.1 KLINIEK ................................................................................................................................................. 66
10.2 INSOMNIA.............................................................................................................................................. 67
10.3 HYPERSOMNIE ........................................................................................................................................ 68
10.4 NARCOLEPSIE ......................................................................................................................................... 69
10.5 PARASOMNIE ......................................................................................................................................... 71
11 PERSOONLIJKHEIDSSTOORNISSEN ....................................................................................................... 74
11.1 INLEIDING .............................................................................................................................................. 74
11.2 SYNDROMEN .......................................................................................................................................... 74
11.3 EPIDEMIOLOGIE ...................................................................................................................................... 78
11.4 ETIOPATHOGENESE .................................................................................................................................. 79
11.5 DIAGNOSTIEK ......................................................................................................................................... 80
11.6 BEHANDELING ........................................................................................................................................ 80
11.7 SAMENVATTING ...................................................................................................................................... 83
12 SOMATISCHE SYMPTOOMSTOORNIS ................................................................................................... 84
12.1 INLEIDING SOMATISATIE ............................................................................................................................ 84
12.2 ETIOPATHOLOGIE .................................................................................................................................... 85
12.3 BELEID .................................................................................................................................................. 87
12.4 NAGEBOOTSTE STOORNIS .......................................................................................................................... 88
13 AANPASSINGSSTOORNISSEN ............................................................................................................... 90
14 PSYCHOTRAUMA GERELATEERDE STOORNIS ....................................................................................... 92
14.1 ACUTE STRESSSTOORNIS (ASS) .................................................................................................................. 92
14.2 POSTTRAUMATISCHE STRESSSTOORNIS (PTSS) .............................................................................................. 92
14.3 ETIOPATHOGENESE .................................................................................................................................. 93
14.4 BEHANDELING ........................................................................................................................................ 94
15 OUDERENPSYCHIATRIE ........................................................................................................................ 95
15.1 DE GERIATRISCHE PATIËNT......................................................................................................................... 95
15.2 DELIRIUM .............................................................................................................................................. 96
15.3 NEUROCOGNITIEVE STOORNISSEN ............................................................................................................... 98
15.4 APATHIE ................................................................................................................................................ 99
15.5 DEPRESSIE ........................................................................................................................................... 100
15.6 ALGEMENE PRINCIPES BEHANDELING OUDERENPSYCHIATRIE ........................................................................... 100
16 KINDER- EN JEUGDPSYCHIATRIE ........................................................................................................ 101
16.1 INLEIDING ............................................................................................................................................ 101
16.2 KINDERPSYCHIATERISCH ONDERZOEK ......................................................................................................... 102
16.3 ONTWIKKELINGSSTOORNISSEN: ADHD...................................................................................................... 102
16.4 ONTWIKKELINGSSTOORNIS: ASS .............................................................................................................. 105
16.5 ANDERE ONTWIKKELINGSSTOORNISSEN ...................................................................................................... 107
16.6 EXTERNALISERENDE STOORNISSEN: GEDRAGSSTOORNIS ................................................................................. 107
16.7 INTERNALISERENDE STOORNISSEN: ANGSTSTOORNISSEN ................................................................................ 110
16.8 INTERNALISERENDE STOORNISSEN: DEPRESSIE ............................................................................................. 111
16.9 EETSTOORNISSEN .................................................................................................................................. 113
17 MIDDELEN MISBRUIK ........................................................................................................................ 115
17.1 SYNDROMEN ........................................................................................................................................ 115
3
, 17.2 DIAGNOSTIEK ....................................................................................................................................... 117
17.3 ETIOPATHOGENESE ................................................................................................................................ 118
17.4 BEHANDELING ...................................................................................................................................... 121
18 ONTWIKKELINGSSTOORNISSEN BIJ VOLWASSENEN ........................................................................... 124
18.1 ADHDH ............................................................................................................................................. 124
18.2 AUTISMESPECTRUMSTOORNISSEN............................................................................................................. 125
19 FORENSISCHE PSYCHIATRIE ............................................................................................................... 127
19.1 ALGEMEEN........................................................................................................................................... 127
19.2 DWANGOPNAME................................................................................................................................... 127
19.3 OMSTANDIGHEDEN MEDISCH VERSLAG ...................................................................................................... 128
- OPGESTELD (IN MOEDERTAAL VAN PATIËNT) DOOR EEN ARTS, BEVOEGD OM DE GENEESKUNDE UIT TE OEFENEN ............ 128
O GEEN BAND MET PATIËNT OF DE AANVRAGER ................................................................................................... 128
O GEEN (AANGETROUWDE) FAMILIE IS VAN DE PATIËNT OF DE AANVRAGER ............................................................... 128
O NIET VERBONDEN IS OP OM HET EVEN WELKE MANIER AAN DE INSTELLING WAAR DE PATIËNT VERBLIJFT....................... 128
19.4 ONBEKWAAMHEIDSVERKLARING ............................................................................................................... 128
19.5 INTERNERING........................................................................................................................................ 129
19.6 PARAFILIE ............................................................................................................................................ 131
19.7 SEKSUELE DELIQUENTEN ......................................................................................................................... 131
19.8 AGRESSIE ............................................................................................................................................. 132
19.9 PERIODIEKE EXPLOSIEVE STOORNIS ............................................................................................................ 132
19.10 PSYCHOPATHIE ..................................................................................................................................... 133
20 EXTRA: FARMACO.............................................................................................................................. 134
4
