Klinische Psychiatrie
Examen:
• Open vragen
Inhoudsopgave
1. Inleiding (DSM-5) .................................................................................................................................... 4
I. Psychopathologie ....................................................................................................................................... 5
II. Psychiatrische stoornis ............................................................................................................................... 5
III. Classificatie ............................................................................................................................................ 6
a) Verschillende soorten classificaties: ...................................................................................................... 7
b) Voor- en nadelen ................................................................................................................................... 7
c) Geschiedenis .......................................................................................................................................... 8
IV. Diagnostiek ............................................................................................................................................ 8
V. Opzet DSM-5 .............................................................................................................................................. 8
a) Deel 1 ..................................................................................................................................................... 8
b) Deel 2 ..................................................................................................................................................... 8
c) Deel 3 ..................................................................................................................................................... 9
VI. Stellingen ............................................................................................................................................... 9
VII. Conclusie .............................................................................................................................................. 10
2. Inleiding ............................................................................................................................................... 10
I. Normaliteit en psychopathologie ............................................................................................................. 10
II. Normaliteit ............................................................................................................................................... 10
III. Criteria normaliteit .............................................................................................................................. 11
IV. Probleem van subjectiviteit.................................................................................................................. 11
V. Epidemiologie ........................................................................................................................................... 11
VI. Algemene prevalentie .......................................................................................................................... 12
VII. Geschiendenis van de psychiatrie ........................................................................................................ 12
VIII. Ethiopathogenese (=verklaringsmodel) ............................................................................................... 14
IX. Fysiopathogenese ................................................................................................................................ 14
a) Genetica ............................................................................................................................................... 14
b) Neurotransmitters ............................................................................................................................... 17
X. Psychopathogenese.................................................................................................................................. 18
a) Psychologisch perspectief .................................................................................................................... 18
XI. Psychische functies .............................................................................................................................. 19
a) Stoornis is het psychisch functioneren ................................................................................................ 19
XII. Het psychiatrisch onderzoek ................................................................................................................ 21
1
, a) Anamnese (bevraging van problemen van klachten) .......................................................................... 21
b) Onderzoek ........................................................................................................................................... 22
3. Neurocognitieve stoornissen ................................................................................................................ 23
a) Epidemiologie ...................................................................................................................................... 23
b) Het geheugen ...................................................................................................................................... 24
c) Ouderdom (senescentie) ..................................................................................................................... 24
d) Neuropsychologische testen................................................................................................................ 25
I. Dementie .................................................................................................................................................. 25
a) Geheugen en veroudering ................................................................................................................... 25
b) Epidemiologie (Expertisecentrum dementie Vlaanderen)................................................................... 26
c) Klinische kenmerken ............................................................................................................................ 26
• Desoriëntatie in tijd ............................................................................................................................. 27
2. (Dementie:) Diagnostiek ...................................................................................................................... 34
II. Delirium .................................................................................................................................................... 35
III. Amnestische stoornissen...................................................................................................................... 37
4. Middelengerelateerde stoornissen en verslavingsstoornissen .............................................................. 37
I. Stoornissen in het gebruik: ....................................................................................................................... 38
a) Misbruik van een middel ..................................................................................................................... 38
b) Middelenafhankelijkheid ..................................................................................................................... 38
II. Stoornissen door het gebruik ................................................................................................................... 39
a) Intoxicatie door een middel ................................................................................................................. 39
b) Onthouding van een middel ................................................................................................................ 39
III. Psychoactieve stoffen .......................................................................................................................... 39
a) Indeling – algemeen............................................................................................................................. 39
b) Alcoholgebruik ..................................................................................................................................... 40
IV. Middelengerelateerde en verslavingsstoornissen: diagnostiek ........................................................... 42
V. Middelengerelateerde en verslavingsstoornissen: etiopathogenese ....................................................... 42
VI. Aan middelen geboden stoornissen: prognose .................................................................................... 43
VII. Preventie - Behandeling ....................................................................................................................... 43
a) Behandeling – Algemeen ..................................................................................................................... 43
5. Schirzofrenie ........................................................................................................................................ 44
I. Psychotische stoornissen .......................................................................................................................... 44
II. Schizofrenie .............................................................................................................................................. 45
a) Kenmerken........................................................................................................................................... 45
b) Comorbiditeit, DD (differentiële diagnose), diagnostiek ..................................................................... 47
c) Epidemiologie ...................................................................................................................................... 49
d) Etiopathogenese .................................................................................................................................. 49
e) Behandeling ......................................................................................................................................... 53
f) Prognose, beloop ................................................................................................................................. 54
III. Schizofreniforme stoornis .................................................................................................................... 55
IV. Schizoaffectieve stoornis...................................................................................................................... 55
V. Waanstoornis ........................................................................................................................................... 56
2
, VI. Kortdurende psychotische stoornis ...................................................................................................... 56
VII. Gedeelde psychotische stoornis ........................................................................................................... 57
6. Stemmingsstoornissen.......................................................................................................................... 57
I. Definitie episodes ..................................................................................................................................... 57
a) Depressieve ......................................................................................................................................... 57
b) (Hypo)manische ................................................................................................................................... 58
c) Gemengde ........................................................................................................................................... 59
II. Kenmerken stemmingsstoornissen........................................................................................................... 59
a) Uni: depressie, dysthymie.................................................................................................................... 59
b) Bi: Bipolaire stoornis type 1, 2, cyclothemie........................................................................................ 60
III. Diagnostiek en comorbiditeit ............................................................................................................... 61
IV. Epidemiologie en etiopathogenese ...................................................................................................... 62
V. Behandeling ............................................................................................................................................. 64
VI. Suïcidaal proces ................................................................................................................................... 66
7. Angststoornissen .................................................................................................................................. 70
I. Inleiding.................................................................................................................................................... 71
a) Begrip angst ......................................................................................................................................... 71
b) Cerebraal angstcircuit .......................................................................................................................... 71
II. Generieke behandeling ............................................................................................................................ 71
III. Beschrijving specifieke angststoornissen ............................................................................................. 71
a) Kenmerken........................................................................................................................................... 72
b) Etiopathogenese en behandeling ........................................................................................................ 73
IV. Paniekstoornis...................................................................................................................................... 73
V. Agorafobie................................................................................................................................................ 74
VI. Sociale fobie ......................................................................................................................................... 74
VII. Obsessief-compulsieve stoornis (OCS) ................................................................................................. 75
VIII. Gegeneraliseerde angsstoornis (GAS) .................................................................................................. 76
IX. Posttraumatische stressstoornis (PTSS) ............................................................................................... 77
X. Acute stresstoornis ................................................................................................................................... 78
8. Eetstoornissen ...................................................................................................................................... 78
I. Anorexia Nervosa ..................................................................................................................................... 79
II. Bulimia Nervosa ....................................................................................................................................... 79
III. Diagnostiek eetstoornissen .................................................................................................................. 80
IV. Etiopathogenese eetstoornissen .......................................................................................................... 81
V. Behandeling eetstoornissen ..................................................................................................................... 81
9. Kinder- en jeugdpsychiatrie .................................................................................................................. 82
I. Inleiding (specificiteit) .............................................................................................................................. 82
a) Definitie psychiatrische stoornis bij kinderen en jongeren ................................................................. 82
b) Prevalentie ........................................................................................................................................... 83
3
, II. Ontwikkelingsstoornissen......................................................................................................................... 83
a) ADHD ................................................................................................................................................... 83
b) ASS ....................................................................................................................................................... 87
III. Externaliserende stoornissen ............................................................................................................... 91
a) Oppositionele-opstandige stoornis (ODD) ........................................................................................... 92
b) Normoverschrijdende-gedragsstoornis (conduct disorder) ................................................................ 92
10. Slaapstoornissen .............................................................................................................................. 97
I. Het slaapproces ........................................................................................................................................ 97
II. Dyssomnia (verstoord slaapproces) ......................................................................................................... 97
a) Primaire insomnia ................................................................................................................................ 97
b) Primaire hypersomnia ......................................................................................................................... 97
c) Narcolepsie .......................................................................................................................................... 98
d) Slaapgebonden ademhalingsstoornis .................................................................................................. 98
e) Slaapstoornissen gebonden aan de cicadiane ritmiek ......................................................................... 99
f) Dyssomnia niet anderszins omschreven ............................................................................................ 100
III. Parasomnia ........................................................................................................................................ 100
a) Nachtmerries ..................................................................................................................................... 100
b) Pavor nocturnus (nachtelijke angst) .................................................................................................. 101
c) Slaapwandelen................................................................................................................................... 102
IV. Behandeling (insomnia/hypersomnia) ............................................................................................... 102
V. Behandeling dyssomnia (narcolepsie) .................................................................................................... 103
VI. Behandeling dyssomnia (andere)....................................................................................................... 103
VII. Behandeling parasomnia ................................................................................................................... 103
11. Seksuele stoornissen ...................................................................................................................... 104
I. Seksuele disfuncties ................................................................................................................................ 104
a) Stoornissen in het seksueel verlangen .............................................................................................. 104
b) Seksuele opwindingsstoornissen ....................................................................................................... 104
c) Orgasmestoornissen .......................................................................................................................... 104
d) Seksuele pijnstoornissen ................................................................................................................... 104
II. Parafilieën .............................................................................................................................................. 107
12. Persoonlijkheidsstoornissen ........................................................................................................... 110
a) Cluster A............................................................................................................................................. 111
b) Cluster B ............................................................................................................................................. 111
c) Cluster C ............................................................................................................................................. 112
d) Ontwikkeling, beloop en gevolgen persoonlijkheidsstoornissen....................................................... 112
e) Comorbiditeit ..................................................................................................................................... 113
f) Etiopathogenese ................................................................................................................................ 113
1. Inleiding (DSM-5)
4
Examen:
• Open vragen
Inhoudsopgave
1. Inleiding (DSM-5) .................................................................................................................................... 4
I. Psychopathologie ....................................................................................................................................... 5
II. Psychiatrische stoornis ............................................................................................................................... 5
III. Classificatie ............................................................................................................................................ 6
a) Verschillende soorten classificaties: ...................................................................................................... 7
b) Voor- en nadelen ................................................................................................................................... 7
c) Geschiedenis .......................................................................................................................................... 8
IV. Diagnostiek ............................................................................................................................................ 8
V. Opzet DSM-5 .............................................................................................................................................. 8
a) Deel 1 ..................................................................................................................................................... 8
b) Deel 2 ..................................................................................................................................................... 8
c) Deel 3 ..................................................................................................................................................... 9
VI. Stellingen ............................................................................................................................................... 9
VII. Conclusie .............................................................................................................................................. 10
2. Inleiding ............................................................................................................................................... 10
I. Normaliteit en psychopathologie ............................................................................................................. 10
II. Normaliteit ............................................................................................................................................... 10
III. Criteria normaliteit .............................................................................................................................. 11
IV. Probleem van subjectiviteit.................................................................................................................. 11
V. Epidemiologie ........................................................................................................................................... 11
VI. Algemene prevalentie .......................................................................................................................... 12
VII. Geschiendenis van de psychiatrie ........................................................................................................ 12
VIII. Ethiopathogenese (=verklaringsmodel) ............................................................................................... 14
IX. Fysiopathogenese ................................................................................................................................ 14
a) Genetica ............................................................................................................................................... 14
b) Neurotransmitters ............................................................................................................................... 17
X. Psychopathogenese.................................................................................................................................. 18
a) Psychologisch perspectief .................................................................................................................... 18
XI. Psychische functies .............................................................................................................................. 19
a) Stoornis is het psychisch functioneren ................................................................................................ 19
XII. Het psychiatrisch onderzoek ................................................................................................................ 21
1
, a) Anamnese (bevraging van problemen van klachten) .......................................................................... 21
b) Onderzoek ........................................................................................................................................... 22
3. Neurocognitieve stoornissen ................................................................................................................ 23
a) Epidemiologie ...................................................................................................................................... 23
b) Het geheugen ...................................................................................................................................... 24
c) Ouderdom (senescentie) ..................................................................................................................... 24
d) Neuropsychologische testen................................................................................................................ 25
I. Dementie .................................................................................................................................................. 25
a) Geheugen en veroudering ................................................................................................................... 25
b) Epidemiologie (Expertisecentrum dementie Vlaanderen)................................................................... 26
c) Klinische kenmerken ............................................................................................................................ 26
• Desoriëntatie in tijd ............................................................................................................................. 27
2. (Dementie:) Diagnostiek ...................................................................................................................... 34
II. Delirium .................................................................................................................................................... 35
III. Amnestische stoornissen...................................................................................................................... 37
4. Middelengerelateerde stoornissen en verslavingsstoornissen .............................................................. 37
I. Stoornissen in het gebruik: ....................................................................................................................... 38
a) Misbruik van een middel ..................................................................................................................... 38
b) Middelenafhankelijkheid ..................................................................................................................... 38
II. Stoornissen door het gebruik ................................................................................................................... 39
a) Intoxicatie door een middel ................................................................................................................. 39
b) Onthouding van een middel ................................................................................................................ 39
III. Psychoactieve stoffen .......................................................................................................................... 39
a) Indeling – algemeen............................................................................................................................. 39
b) Alcoholgebruik ..................................................................................................................................... 40
IV. Middelengerelateerde en verslavingsstoornissen: diagnostiek ........................................................... 42
V. Middelengerelateerde en verslavingsstoornissen: etiopathogenese ....................................................... 42
VI. Aan middelen geboden stoornissen: prognose .................................................................................... 43
VII. Preventie - Behandeling ....................................................................................................................... 43
a) Behandeling – Algemeen ..................................................................................................................... 43
5. Schirzofrenie ........................................................................................................................................ 44
I. Psychotische stoornissen .......................................................................................................................... 44
II. Schizofrenie .............................................................................................................................................. 45
a) Kenmerken........................................................................................................................................... 45
b) Comorbiditeit, DD (differentiële diagnose), diagnostiek ..................................................................... 47
c) Epidemiologie ...................................................................................................................................... 49
d) Etiopathogenese .................................................................................................................................. 49
e) Behandeling ......................................................................................................................................... 53
f) Prognose, beloop ................................................................................................................................. 54
III. Schizofreniforme stoornis .................................................................................................................... 55
IV. Schizoaffectieve stoornis...................................................................................................................... 55
V. Waanstoornis ........................................................................................................................................... 56
2
, VI. Kortdurende psychotische stoornis ...................................................................................................... 56
VII. Gedeelde psychotische stoornis ........................................................................................................... 57
6. Stemmingsstoornissen.......................................................................................................................... 57
I. Definitie episodes ..................................................................................................................................... 57
a) Depressieve ......................................................................................................................................... 57
b) (Hypo)manische ................................................................................................................................... 58
c) Gemengde ........................................................................................................................................... 59
II. Kenmerken stemmingsstoornissen........................................................................................................... 59
a) Uni: depressie, dysthymie.................................................................................................................... 59
b) Bi: Bipolaire stoornis type 1, 2, cyclothemie........................................................................................ 60
III. Diagnostiek en comorbiditeit ............................................................................................................... 61
IV. Epidemiologie en etiopathogenese ...................................................................................................... 62
V. Behandeling ............................................................................................................................................. 64
VI. Suïcidaal proces ................................................................................................................................... 66
7. Angststoornissen .................................................................................................................................. 70
I. Inleiding.................................................................................................................................................... 71
a) Begrip angst ......................................................................................................................................... 71
b) Cerebraal angstcircuit .......................................................................................................................... 71
II. Generieke behandeling ............................................................................................................................ 71
III. Beschrijving specifieke angststoornissen ............................................................................................. 71
a) Kenmerken........................................................................................................................................... 72
b) Etiopathogenese en behandeling ........................................................................................................ 73
IV. Paniekstoornis...................................................................................................................................... 73
V. Agorafobie................................................................................................................................................ 74
VI. Sociale fobie ......................................................................................................................................... 74
VII. Obsessief-compulsieve stoornis (OCS) ................................................................................................. 75
VIII. Gegeneraliseerde angsstoornis (GAS) .................................................................................................. 76
IX. Posttraumatische stressstoornis (PTSS) ............................................................................................... 77
X. Acute stresstoornis ................................................................................................................................... 78
8. Eetstoornissen ...................................................................................................................................... 78
I. Anorexia Nervosa ..................................................................................................................................... 79
II. Bulimia Nervosa ....................................................................................................................................... 79
III. Diagnostiek eetstoornissen .................................................................................................................. 80
IV. Etiopathogenese eetstoornissen .......................................................................................................... 81
V. Behandeling eetstoornissen ..................................................................................................................... 81
9. Kinder- en jeugdpsychiatrie .................................................................................................................. 82
I. Inleiding (specificiteit) .............................................................................................................................. 82
a) Definitie psychiatrische stoornis bij kinderen en jongeren ................................................................. 82
b) Prevalentie ........................................................................................................................................... 83
3
, II. Ontwikkelingsstoornissen......................................................................................................................... 83
a) ADHD ................................................................................................................................................... 83
b) ASS ....................................................................................................................................................... 87
III. Externaliserende stoornissen ............................................................................................................... 91
a) Oppositionele-opstandige stoornis (ODD) ........................................................................................... 92
b) Normoverschrijdende-gedragsstoornis (conduct disorder) ................................................................ 92
10. Slaapstoornissen .............................................................................................................................. 97
I. Het slaapproces ........................................................................................................................................ 97
II. Dyssomnia (verstoord slaapproces) ......................................................................................................... 97
a) Primaire insomnia ................................................................................................................................ 97
b) Primaire hypersomnia ......................................................................................................................... 97
c) Narcolepsie .......................................................................................................................................... 98
d) Slaapgebonden ademhalingsstoornis .................................................................................................. 98
e) Slaapstoornissen gebonden aan de cicadiane ritmiek ......................................................................... 99
f) Dyssomnia niet anderszins omschreven ............................................................................................ 100
III. Parasomnia ........................................................................................................................................ 100
a) Nachtmerries ..................................................................................................................................... 100
b) Pavor nocturnus (nachtelijke angst) .................................................................................................. 101
c) Slaapwandelen................................................................................................................................... 102
IV. Behandeling (insomnia/hypersomnia) ............................................................................................... 102
V. Behandeling dyssomnia (narcolepsie) .................................................................................................... 103
VI. Behandeling dyssomnia (andere)....................................................................................................... 103
VII. Behandeling parasomnia ................................................................................................................... 103
11. Seksuele stoornissen ...................................................................................................................... 104
I. Seksuele disfuncties ................................................................................................................................ 104
a) Stoornissen in het seksueel verlangen .............................................................................................. 104
b) Seksuele opwindingsstoornissen ....................................................................................................... 104
c) Orgasmestoornissen .......................................................................................................................... 104
d) Seksuele pijnstoornissen ................................................................................................................... 104
II. Parafilieën .............................................................................................................................................. 107
12. Persoonlijkheidsstoornissen ........................................................................................................... 110
a) Cluster A............................................................................................................................................. 111
b) Cluster B ............................................................................................................................................. 111
c) Cluster C ............................................................................................................................................. 112
d) Ontwikkeling, beloop en gevolgen persoonlijkheidsstoornissen....................................................... 112
e) Comorbiditeit ..................................................................................................................................... 113
f) Etiopathogenese ................................................................................................................................ 113
1. Inleiding (DSM-5)
4
