S1
Mens en Gezondheid 2
ACADEMIEJAAR 2025-2026 AP HOGE SCHOOOL
,Inhoud
1) Introductie in de pathologie ...................................................................................................................................................................................................................................................................................................................................................................... 7
1.1 Wat het inhoudt ..............................................................................................................................................................................................................................................................................................................................................................................................................................................7
1.2 Belangrijke concepten .....................................................................................................................................................................................................................................................................................................................................................................................................................................7
1.3 (Ab)normaal gedrag ........................................................................................................................................................................................................................................................................................................................................................................................................................................8
1.3.1 Veranderingen in de kijk op (ab)normaal gedrag ..........................................................................................................................................................................................................................................................................................................................................................................8
1.3.2 Criteria van afwijkend gedrag .........................................................................................................................................................................................................................................................................................................................................................................................................9
1.4 Ontstaan van psychopathologie .................................................................................................................................................................................................................................................................................................................................................................................................................. 10
1.4.1 Biopsychosociaal model ............................................................................................................................................................................................................................................................................................................................................................................................................... 10
1.4.2 Het diathese – stressmodel.......................................................................................................................................................................................................................................................................................................................................................................................................... 12
1.4.3 Het nature – nurture debat .......................................................................................................................................................................................................................................................................................................................................................................................................... 12
1.5 Instandhouding van pathologie ................................................................................................................................................................................................................................................................................................................................................................................................................... 13
1.5.1 Cognitieve processen.................................................................................................................................................................................................................................................................................................................................................................................................................... 13
1.5.2 Gedragsmatige factoren ............................................................................................................................................................................................................................................................................................................................................................................................................... 13
1.5.3 Emotionele processen .................................................................................................................................................................................................................................................................................................................................................................................................................. 13
1.5.4 Sociale en relationele factoren .................................................................................................................................................................................................................................................................................................................................................................................................... 13
1.5.5 Biologische factoren ..................................................................................................................................................................................................................................................................................................................................................................................................................... 13
1.5.6 Omgevingsfactoren....................................................................................................................................................................................................................................................................................................................................................................................................................... 13
1.6 Behandeling in de pathologie ...................................................................................................................................................................................................................................................................................................................................................................................................................... 14
1.6.1 Psychodynamische modellen ....................................................................................................................................................................................................................................................................................................................................................................................................... 14
1.6.2 Behavioristisch modellen en zijn afgeleiden ............................................................................................................................................................................................................................................................................................................................................................................... 14
1.6.3 Humanistische modellen .............................................................................................................................................................................................................................................................................................................................................................................................................. 15
1.6.4 Systeemmodellen ......................................................................................................................................................................................................................................................................................................................................................................................................................... 16
2) Diagnostiek in de klinische psychologie ................................................................................................................................................................................................................................................................................................................................................... 17
2.1 Systematische aanpak in de psychodiagnostiek......................................................................................................................................................................................................................................................................................................................................................................................... 17
2.1.1 Wetenschappelijke methode ....................................................................................................................................................................................................................................................................................................................................................................................................... 17
2.1.2 Psychodiagnostische cyclus .......................................................................................................................................................................................................................................................................................................................................................................................................... 18
2.2 Diagnostische instrumenten ........................................................................................................................................................................................................................................................................................................................................................................................................................ 18
2.2.1 Keuze voor diagnostische instrumenten ..................................................................................................................................................................................................................................................................................................................................................................................... 19
2.2.2 Soorten diagnostische instrumenten .......................................................................................................................................................................................................................................................................................................................................................................................... 19
a. Kwantitatieve diagnostiek ..................................................................................................................................................................................................................................................................................................................................................................................... 20
b. Kwalitatieve diagnostiek........................................................................................................................................................................................................................................................................................................................................................................................ 21
2.2.3 Speciale aandacht: intake of aanmeldingsgesprek..................................................................................................................................................................................................................................................................................................................................................................... 22
2.2.4 Computerdiagnostiek ................................................................................................................................................................................................................................................................................................................................................................................................................... 22
2.2.5 Andere uitdagingen binnen de diagnostiek ................................................................................................................................................................................................................................................................................................................................................................................ 22
2.2.6 Kwaliteitsbewaking ....................................................................................................................................................................................................................................................................................................................................................................................................................... 23
2.3 Classificatiesystemen ................................................................................................................................................................................................................................................................................................................................................................................................................................... 23
2.3.1 Verschillende classificatiesystem en binnen de psychopathologie ........................................................................................................................................................................................................................................................................................................................................... 23
2.3.2 DSM-5 ............................................................................................................................................................................................................................................................................................................................................................................................................................................ 24
2.3.3 Aandachtspunten in de diagnostiek ............................................................................................................................................................................................................................................................................................................................................................................................ 25
c. VIDEO over stigma’s ............................................................................................................................................................................................................................................................................................................................................................................................... 25
3) Stemmingsstoornissen ............................................................................................................................................................................................................................................................................................................................................................................ 26
3.1 Wat het inhoudt ........................................................................................................................................................................................................................................................................................................................................................................................................................................... 26
3.2 Depressieve stemmingsstoornissen ............................................................................................................................................................................................................................................................................................................................................................................................................ 27
3.2.1 Majeure depressieve stoornis...................................................................................................................................................................................................................................................................................................................................................................................................... 28
3.2.2 Persisterende depressieve stoornis ............................................................................................................................................................................................................................................................................................................................................................................................. 29
3.2.3 Premenstruele stemmingsstoornis.............................................................................................................................................................................................................................................................................................................................................................................................. 30
3.2.4 Leeftijdsverschillen ....................................................................................................................................................................................................................................................................................................................................................................................................................... 30
a. Depressie bij kinderen (+/- tot 12j) ....................................................................................................................................................................................................................................................................................................................................................................... 30
b. Depressie bij jongeren en adolescenten ............................................................................................................................................................................................................................................................................................................................................................... 31
c. Depressie bij ouderen ............................................................................................................................................................................................................................................................................................................................................................................................ 32
3.2.5 Genderverschillen ......................................................................................................................................................................................................................................................................................................................................................................................................................... 33
3.2.6 Prevalentiecijfers .......................................................................................................................................................................................................................................................................................................................................................................................................................... 33
3.2.7 Culturele verschillen ..................................................................................................................................................................................................................................................................................................................................................................................................................... 34
3.2.8 Ontstaan en verloop ..................................................................................................................................................................................................................................................................................................................................................................................................................... 35
a. Risico- en beschermende factoren ........................................................................................................................................................................................................................................................................................................................................................................ 35
b. Visie o/h ontstaan v. depressie vanuit de therapeutische stromingen en modellen ......................................................................................................................................................................................................................................................................................... 36
c. Het cognitief model van Beck ................................................................................................................................................................................................................................................................................................................................................................................ 36
3.2.9 Comorbiditeit ................................................................................................................................................................................................................................................................................................................................................................................................................................ 37
3.2.10 Suïcide ......................................................................................................................................................................................................................................................................................................................................................................................................................................... 38
3.2.11 Diagnostiek.................................................................................................................................................................................................................................................................................................................................................................................................................................. 38
3.2.12 Verloop ........................................................................................................................................................................................................................................................................................................................................................................................................................................ 38
3.2.13 In contact..................................................................................................................................................................................................................................................................................................................................................................................................................................... 39
3.3 Bipolaire en aanverwante stoornissen........................................................................................................................................................................................................................................................................................................................................................................................................ 39
3.3.1 Wat het inhoudt ............................................................................................................................................................................................................................................................................................................................................................................................................................ 39
3.3.2 Episodes......................................................................................................................................................................................................................................................................................................................................................................................................................................... 40
a. Manische episode .................................................................................................................................................................................................................................................................................................................................................................................................. 40
b. Hypomane episode ................................................................................................................................................................................................................................................................................................................................................................................................ 41
c. Depressieve episode............................................................................................................................................................................................................................................................................................................................................................................................... 42
d. Gemengde episode ................................................................................................................................................................................................................................................................................................................................................................................................ 42
3.3.3 Subtypes ........................................................................................................................................................................................................................................................................................................................................................................................................................................ 42
a. Bipolaire-I-stornis ................................................................................................................................................................................................................................................................................................................................................................................................... 43
b. Bipolaire-II-stoornis................................................................................................................................................................................................................................................................................................................................................................................................ 43
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, c. Cyclotyme stoornis ................................................................................................................................................................................................................................................................................................................................................................................................. 44
d. Rapid cycling .......................................................................................................................................................................................................................................................................................................................................................................................................... 44
3.3.4 Kritische bedenking ...................................................................................................................................................................................................................................................................................................................................................................................................................... 44
3.3.5 Prevalentie .................................................................................................................................................................................................................................................................................................................................................................................................................................... 45
3.3.6 Culturele verschillen ..................................................................................................................................................................................................................................................................................................................................................................................................................... 45
3.3.7 Ontstaan en verloop ..................................................................................................................................................................................................................................................................................................................................................................................................................... 46
3.3.8 Neurologie ..................................................................................................................................................................................................................................................................................................................................................................................................................................... 46
3.3.9 Comorbiditeit ................................................................................................................................................................................................................................................................................................................................................................................................................................ 47
3.3.10 Diagnostiek.................................................................................................................................................................................................................................................................................................................................................................................................................................. 47
a. Overlap met ADHD ................................................................................................................................................................................................................................................................................................................................................................................................. 48
3.3.11 Hedendaagse tendensen ........................................................................................................................................................................................................................................................................................................................................................................................................... 48
3.3.12 Ups & Downs............................................................................................................................................................................................................................................................................................................................................................................................................................... 48
4) Psychotrauma-, stressorgerelateerde en dissociatieve stoornissen ........................................................................................................................................................................................................................................................................................................... 48
4.1 Trauma- en stressorgerelateerde stoornissen ............................................................................................................................................................................................................................................................................................................................................................................................ 49
4.1.1 Subtyperingen ............................................................................................................................................................................................................................................................................................................................................................................................................................... 50
4.1.2 Symptomen ................................................................................................................................................................................................................................................................................................................................................................................................................................... 50
a. Aanpassingsstoornis .............................................................................................................................................................................................................................................................................................................................................................................................. 50
b. Acute stressstoornis ............................................................................................................................................................................................................................................................................................................................................................................................... 51
c. Posttraumatische stressstoornis ........................................................................................................................................................................................................................................................................................................................................................................... 53
d. Complexe PTSS ....................................................................................................................................................................................................................................................................................................................................................................................................... 54
4.1.3 Leeftijdsverschillen ....................................................................................................................................................................................................................................................................................................................................................................................................................... 54
4.1.4 Prevalentie .................................................................................................................................................................................................................................................................................................................................................................................................................................... 57
a. Aanpassingsstoornis ............................................................................................................................................................................................................................................................................................................................................................................................. 57
b. Acute stressststoornis ........................................................................................................................................................................................................................................................................................................................................................................................... 57
c. Posttraumatische stressstoornis (PTSS) .............................................................................................................................................................................................................................................................................................................................................................. 57
d. Complexe posttraumatische stressstoornis (cPTSS) ........................................................................................................................................................................................................................................................................................................................................... 58
4.1.5 Ontstaan en verloop ..................................................................................................................................................................................................................................................................................................................................................................................................................... 58
a. Aanpassingsstoornis ............................................................................................................................................................................................................................................................................................................................................................................................. 58
b. Acute stressstoornis .............................................................................................................................................................................................................................................................................................................................................................................................. 59
c. Posttraumatische stressstoornis (PTSS) .............................................................................................................................................................................................................................................................................................................................................................. 59
d. Complexe posttraumatische stressstoornis (cPTSS) ........................................................................................................................................................................................................................................................................................................................................... 60
4.1.6 Comorbiditeit ................................................................................................................................................................................................................................................................................................................................................................................................................................ 61
a. Aanpassingsstoornis ............................................................................................................................................................................................................................................................................................................................................................................................. 61
b. Acute stressstoornis .............................................................................................................................................................................................................................................................................................................................................................................................. 61
c. Posttraumatische stressstoornis .......................................................................................................................................................................................................................................................................................................................................................................... 61
d. Complexe posttraumatische stressstoornis (cPTSS) ........................................................................................................................................................................................................................................................................................................................................... 61
4.1.7 Diagnostiek .................................................................................................................................................................................................................................................................................................................................................................................................................................... 61
4.1.8 Aandachtspunten in het werkveld............................................................................................................................................................................................................................................................................................................................................................................................... 62
4.2 Dissociatieve stoornissen ............................................................................................................................................................................................................................................................................................................................................................................................................................. 62
4.2.1 Subtyperingen ............................................................................................................................................................................................................................................................................................................................................................................................................................... 63
4.2.2 Symptomen ................................................................................................................................................................................................................................................................................................................................................................................................................................... 64
a. Dissociatieve identiteitsstoornis (DIS)................................................................................................................................................................................................................................................................................................................................................................... 64
b. Dissociatieve amnesie............................................................................................................................................................................................................................................................................................................................................................................................ 65
c. Depersonalisatie-/derealisatiestoornis ................................................................................................................................................................................................................................................................................................................................................................ 66
4.2.3 Prevalentie .................................................................................................................................................................................................................................................................................................................................................................................................................................... 67
4.2.4 Ontstaan en verloop ..................................................................................................................................................................................................................................................................................................................................................................................................................... 67
a. Verklaringsmodellen .............................................................................................................................................................................................................................................................................................................................................................................................. 67
I. Traumaperspectief .......................................................................................................................................................................................................................................................................................................................................................................... 67
II. Socio-cognitief model ..................................................................................................................................................................................................................................................................................................................................................................... 67
II. Biologisch model ............................................................................................................................................................................................................................................................................................................................................................................. 68
b. Risico- en beschermende factoren ........................................................................................................................................................................................................................................................................................................................................................................ 68
4.2.5 Culturele verschillen ..................................................................................................................................................................................................................................................................................................................................................................................................................... 68
4.2.6 Comorbiditeiten ............................................................................................................................................................................................................................................................................................................................................................................................................................ 69
4.2.7 Diagnostiek .................................................................................................................................................................................................................................................................................................................................................................................................................................... 69
5) Angststoornissen .................................................................................................................................................................................................................................................................................................................................................................................... 69
5.1 Vrees en angst .............................................................................................................................................................................................................................................................................................................................................................................................................................................. 69
5.2 Subtyperingen .............................................................................................................................................................................................................................................................................................................................................................................................................................................. 71
5.3 Symptomen ................................................................................................................................................................................................................................................................................................................................................................................................................................................... 71
5.3.1 Specifieke fobie ............................................................................................................................................................................................................................................................................................................................................................................................................................. 71
5.3.2 Sociale-angststoornis.................................................................................................................................................................................................................................................................................................................................................................................................................... 72
5.3.3 Paniekstoornis ............................................................................................................................................................................................................................................................................................................................................................................................................................... 73
5.3.4 Agorafobie ..................................................................................................................................................................................................................................................................................................................................................................................................................................... 74
5.3.5 Gegeneraliseerde angststoornis .................................................................................................................................................................................................................................................................................................................................................................................................. 74
5.4 Prevalentie .................................................................................................................................................................................................................................................................................................................................................................................................................................................... 75
5.5 Culturele verschillen ..................................................................................................................................................................................................................................................................................................................................................................................................................................... 75
5.6 Ontstaan en verloop ..................................................................................................................................................................................................................................................................................................................................................................................................................................... 76
5.6.1 Risicofactoren................................................................................................................................................................................................................................................................................................................................................................................................................................ 76
a. Familiale belasting (diathese-stressmodel) .......................................................................................................................................................................................................................................................................................................................................................... 76
b. Afwijkingen in de hersenen ................................................................................................................................................................................................................................................................................................................................................................................... 77
5.6.2 Verklarende modellen .................................................................................................................................................................................................................................................................................................................................................................................................................. 77
a. Het cognitief-biologisch model van Clark (1958) ................................................................................................................................................................................................................................................................................................................................................. 77
b. Het multifactorieel model van fobieën ................................................................................................................................................................................................................................................................................................................................................................. 78
5.7 Comorbiditeit ................................................................................................................................................................................................................................................................................................................................................................................................................................................ 79
5.7.1 Specifieke fobie ............................................................................................................................................................................................................................................................................................................................................................................................................................. 79
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, 5.7.2 Sociale-angststoornis.................................................................................................................................................................................................................................................................................................................................................................................................................... 79
5.7.3 Paniekstoornis ............................................................................................................................................................................................................................................................................................................................................................................................................................... 79
5.7.4 Agorafobie ..................................................................................................................................................................................................................................................................................................................................................................................................................................... 79
5.7.5 Gegeneraliseerde angststoornis .................................................................................................................................................................................................................................................................................................................................................................................................. 80
5.8 Diagnostiek ................................................................................................................................................................................................................................................................................................................................................................................................................................................... 80
6) Obsessief-compulsieve en aanverwante stoornissen ................................................................................................................................................................................................................................................................................................................................ 80
6.1 Subtyperingen .............................................................................................................................................................................................................................................................................................................................................................................................................................................. 81
6.2 Obsessieve-compulsieve stoornis (OCD) – symptomen ............................................................................................................................................................................................................................................................................................................................................................................ 81
6.3 Prevalentie .................................................................................................................................................................................................................................................................................................................................................................................................................................................... 82
6.4 Ontstaan en verloop ..................................................................................................................................................................................................................................................................................................................................................................................................................................... 82
6.4.1 Biologisch verklaringsmodel ........................................................................................................................................................................................................................................................................................................................................................................................................ 82
6.4.2 Psychodynamisch verklaringsmodel............................................................................................................................................................................................................................................................................................................................................................................................ 83
6.4.3 Het cognitief verklaringsmodel .................................................................................................................................................................................................................................................................................................................................................................................................... 83
6.4.4 Het leertheoretisch verklaringsmodel......................................................................................................................................................................................................................................................................................................................................................................................... 84
6.5 Culturele verschillen ..................................................................................................................................................................................................................................................................................................................................................................................................................................... 84
6.6 Comorbiditeit ................................................................................................................................................................................................................................................................................................................................................................................................................................................ 85
6.7 Diagnostiek ................................................................................................................................................................................................................................................................................................................................................................................................................................................... 85
7) Persoonlijkheidsstoornissen .................................................................................................................................................................................................................................................................................................................................................................... 86
7.1 Inhoud ........................................................................................................................................................................................................................................................................................................................................................................................................................................................... 86
7.2 Subtyperingen .............................................................................................................................................................................................................................................................................................................................................................................................................................................. 87
7.3 Symptomen ................................................................................................................................................................................................................................................................................................................................................................................................................................................... 88
7.3.1 Cluster A: vreemd, excentriek, afstandelijk ................................................................................................................................................................................................................................................................................................................................................................................ 88
a. Paranoïde persoonlijkheidsstoornis ...................................................................................................................................................................................................................................................................................................................................................................... 89
b. Schizoïde persoonlijkheidsstoornis ....................................................................................................................................................................................................................................................................................................................................................................... 90
c. Schizotypische persoonlijkheidsstoornis ............................................................................................................................................................................................................................................................................................................................................................... 91
7.3.2 Cluster B: dramatisch, emotioneel, grillig ................................................................................................................................................................................................................................................................................................................................................................................... 91
a. Antisociale persoonlijkheidsstoornis ..................................................................................................................................................................................................................................................................................................................................................................... 92
b. Borderline persoonlijkheidsstoornis...................................................................................................................................................................................................................................................................................................................................................................... 93
c. Histrionische persoonlijkheidsstoornis ................................................................................................................................................................................................................................................................................................................................................................. 94
d. Narcistische persoonlijkheidsstoornis ................................................................................................................................................................................................................................................................................................................................................................... 95
7.3.3 Cluster C: angstig, vermijdend, afhankelijk................................................................................................................................................................................................................................................................................................................................................................................. 95
a. Vermijdende persoonlijkheidsstoornis .................................................................................................................................................................................................................................................................................................................................................................. 96
b. Afhankelijke persoonlijkheidsstoornis................................................................................................................................................................................................................................................................................................................................................................... 97
c. Obsessief-compulsieve persoonlijkheidsstoornis ................................................................................................................................................................................................................................................................................................................................................. 98
7.4 Prevalentie .................................................................................................................................................................................................................................................................................................................................................................................................................................................... 98
7.5 Leeftijdsverschillen ....................................................................................................................................................................................................................................................................................................................................................................................................................................... 99
a. Ontwikkeling en beloop ....................................................................................................................................................................................................................................................................................................................................................................................... 100
7.6 Culturele verschillen ................................................................................................................................................................................................................................................................................................................................................................................................................................... 101
7.7 Ontstaan en verloop ................................................................................................................................................................................................................................................................................................................................................................................................................................... 101
7.8 Comorbiditeit .............................................................................................................................................................................................................................................................................................................................................................................................................................................. 102
7.9 Diagnostiek ................................................................................................................................................................................................................................................................................................................................................................................................................................................. 103
8) Middelgerelateerde en verslavingsstoornissen .......................................................................................................................................................................................................................................................................................................................................104
8.1 Wat het inhoudt ......................................................................................................................................................................................................................................................................................................................................................................................................................................... 104
8.2 Subtyperingen ............................................................................................................................................................................................................................................................................................................................................................................................................................................ 105
8.2.1 De middelgerelateerde stoornissen .......................................................................................................................................................................................................................................................................................................................................................................................... 105
a. Classificatie van middelen ................................................................................................................................................................................................................................................................................................................................................................................... 106
I. Indeling in middelen volgens werkingsmechanismen ........................................................................................................................................................................................................................................................................................................................................... 106
II. Indeling volgens beleid en preventie .................................................................................................................................................................................................................................................................................................................................................. 108
b. Stoornissen in en door het gebruik van een middel........................................................................................................................................................................................................................................................................................................................................... 108
8.2.2 De niet-middelgerelateerde stoornissen .................................................................................................................................................................................................................................................................................................................................................................................. 109
8.3 Symptomen ................................................................................................................................................................................................................................................................................................................................................................................................................................................. 109
8.3.1 Middelgerelateerde stoornissen................................................................................................................................................................................................................................................................................................................................................................................................ 109
a. Stoornis in het gebruik van middelen ................................................................................................................................................................................................................................................................................................................................................................. 110
b. Middel geïnduceerde stoornissen ....................................................................................................................................................................................................................................................................................................................................................................... 111
I. Intoxicatie............................................................................................................................................................................................................................................................................................................................................................................................... 111
II. Onthouding ........................................................................................................................................................................................................................................................................................................................................................................................... 111
III. Middel geïnduceerde mentale stoornissen ....................................................................................................................................................................................................................................................................................................................................... 112
8.3.2 Niet-middelgerelateerde stoornissen: gokstoornis .................................................................................................................................................................................................................................................................................................................................................................. 113
8.4 Leeftijdsverschillen ..................................................................................................................................................................................................................................................................................................................................................................................................................................... 113
8.4.1 Middelgerelateerde stoornis: Alcohol ....................................................................................................................................................................................................................................................................................................................................................................................... 114
a. Stoornis in het gebruik van alcohol..................................................................................................................................................................................................................................................................................................................................................................... 114
b. Middel geïnduceerd: intoxicatie .......................................................................................................................................................................................................................................................................................................................................................................... 114
c. Middel geïnduceerde: onthouding...................................................................................................................................................................................................................................................................................................................................................................... 114
8.4.2 De gokstoornis ............................................................................................................................................................................................................................................................................................................................................................................................................................ 115
8.5 Prevalentie .................................................................................................................................................................................................................................................................................................................................................................................................................................................. 115
8.5.1 Alcohol ......................................................................................................................................................................................................................................................................................................................................................................................................................................... 115
8.5.2 Tabak ............................................................................................................................................................................................................................................................................................................................................................................................................................................ 116
8.5.3 Cannabis ...................................................................................................................................................................................................................................................................................................................................................................................................................................... 116
8.5.4 Andere illegale drugs .................................................................................................................................................................................................................................................................................................................................................................................................................. 116
8.5.5 Kansspelen .................................................................................................................................................................................................................................................................................................................................................................................................................................. 116
8.6 Culturele verschillen ................................................................................................................................................................................................................................................................................................................................................................................................................................... 116
8.7 Ontstaan en verloop ................................................................................................................................................................................................................................................................................................................................................................................................................................... 117
8.7.1 Neurobiologisch perspectief: belangrijkste breinveranderingen ............................................................................................................................................................................................................................................................................................................................................ 117
a. De verstoring van het beloningssysteem ............................................................................................................................................................................................................................................................................................................................................................ 117
3
, b. Ontstaan van automatismen .............................................................................................................................................................................................................................................................................................................................................................................. 118
c. De afname van het controlerend systeem.......................................................................................................................................................................................................................................................................................................................................................... 119
d. Het ontstaan van craving .................................................................................................................................................................................................................................................................................................................................................................................... 119
e. Het ontstaan van tolerantie ................................................................................................................................................................................................................................................................................................................................................................................ 119
f. Het ontstaan van onthoudingsverschijnselen .................................................................................................................................................................................................................................................................................................................................................... 120
8.7.2 Risico- en beschermende factoren: MMM-model ................................................................................................................................................................................................................................................................................................................................................................... 120
8.7.3 De gokstoornis ............................................................................................................................................................................................................................................................................................................................................................................................................................ 120
8.8 Comorbiditeit .............................................................................................................................................................................................................................................................................................................................................................................................................................................. 121
8.8.1 Middelgerelateerde stoornissen bij alcohol ............................................................................................................................................................................................................................................................................................................................................................................. 121
8.8.2 Gokstoornis ................................................................................................................................................................................................................................................................................................................................................................................................................................. 121
8.9 Diagnostiek ................................................................................................................................................................................................................................................................................................................................................................................................................................................. 122
9) Schizofreniespectrum en andere psychotische stoornissen .....................................................................................................................................................................................................................................................................................................................122
9.1 Subtyperingen ............................................................................................................................................................................................................................................................................................................................................................................................................................................ 122
9.2 Symptomen ................................................................................................................................................................................................................................................................................................................................................................................................................................................. 123
9.2.1 Basissymptomen ......................................................................................................................................................................................................................................................................................................................................................................................................................... 123
a. Positieve en negatieve symptomen .................................................................................................................................................................................................................................................................................................................................................................... 123
b. Uitingsvormen ...................................................................................................................................................................................................................................................................................................................................................................................................... 123
9.2.2 Subtypes ...................................................................................................................................................................................................................................................................................................................................................................................................................................... 126
a. Kortdurende psychotische stoornis ..................................................................................................................................................................................................................................................................................................................................................................... 126
b. Schizofrenie .......................................................................................................................................................................................................................................................................................................................................................................................................... 127
c. Schizofreniforme stoornis .................................................................................................................................................................................................................................................................................................................................................................................... 128
d. Waanstoornis ....................................................................................................................................................................................................................................................................................................................................................................................................... 128
9.3 Leeftijdsverschillen ..................................................................................................................................................................................................................................................................................................................................................................................................................................... 129
9.4 Prevalentie .................................................................................................................................................................................................................................................................................................................................................................................................................................................. 129
9.5 Culturele verschillen ................................................................................................................................................................................................................................................................................................................................................................................................................................... 130
9.6 Ontstaan en verloop ................................................................................................................................................................................................................................................................................................................................................................................................................................... 130
9.6.1 Ontwikkeling en evolutie............................................................................................................................................................................................................................................................................................................................................................................................................ 130
9.6.2 Diathese – stressmodel .............................................................................................................................................................................................................................................................................................................................................................................................................. 131
a. Diathese ................................................................................................................................................................................................................................................................................................................................................................................................................ 131
b. Stress..................................................................................................................................................................................................................................................................................................................................................................................................................... 132
9.6.3 Hedendaagse ontwikkelingen .................................................................................................................................................................................................................................................................................................................................................................................................... 132
a. Psychose als resultaat van disfunctionele coping .............................................................................................................................................................................................................................................................................................................................................. 133
b. Psychose en taaldysfunctie.................................................................................................................................................................................................................................................................................................................................................................................. 133
c. Selienshypothese .................................................................................................................................................................................................................................................................................................................................................................................................. 133
9.7 Comorbiditeit .............................................................................................................................................................................................................................................................................................................................................................................................................................................. 133
9.8 Aandachtspunten ....................................................................................................................................................................................................................................................................................................................................................................................................................................... 134
9.9 Diagnostiek ................................................................................................................................................................................................................................................................................................................................................................................................................................................. 134
9.9.1 Fasengebonden richtlijnen ......................................................................................................................................................................................................................................................................................................................................................................................................... 134
9.9.2 Stappen in de diagnostiek .......................................................................................................................................................................................................................................................................................................................................................................................................... 135
10) Neurocognitieve stoornissen ..................................................................................................................................................................................................................................................................................................................................................................135
10.1 Subtyperingen .......................................................................................................................................................................................................................................................................................................................................................................................................................................... 135
10.2 Symptomen............................................................................................................................................................................................................................................................................................................................................................................................................................................... 136
10.3 Prevalentie ................................................................................................................................................................................................................................................................................................................................................................................................................................................ 137
10.4 Ontstaan en verloop................................................................................................................................................................................................................................................................................................................................................................................................................................. 137
10.4.1 Risico- en uitlokkende factoren ............................................................................................................................................................................................................................................................................................................................................................................................... 137
10.4.2 Verklaringsmodellen ................................................................................................................................................................................................................................................................................................................................................................................................................. 138
a. Ontstekingshypothese ......................................................................................................................................................................................................................................................................................................................................................................................... 138
b. Neurotransmitterhypothese ................................................................................................................................................................................................................................................................................................................................................................................ 138
10.5 Diagnostiek ............................................................................................................................................................................................................................................................................................................................................................................................................................................... 138
11) Voedings- en eetstoornissen ..................................................................................................................................................................................................................................................................................................................................................................139
11.1 Subtyperingen .......................................................................................................................................................................................................................................................................................................................................................................................................................................... 140
11.2 Symptomen............................................................................................................................................................................................................................................................................................................................................................................................................................................... 140
11.2.1 Anorexia Nervosa ..................................................................................................................................................................................................................................................................................................................................................................................................................... 140
11.2.2 Boulimia Nervosa...................................................................................................................................................................................................................................................................................................................................................................................................................... 142
11.2.3 Eetbuistoornis ........................................................................................................................................................................................................................................................................................................................................................................................................................... 143
11.2.4 Eetbuien doorheen de stoornissen ......................................................................................................................................................................................................................................................................................................................................................................................... 143
11.2.5 Signalen in de thuiscontext ...................................................................................................................................................................................................................................................................................................................................................................................................... 144
a. Veranderingen in massa ...................................................................................................................................................................................................................................................................................................................................................................................... 144
b. Gedrag tijdens maaltijden ................................................................................................................................................................................................................................................................................................................................................................................... 144
c. Preoccupatie met eten, gewicht en uiterlijk ....................................................................................................................................................................................................................................................................................................................................................... 145
d. Beweeggedrag ..................................................................................................................................................................................................................................................................................................................................................................................................... 145
e. Andere signalen ................................................................................................................................................................................................................................................................................................................................................................................................... 145
11.2.6 Signalen in de schoolcontext en vrije tijd ............................................................................................................................................................................................................................................................................................................................................................................... 145
a. Schoolcontext ....................................................................................................................................................................................................................................................................................................................................................................................................... 145
b. Vrije tijd................................................................................................................................................................................................................................................................................................................................................................................................................. 145
11.3 Prevalentie ................................................................................................................................................................................................................................................................................................................................................................................................................................................ 146
11.4 Ontstaan en verloop................................................................................................................................................................................................................................................................................................................................................................................................................................. 146
11.4.1 Biologische factoren ................................................................................................................................................................................................................................................................................................................................................................................................................. 146
a. Genetica ................................................................................................................................................................................................................................................................................................................................................................................................................ 146
b. Hersenen ............................................................................................................................................................................................................................................................................................................................................................................................................... 147
11.4.2 Psychologische factoren ........................................................................................................................................................................................................................................................................................................................................................................................................... 147
11.4.3 Socio-culturele factoren ........................................................................................................................................................................................................................................................................................................................................................................................................... 148
11.5 Comorbiditeit............................................................................................................................................................................................................................................................................................................................................................................................................................................ 148
11.5.1 Lichamelijke klachten ............................................................................................................................................................................................................................................................................................................................................................................................................... 148
4
, 11.5.2 Psychologische klachten ........................................................................................................................................................................................................................................................................................................................................................................................................... 148
11.6 Diagnostiek ............................................................................................................................................................................................................................................................................................................................................................................................................................................... 149
12) Slaap- en waakstoornissen .....................................................................................................................................................................................................................................................................................................................................................................149
12.1 Gewone slaap ........................................................................................................................................................................................................................................................................................................................................................................................................................................... 149
12.2 Subtyperingen .......................................................................................................................................................................................................................................................................................................................................................................................................................................... 151
12.3 Symptomen............................................................................................................................................................................................................................................................................................................................................................................................................................................... 152
12.3.1 Insomnia stoornis ..................................................................................................................................................................................................................................................................................................................................................................................................................... 152
12.3.2 Hypersomnolentiestoornis....................................................................................................................................................................................................................................................................................................................................................................................................... 152
12.3.3 Narcolepsie ............................................................................................................................................................................................................................................................................................................................................................................................................................... 153
12.3.4 Circadiane slaap-waakstoornissen .......................................................................................................................................................................................................................................................................................................................................................................................... 153
12.3.5 Non-REM slaaparousalstoornis ............................................................................................................................................................................................................................................................................................................................................................................................... 154
12.3.6 Nachtmerriestoornis ................................................................................................................................................................................................................................................................................................................................................................................................................ 154
12.3.7 REM-slaapgedragstoornis ........................................................................................................................................................................................................................................................................................................................................................................................................ 154
12.4 Prevalentie ................................................................................................................................................................................................................................................................................................................................................................................................................................................ 155
12.5 Ontstaan en verloop................................................................................................................................................................................................................................................................................................................................................................................................................................. 155
12.5.1 Verklaringsmodel voor insomnia ............................................................................................................................................................................................................................................................................................................................................................................................. 156
12.5.2 Verklaringsmodel voor narcolepsie ......................................................................................................................................................................................................................................................................................................................................................................................... 157
12.6 Comorbiditeit............................................................................................................................................................................................................................................................................................................................................................................................................................................ 157
12.6.1 Psychiatrische comorbiditeit.................................................................................................................................................................................................................................................................................................................................................................................................... 157
12.6.2 Medische comorbiditeit ........................................................................................................................................................................................................................................................................................................................................................................................................... 158
12.7 Diagnostiek ............................................................................................................................................................................................................................................................................................................................................................................................................................................... 158
13) Seksualiteitsstoornissen .........................................................................................................................................................................................................................................................................................................................................................................159
13.1 Subtyperingen .......................................................................................................................................................................................................................................................................................................................................................................................................................................... 159
13.2 Symptomen............................................................................................................................................................................................................................................................................................................................................................................................................................................... 160
13.2.1 DSM-5 algemene criteria ......................................................................................................................................................................................................................................................................................................................................................................................................... 160
13.2.2 Seksuele disfuncties ................................................................................................................................................................................................................................................................................................................................................................................................................. 161
a. Seksuele disfuncties bij mannen ......................................................................................................................................................................................................................................................................................................................................................................... 161
I. Vroege ejaculatie ................................................................................................................................................................................................................................................................................................................................................................................... 161
II. Erectiestoornis ...................................................................................................................................................................................................................................................................................................................................................................................... 161
III. Stoornis in seksueel verlangen ........................................................................................................................................................................................................................................................................................................................................................... 162
IV. Voortijdige (vroege) ejaculatie ........................................................................................................................................................................................................................................................................................................................................................... 162
b. Seksuele disfuncties bij vrouwen......................................................................................................................................................................................................................................................................................................................................................................... 163
I. Vrouwelijke orgasmestoornis ............................................................................................................................................................................................................................................................................................................................................................... 163
II. Stoornis in seksueel verlangen/opwinding bij vrouwen .................................................................................................................................................................................................................................................................................................................... 163
III. Genito-pelviene pijn-/penetratiestoornis.......................................................................................................................................................................................................................................................................................................................................... 164
c. Seksuele disfunctie bij mannen en vrouwen ...................................................................................................................................................................................................................................................................................................................................................... 164
13.3 Prevalentie ................................................................................................................................................................................................................................................................................................................................................................................................................................................ 164
13.4 Ontstaan en verloop................................................................................................................................................................................................................................................................................................................................................................................................................................. 165
13.4.1 Seksuele responscyclus ............................................................................................................................................................................................................................................................................................................................................................................................................ 165
13.4.2 Oorzaken van verstoring in de seksuele responscyclus ......................................................................................................................................................................................................................................................................................................................................................... 166
13.5 Comorbiditeit............................................................................................................................................................................................................................................................................................................................................................................................................................................ 166
13.6 Diagnostiek ............................................................................................................................................................................................................................................................................................................................................................................................................................................... 167
14) Parafiele stoornissen ..............................................................................................................................................................................................................................................................................................................................................................................167
14.1 Subtyperingen .......................................................................................................................................................................................................................................................................................................................................................................................................................................... 167
14.2 Symptomen............................................................................................................................................................................................................................................................................................................................................................................................................................................... 168
14.2.1 Voyeuristische stoornis ............................................................................................................................................................................................................................................................................................................................................................................................................ 168
14.2.2 Exhibitionistische stoornis ....................................................................................................................................................................................................................................................................................................................................................................................................... 169
14.2.3 Frotteuristische stoornis .......................................................................................................................................................................................................................................................................................................................................................................................................... 169
14.2.4 Seksuele masochismestoornis ................................................................................................................................................................................................................................................................................................................................................................................................. 169
14.2.5 Seksuele sadismestoornis ........................................................................................................................................................................................................................................................................................................................................................................................................ 170
14.2.6 Pedofiele stoornis ..................................................................................................................................................................................................................................................................................................................................................................................................................... 170
14.2.7 Fetisjistische stoornis ............................................................................................................................................................................................................................................................................................................................................................................................................... 171
14.2.8 Transvestische stoornis ............................................................................................................................................................................................................................................................................................................................................................................................................ 171
14.3 Prevalentie ................................................................................................................................................................................................................................................................................................................................................................................................................................................ 171
14.4 Ontstaan en verloop................................................................................................................................................................................................................................................................................................................................................................................................................................. 172
14.4.1 Leertheoretische modellen ...................................................................................................................................................................................................................................................................................................................................................................................................... 172
14.4.2 Cognitieve modellen................................................................................................................................................................................................................................................................................................................................................................................................................. 172
14.4.3 Hechting- en ontwikkelingsmodellen ...................................................................................................................................................................................................................................................................................................................................................................................... 172
14.4.4 Neurobiologische en hormonale modellen ............................................................................................................................................................................................................................................................................................................................................................................ 172
14.4.5 Sociaal-ecologische modellen .................................................................................................................................................................................................................................................................................................................................................................................................. 173
14.5 Comorbiditeit............................................................................................................................................................................................................................................................................................................................................................................................................................................ 173
14.6 Diagnostiek ............................................................................................................................................................................................................................................................................................................................................................................................................................................... 173
15) Thema specifieke therapieën..................................................................................................................................................................................................................................................................................................................................................................174
15.1 Laagdrempelige initiatieven .................................................................................................................................................................................................................................................................................................................................................................................................................... 176
15.1.1 Informatiekanalen .................................................................................................................................................................................................................................................................................................................................................................................................................... 176
15.1.2 E-mental health ........................................................................................................................................................................................................................................................................................................................................................................................................................ 176
15.1.3 Verenigingen en vrijwilligers .................................................................................................................................................................................................................................................................................................................................................................................................... 177
15.1.4 Outreachend werken ................................................................................................................................................................................................................................................................................................................................................................................................................ 177
15.2 Ambulante en residentiële zorg .............................................................................................................................................................................................................................................................................................................................................................................................................. 178
15.3 Psychotherapeutische behandelvormen ................................................................................................................................................................................................................................................................................................................................................................................................ 178
15.3.1 Mentalisation Based Therapy (MBT) ....................................................................................................................................................................................................................................................................................................................................................................................... 178
15.3.2 Transference focused therapy (TFP) ........................................................................................................................................................................................................................................................................................................................................................................................ 179
15.3.3 Klassieke gedragstherapie ........................................................................................................................................................................................................................................................................................................................................................................................................ 179
15.3.4 Exposure therapie..................................................................................................................................................................................................................................................................................................................................................................................................................... 179
5
, 15.3.5 Narrative exposure therapie (NET) .......................................................................................................................................................................................................................................................................................................................................................................................... 179
15.3.6 Cognitieve gedragstherapie ..................................................................................................................................................................................................................................................................................................................................................................................................... 179
15.3.7 Eye movement desentisation and reprocessing (EMDR) ....................................................................................................................................................................................................................................................................................................................................................... 180
15.3.8 Imaginaire rescripting therapie (ImRs) .................................................................................................................................................................................................................................................................................................................................................................................... 180
15.3.9 Contextuele en acceptatiegerichte therapie .......................................................................................................................................................................................................................................................................................................................................................................... 180
15.3.10 Dialectische gedragstherapie ................................................................................................................................................................................................................................................................................................................................................................................................. 180
15.3.11 Acceptance and commitment therapy (ACT) ....................................................................................................................................................................................................................................................................................................................................................................... 181
15.3.12 Mindfulness based cognitive therapy ................................................................................................................................................................................................................................................................................................................................................................................... 181
15.3.13 Humanistische modellen ....................................................................................................................................................................................................................................................................................................................................................................................................... 181
15.3.14 Systeemmodellen ................................................................................................................................................................................................................................................................................................................................................................................................................... 181
15.3.15 Ecletische en integratieve behandelvormen ........................................................................................................................................................................................................................................................................................................................................................................ 181
15.4 Psychologische interventies..................................................................................................................................................................................................................................................................................................................................................................................................................... 182
15.5 Medische zorg .......................................................................................................................................................................................................................................................................................................................................................................................................................................... 183
15.5.1 Psychofarmaca .......................................................................................................................................................................................................................................................................................................................................................................................................................... 183
a. Antidepressiva ...................................................................................................................................................................................................................................................................................................................................................................................................... 183
b. Stemmingsstabilisatoren ..................................................................................................................................................................................................................................................................................................................................................................................... 184
c. Antipsychotica ...................................................................................................................................................................................................................................................................................................................................................................................................... 185
15.5.2 Neuromodulatie/hersengerichte interventies........................................................................................................................................................................................................................................................................................................................................................................ 186
15.5.3 Chronobiologische en somatische interventies...................................................................................................................................................................................................................................................................................................................................................................... 186
15.5.4 Medische zorg – aanpakken van medische oorzaken ............................................................................................................................................................................................................................................................................................................................................................ 187
16) Hedendaagse tendensen ........................................................................................................................................................................................................................................................................................................................................................................187
16.1 Evidence based werken ........................................................................................................................................................................................................................................................................................................................................................................................................................... 187
16.2 Staging en profiling .................................................................................................................................................................................................................................................................................................................................................................................................................................. 188
16.3 Hypnotherapie .......................................................................................................................................................................................................................................................................................................................................................................................................................................... 189
16.4 Virtual reality ............................................................................................................................................................................................................................................................................................................................................................................................................................................ 189
16.5 Artificiële intelligentie .............................................................................................................................................................................................................................................................................................................................................................................................................................. 189
16.6 Polyvagaaltheorie ..................................................................................................................................................................................................................................................................................................................................................................................................................................... 190
6
,1) Introductie in de pathologie
1.1 Wat het inhoudt
Psychopathologie: Studie v/h geestelijk lijden of de leer v. psychische stoornissen => afwijkende emoties,
gedachten & aandoeningen
Stoornis: E. klinisch vastgestelde aandoening volgens de diagnostische criteria => vaak pas gege wnr h. impact heeft
o/h functioneren
Psychopathologie richt zich op … v. afwijkende emoties, gedachten en aandoeningen:
Beschrijving: gedetailleerd in kaart brengen v. symptomen en kenmerken v. psychische stoornissen
Persoon heeft profiel v. problemen, welke problemen, wat het allemaal inhoudt. => de studie over
wat het inhoudt
Classificatie: systematisch indelen v. psychische aandoeningen in diagnostische categorieën
Alle klachten proberen groeperen term aan proberen geven
Oorzaken: onderzoeken v. biologische, psychologische & sociale factoren die bijdragen a/h ontstaan v.
psychische aandoeningen
=> zoeken naar hoe komt h. dat de problematiek ontstaat
Vb. met heel duidelijke: trauma gerelateerde stoornis, postnatale depressie
Behandelingen: ontwikkelen en evalueren v. effectieve therapieën & interventies om psych. stoornissen
te verlichten of te genezen
=> Hoe kunnen we die mensen helpen
Beschrijving
Psychopathologie
Classificatie
Oorzaken
Behandelingen
➔ Doel psychopathologie = welzijn v. mensen met psychische problemen te verbeteren
Meeste therapieën = ontstaan uit beschrijvingen en classificaties (=> andere onethische experimenten WOII)
1.2 Belangrijke concepten
Symptoom: Uiting v/e onderliggend probleem, waarneembaar of door de patiënt aangegeven klacht. Kan
betrekking hebben op lichamelijke, psychische, sociale en/of existentiële aspecten.
Syndroom: e. verzameling/combinatie v. symptomen die samen e. spec. aandoening vormen. (≠ elk symptoom afz.
= e. probleem) Bij meerdere spec. symptomen die te gelijk optreden kan er e. diagnose worden gesteld.
7
, Syndroom
Symptomen
Comorbiditeit: samengaan v. ++ aandoeningen/syndromen, tegelijkertijd voorkomen v. 2 of + psychische en/of
lichamelijke aandoeningen bij 1 persoon. => er is e. primaire stoornis en ook een secundaire/andere aandoening.
vb.: piekeren (primair) en slaapproblemen (secundair)
Primaire stoornis: de stoornis die h. meeste effect heeft o/h functioneren v/d persoon, of de stoornis die er h. 1ste
was.
Secundaire stoornis: = e. gevolg v/d primaire dat deze gevormd wordt.
Comorbiditeit
Syndroom A Syndroom B
(primaire) (secundaire)
1.3 (Ab)normaal gedrag
Psychopathologie = afwijkende emoties, gedachten & gedragingen
wat beschouwd als afwijkend = afh. v. versch. factoren & interpretaties
Hoe gedrag als abnormaal gedefinieerd?
Cultuur
Maatschappelijke normen
Historische context
Norm: wnr de meeste mensen dit ook doen is het de norm
Abnormaal gedrag: vanaf h. ≠ meer voldoet a/d norm
Wnr h. gedrag regelmatig voorkomt bij de persoon
Wnr de persoon zichzelf in gevaar brengt/afremt
Iets uniek dat de persoon doet, uitzonderlijk
1.3.1 Veranderingen in de kijk op (ab)normaal gedrag
Afwijkend gedrag doorheen de tijd beïnvloed door:
Cultuur
Religie
Wetenschap
8
, Heeft invloed op hoe gedrag verklaren + welke behandelingen toepassen
Belangrijke veranderingen doorheen de tijd:
Oudheid & middeleeuwen
- Toegeschreven aan 18de - 19de eeuw
bovennatuurlijke
krachten - individuen met ernstige 20ste eeuw
- Klassieke oudheid - psychische problemen =
Hippocrates = opgesloten in instelling - Keerpunt = 21ste eeuw
behandeling door diëten, - 19de eeuw = psychoanalyse
medicijnen en verbeteringen in - psychiatrie beïnvloed - versch. tehrapeutische
lichamelijke oefeningen behandeling -> opkomst door ontwikkeling v. techn. combineren
psychiatrische medicijnen - ++ gepersonaliseerde
ziekenhuizen behandelingen
- opkomst
neurowetenschappen
- nadruk op
biopsychosociaal model
- belang v. preventie
Veranderingen op kijk kan binnen tijdseenheid en tss tijdseenheden
Vb.: homoseksualiteit, trauma- en stressgerelateerde stoornissen
Verschillen in kijk op psychische problemen
Tussen generaties => manier v. kijken bij kinderen, ouders en grootouders
Binnen generaties => verschillen in hoe interpreteren en aanpak tss dezelfde leeftijden
Kijk op psychisch welzijn = gevormd complex samenspel v. individuele, sociale en culturele factoren
= dynamisch beeld!!
1.3.2 Criteria van afwijkend gedrag
6 criteria om v. abnormaal gedrag te spreken:
• Uitzonderlijk: zeldzaam/ongebruikelijk in vgl met wat de meeste mensen doen.
Vb.: stemmen horen & nachten overslaan
• Sociaal afwijkend: afwijken v/d normen en regels v/d samenleving of cultuur waarin h. zich afspeelt
Vb.: stemmen horen
• Foute perceptie/interpretatie v/d realiteit: de werkelijkheid anders ervaren den h. i/d realiteit is.
vb.: denken dat e. bep. bekend persoon verliefd op je is
• Aanzienlijk emotioneel lijden: klachten zorgen voor e. aanzienlijke lijdensdruk.
Vb.: uitgeput, angstig, gespannen
• Ongepast ≈ contraproductief: klachten belemmeren de persoon i/h nrm funcioneren.
Vb.: te laat komen i/d les, nachten overslaan
• Gevaar: gedrag = gevaarlijk voor de persoon zelf of voor anderen.
Vb.: niet kunnen stoppen met middelengebruik
9
Mens en Gezondheid 2
ACADEMIEJAAR 2025-2026 AP HOGE SCHOOOL
,Inhoud
1) Introductie in de pathologie ...................................................................................................................................................................................................................................................................................................................................................................... 7
1.1 Wat het inhoudt ..............................................................................................................................................................................................................................................................................................................................................................................................................................................7
1.2 Belangrijke concepten .....................................................................................................................................................................................................................................................................................................................................................................................................................................7
1.3 (Ab)normaal gedrag ........................................................................................................................................................................................................................................................................................................................................................................................................................................8
1.3.1 Veranderingen in de kijk op (ab)normaal gedrag ..........................................................................................................................................................................................................................................................................................................................................................................8
1.3.2 Criteria van afwijkend gedrag .........................................................................................................................................................................................................................................................................................................................................................................................................9
1.4 Ontstaan van psychopathologie .................................................................................................................................................................................................................................................................................................................................................................................................................. 10
1.4.1 Biopsychosociaal model ............................................................................................................................................................................................................................................................................................................................................................................................................... 10
1.4.2 Het diathese – stressmodel.......................................................................................................................................................................................................................................................................................................................................................................................................... 12
1.4.3 Het nature – nurture debat .......................................................................................................................................................................................................................................................................................................................................................................................................... 12
1.5 Instandhouding van pathologie ................................................................................................................................................................................................................................................................................................................................................................................................................... 13
1.5.1 Cognitieve processen.................................................................................................................................................................................................................................................................................................................................................................................................................... 13
1.5.2 Gedragsmatige factoren ............................................................................................................................................................................................................................................................................................................................................................................................................... 13
1.5.3 Emotionele processen .................................................................................................................................................................................................................................................................................................................................................................................................................. 13
1.5.4 Sociale en relationele factoren .................................................................................................................................................................................................................................................................................................................................................................................................... 13
1.5.5 Biologische factoren ..................................................................................................................................................................................................................................................................................................................................................................................................................... 13
1.5.6 Omgevingsfactoren....................................................................................................................................................................................................................................................................................................................................................................................................................... 13
1.6 Behandeling in de pathologie ...................................................................................................................................................................................................................................................................................................................................................................................................................... 14
1.6.1 Psychodynamische modellen ....................................................................................................................................................................................................................................................................................................................................................................................................... 14
1.6.2 Behavioristisch modellen en zijn afgeleiden ............................................................................................................................................................................................................................................................................................................................................................................... 14
1.6.3 Humanistische modellen .............................................................................................................................................................................................................................................................................................................................................................................................................. 15
1.6.4 Systeemmodellen ......................................................................................................................................................................................................................................................................................................................................................................................................................... 16
2) Diagnostiek in de klinische psychologie ................................................................................................................................................................................................................................................................................................................................................... 17
2.1 Systematische aanpak in de psychodiagnostiek......................................................................................................................................................................................................................................................................................................................................................................................... 17
2.1.1 Wetenschappelijke methode ....................................................................................................................................................................................................................................................................................................................................................................................................... 17
2.1.2 Psychodiagnostische cyclus .......................................................................................................................................................................................................................................................................................................................................................................................................... 18
2.2 Diagnostische instrumenten ........................................................................................................................................................................................................................................................................................................................................................................................................................ 18
2.2.1 Keuze voor diagnostische instrumenten ..................................................................................................................................................................................................................................................................................................................................................................................... 19
2.2.2 Soorten diagnostische instrumenten .......................................................................................................................................................................................................................................................................................................................................................................................... 19
a. Kwantitatieve diagnostiek ..................................................................................................................................................................................................................................................................................................................................................................................... 20
b. Kwalitatieve diagnostiek........................................................................................................................................................................................................................................................................................................................................................................................ 21
2.2.3 Speciale aandacht: intake of aanmeldingsgesprek..................................................................................................................................................................................................................................................................................................................................................................... 22
2.2.4 Computerdiagnostiek ................................................................................................................................................................................................................................................................................................................................................................................................................... 22
2.2.5 Andere uitdagingen binnen de diagnostiek ................................................................................................................................................................................................................................................................................................................................................................................ 22
2.2.6 Kwaliteitsbewaking ....................................................................................................................................................................................................................................................................................................................................................................................................................... 23
2.3 Classificatiesystemen ................................................................................................................................................................................................................................................................................................................................................................................................................................... 23
2.3.1 Verschillende classificatiesystem en binnen de psychopathologie ........................................................................................................................................................................................................................................................................................................................................... 23
2.3.2 DSM-5 ............................................................................................................................................................................................................................................................................................................................................................................................................................................ 24
2.3.3 Aandachtspunten in de diagnostiek ............................................................................................................................................................................................................................................................................................................................................................................................ 25
c. VIDEO over stigma’s ............................................................................................................................................................................................................................................................................................................................................................................................... 25
3) Stemmingsstoornissen ............................................................................................................................................................................................................................................................................................................................................................................ 26
3.1 Wat het inhoudt ........................................................................................................................................................................................................................................................................................................................................................................................................................................... 26
3.2 Depressieve stemmingsstoornissen ............................................................................................................................................................................................................................................................................................................................................................................................................ 27
3.2.1 Majeure depressieve stoornis...................................................................................................................................................................................................................................................................................................................................................................................................... 28
3.2.2 Persisterende depressieve stoornis ............................................................................................................................................................................................................................................................................................................................................................................................. 29
3.2.3 Premenstruele stemmingsstoornis.............................................................................................................................................................................................................................................................................................................................................................................................. 30
3.2.4 Leeftijdsverschillen ....................................................................................................................................................................................................................................................................................................................................................................................................................... 30
a. Depressie bij kinderen (+/- tot 12j) ....................................................................................................................................................................................................................................................................................................................................................................... 30
b. Depressie bij jongeren en adolescenten ............................................................................................................................................................................................................................................................................................................................................................... 31
c. Depressie bij ouderen ............................................................................................................................................................................................................................................................................................................................................................................................ 32
3.2.5 Genderverschillen ......................................................................................................................................................................................................................................................................................................................................................................................................................... 33
3.2.6 Prevalentiecijfers .......................................................................................................................................................................................................................................................................................................................................................................................................................... 33
3.2.7 Culturele verschillen ..................................................................................................................................................................................................................................................................................................................................................................................................................... 34
3.2.8 Ontstaan en verloop ..................................................................................................................................................................................................................................................................................................................................................................................................................... 35
a. Risico- en beschermende factoren ........................................................................................................................................................................................................................................................................................................................................................................ 35
b. Visie o/h ontstaan v. depressie vanuit de therapeutische stromingen en modellen ......................................................................................................................................................................................................................................................................................... 36
c. Het cognitief model van Beck ................................................................................................................................................................................................................................................................................................................................................................................ 36
3.2.9 Comorbiditeit ................................................................................................................................................................................................................................................................................................................................................................................................................................ 37
3.2.10 Suïcide ......................................................................................................................................................................................................................................................................................................................................................................................................................................... 38
3.2.11 Diagnostiek.................................................................................................................................................................................................................................................................................................................................................................................................................................. 38
3.2.12 Verloop ........................................................................................................................................................................................................................................................................................................................................................................................................................................ 38
3.2.13 In contact..................................................................................................................................................................................................................................................................................................................................................................................................................................... 39
3.3 Bipolaire en aanverwante stoornissen........................................................................................................................................................................................................................................................................................................................................................................................................ 39
3.3.1 Wat het inhoudt ............................................................................................................................................................................................................................................................................................................................................................................................................................ 39
3.3.2 Episodes......................................................................................................................................................................................................................................................................................................................................................................................................................................... 40
a. Manische episode .................................................................................................................................................................................................................................................................................................................................................................................................. 40
b. Hypomane episode ................................................................................................................................................................................................................................................................................................................................................................................................ 41
c. Depressieve episode............................................................................................................................................................................................................................................................................................................................................................................................... 42
d. Gemengde episode ................................................................................................................................................................................................................................................................................................................................................................................................ 42
3.3.3 Subtypes ........................................................................................................................................................................................................................................................................................................................................................................................................................................ 42
a. Bipolaire-I-stornis ................................................................................................................................................................................................................................................................................................................................................................................................... 43
b. Bipolaire-II-stoornis................................................................................................................................................................................................................................................................................................................................................................................................ 43
1
, c. Cyclotyme stoornis ................................................................................................................................................................................................................................................................................................................................................................................................. 44
d. Rapid cycling .......................................................................................................................................................................................................................................................................................................................................................................................................... 44
3.3.4 Kritische bedenking ...................................................................................................................................................................................................................................................................................................................................................................................................................... 44
3.3.5 Prevalentie .................................................................................................................................................................................................................................................................................................................................................................................................................................... 45
3.3.6 Culturele verschillen ..................................................................................................................................................................................................................................................................................................................................................................................................................... 45
3.3.7 Ontstaan en verloop ..................................................................................................................................................................................................................................................................................................................................................................................................................... 46
3.3.8 Neurologie ..................................................................................................................................................................................................................................................................................................................................................................................................................................... 46
3.3.9 Comorbiditeit ................................................................................................................................................................................................................................................................................................................................................................................................................................ 47
3.3.10 Diagnostiek.................................................................................................................................................................................................................................................................................................................................................................................................................................. 47
a. Overlap met ADHD ................................................................................................................................................................................................................................................................................................................................................................................................. 48
3.3.11 Hedendaagse tendensen ........................................................................................................................................................................................................................................................................................................................................................................................................... 48
3.3.12 Ups & Downs............................................................................................................................................................................................................................................................................................................................................................................................................................... 48
4) Psychotrauma-, stressorgerelateerde en dissociatieve stoornissen ........................................................................................................................................................................................................................................................................................................... 48
4.1 Trauma- en stressorgerelateerde stoornissen ............................................................................................................................................................................................................................................................................................................................................................................................ 49
4.1.1 Subtyperingen ............................................................................................................................................................................................................................................................................................................................................................................................................................... 50
4.1.2 Symptomen ................................................................................................................................................................................................................................................................................................................................................................................................................................... 50
a. Aanpassingsstoornis .............................................................................................................................................................................................................................................................................................................................................................................................. 50
b. Acute stressstoornis ............................................................................................................................................................................................................................................................................................................................................................................................... 51
c. Posttraumatische stressstoornis ........................................................................................................................................................................................................................................................................................................................................................................... 53
d. Complexe PTSS ....................................................................................................................................................................................................................................................................................................................................................................................................... 54
4.1.3 Leeftijdsverschillen ....................................................................................................................................................................................................................................................................................................................................................................................................................... 54
4.1.4 Prevalentie .................................................................................................................................................................................................................................................................................................................................................................................................................................... 57
a. Aanpassingsstoornis ............................................................................................................................................................................................................................................................................................................................................................................................. 57
b. Acute stressststoornis ........................................................................................................................................................................................................................................................................................................................................................................................... 57
c. Posttraumatische stressstoornis (PTSS) .............................................................................................................................................................................................................................................................................................................................................................. 57
d. Complexe posttraumatische stressstoornis (cPTSS) ........................................................................................................................................................................................................................................................................................................................................... 58
4.1.5 Ontstaan en verloop ..................................................................................................................................................................................................................................................................................................................................................................................................................... 58
a. Aanpassingsstoornis ............................................................................................................................................................................................................................................................................................................................................................................................. 58
b. Acute stressstoornis .............................................................................................................................................................................................................................................................................................................................................................................................. 59
c. Posttraumatische stressstoornis (PTSS) .............................................................................................................................................................................................................................................................................................................................................................. 59
d. Complexe posttraumatische stressstoornis (cPTSS) ........................................................................................................................................................................................................................................................................................................................................... 60
4.1.6 Comorbiditeit ................................................................................................................................................................................................................................................................................................................................................................................................................................ 61
a. Aanpassingsstoornis ............................................................................................................................................................................................................................................................................................................................................................................................. 61
b. Acute stressstoornis .............................................................................................................................................................................................................................................................................................................................................................................................. 61
c. Posttraumatische stressstoornis .......................................................................................................................................................................................................................................................................................................................................................................... 61
d. Complexe posttraumatische stressstoornis (cPTSS) ........................................................................................................................................................................................................................................................................................................................................... 61
4.1.7 Diagnostiek .................................................................................................................................................................................................................................................................................................................................................................................................................................... 61
4.1.8 Aandachtspunten in het werkveld............................................................................................................................................................................................................................................................................................................................................................................................... 62
4.2 Dissociatieve stoornissen ............................................................................................................................................................................................................................................................................................................................................................................................................................. 62
4.2.1 Subtyperingen ............................................................................................................................................................................................................................................................................................................................................................................................................................... 63
4.2.2 Symptomen ................................................................................................................................................................................................................................................................................................................................................................................................................................... 64
a. Dissociatieve identiteitsstoornis (DIS)................................................................................................................................................................................................................................................................................................................................................................... 64
b. Dissociatieve amnesie............................................................................................................................................................................................................................................................................................................................................................................................ 65
c. Depersonalisatie-/derealisatiestoornis ................................................................................................................................................................................................................................................................................................................................................................ 66
4.2.3 Prevalentie .................................................................................................................................................................................................................................................................................................................................................................................................................................... 67
4.2.4 Ontstaan en verloop ..................................................................................................................................................................................................................................................................................................................................................................................................................... 67
a. Verklaringsmodellen .............................................................................................................................................................................................................................................................................................................................................................................................. 67
I. Traumaperspectief .......................................................................................................................................................................................................................................................................................................................................................................... 67
II. Socio-cognitief model ..................................................................................................................................................................................................................................................................................................................................................................... 67
II. Biologisch model ............................................................................................................................................................................................................................................................................................................................................................................. 68
b. Risico- en beschermende factoren ........................................................................................................................................................................................................................................................................................................................................................................ 68
4.2.5 Culturele verschillen ..................................................................................................................................................................................................................................................................................................................................................................................................................... 68
4.2.6 Comorbiditeiten ............................................................................................................................................................................................................................................................................................................................................................................................................................ 69
4.2.7 Diagnostiek .................................................................................................................................................................................................................................................................................................................................................................................................................................... 69
5) Angststoornissen .................................................................................................................................................................................................................................................................................................................................................................................... 69
5.1 Vrees en angst .............................................................................................................................................................................................................................................................................................................................................................................................................................................. 69
5.2 Subtyperingen .............................................................................................................................................................................................................................................................................................................................................................................................................................................. 71
5.3 Symptomen ................................................................................................................................................................................................................................................................................................................................................................................................................................................... 71
5.3.1 Specifieke fobie ............................................................................................................................................................................................................................................................................................................................................................................................................................. 71
5.3.2 Sociale-angststoornis.................................................................................................................................................................................................................................................................................................................................................................................................................... 72
5.3.3 Paniekstoornis ............................................................................................................................................................................................................................................................................................................................................................................................................................... 73
5.3.4 Agorafobie ..................................................................................................................................................................................................................................................................................................................................................................................................................................... 74
5.3.5 Gegeneraliseerde angststoornis .................................................................................................................................................................................................................................................................................................................................................................................................. 74
5.4 Prevalentie .................................................................................................................................................................................................................................................................................................................................................................................................................................................... 75
5.5 Culturele verschillen ..................................................................................................................................................................................................................................................................................................................................................................................................................................... 75
5.6 Ontstaan en verloop ..................................................................................................................................................................................................................................................................................................................................................................................................................................... 76
5.6.1 Risicofactoren................................................................................................................................................................................................................................................................................................................................................................................................................................ 76
a. Familiale belasting (diathese-stressmodel) .......................................................................................................................................................................................................................................................................................................................................................... 76
b. Afwijkingen in de hersenen ................................................................................................................................................................................................................................................................................................................................................................................... 77
5.6.2 Verklarende modellen .................................................................................................................................................................................................................................................................................................................................................................................................................. 77
a. Het cognitief-biologisch model van Clark (1958) ................................................................................................................................................................................................................................................................................................................................................. 77
b. Het multifactorieel model van fobieën ................................................................................................................................................................................................................................................................................................................................................................. 78
5.7 Comorbiditeit ................................................................................................................................................................................................................................................................................................................................................................................................................................................ 79
5.7.1 Specifieke fobie ............................................................................................................................................................................................................................................................................................................................................................................................................................. 79
2
, 5.7.2 Sociale-angststoornis.................................................................................................................................................................................................................................................................................................................................................................................................................... 79
5.7.3 Paniekstoornis ............................................................................................................................................................................................................................................................................................................................................................................................................................... 79
5.7.4 Agorafobie ..................................................................................................................................................................................................................................................................................................................................................................................................................................... 79
5.7.5 Gegeneraliseerde angststoornis .................................................................................................................................................................................................................................................................................................................................................................................................. 80
5.8 Diagnostiek ................................................................................................................................................................................................................................................................................................................................................................................................................................................... 80
6) Obsessief-compulsieve en aanverwante stoornissen ................................................................................................................................................................................................................................................................................................................................ 80
6.1 Subtyperingen .............................................................................................................................................................................................................................................................................................................................................................................................................................................. 81
6.2 Obsessieve-compulsieve stoornis (OCD) – symptomen ............................................................................................................................................................................................................................................................................................................................................................................ 81
6.3 Prevalentie .................................................................................................................................................................................................................................................................................................................................................................................................................................................... 82
6.4 Ontstaan en verloop ..................................................................................................................................................................................................................................................................................................................................................................................................................................... 82
6.4.1 Biologisch verklaringsmodel ........................................................................................................................................................................................................................................................................................................................................................................................................ 82
6.4.2 Psychodynamisch verklaringsmodel............................................................................................................................................................................................................................................................................................................................................................................................ 83
6.4.3 Het cognitief verklaringsmodel .................................................................................................................................................................................................................................................................................................................................................................................................... 83
6.4.4 Het leertheoretisch verklaringsmodel......................................................................................................................................................................................................................................................................................................................................................................................... 84
6.5 Culturele verschillen ..................................................................................................................................................................................................................................................................................................................................................................................................................................... 84
6.6 Comorbiditeit ................................................................................................................................................................................................................................................................................................................................................................................................................................................ 85
6.7 Diagnostiek ................................................................................................................................................................................................................................................................................................................................................................................................................................................... 85
7) Persoonlijkheidsstoornissen .................................................................................................................................................................................................................................................................................................................................................................... 86
7.1 Inhoud ........................................................................................................................................................................................................................................................................................................................................................................................................................................................... 86
7.2 Subtyperingen .............................................................................................................................................................................................................................................................................................................................................................................................................................................. 87
7.3 Symptomen ................................................................................................................................................................................................................................................................................................................................................................................................................................................... 88
7.3.1 Cluster A: vreemd, excentriek, afstandelijk ................................................................................................................................................................................................................................................................................................................................................................................ 88
a. Paranoïde persoonlijkheidsstoornis ...................................................................................................................................................................................................................................................................................................................................................................... 89
b. Schizoïde persoonlijkheidsstoornis ....................................................................................................................................................................................................................................................................................................................................................................... 90
c. Schizotypische persoonlijkheidsstoornis ............................................................................................................................................................................................................................................................................................................................................................... 91
7.3.2 Cluster B: dramatisch, emotioneel, grillig ................................................................................................................................................................................................................................................................................................................................................................................... 91
a. Antisociale persoonlijkheidsstoornis ..................................................................................................................................................................................................................................................................................................................................................................... 92
b. Borderline persoonlijkheidsstoornis...................................................................................................................................................................................................................................................................................................................................................................... 93
c. Histrionische persoonlijkheidsstoornis ................................................................................................................................................................................................................................................................................................................................................................. 94
d. Narcistische persoonlijkheidsstoornis ................................................................................................................................................................................................................................................................................................................................................................... 95
7.3.3 Cluster C: angstig, vermijdend, afhankelijk................................................................................................................................................................................................................................................................................................................................................................................. 95
a. Vermijdende persoonlijkheidsstoornis .................................................................................................................................................................................................................................................................................................................................................................. 96
b. Afhankelijke persoonlijkheidsstoornis................................................................................................................................................................................................................................................................................................................................................................... 97
c. Obsessief-compulsieve persoonlijkheidsstoornis ................................................................................................................................................................................................................................................................................................................................................. 98
7.4 Prevalentie .................................................................................................................................................................................................................................................................................................................................................................................................................................................... 98
7.5 Leeftijdsverschillen ....................................................................................................................................................................................................................................................................................................................................................................................................................................... 99
a. Ontwikkeling en beloop ....................................................................................................................................................................................................................................................................................................................................................................................... 100
7.6 Culturele verschillen ................................................................................................................................................................................................................................................................................................................................................................................................................................... 101
7.7 Ontstaan en verloop ................................................................................................................................................................................................................................................................................................................................................................................................................................... 101
7.8 Comorbiditeit .............................................................................................................................................................................................................................................................................................................................................................................................................................................. 102
7.9 Diagnostiek ................................................................................................................................................................................................................................................................................................................................................................................................................................................. 103
8) Middelgerelateerde en verslavingsstoornissen .......................................................................................................................................................................................................................................................................................................................................104
8.1 Wat het inhoudt ......................................................................................................................................................................................................................................................................................................................................................................................................................................... 104
8.2 Subtyperingen ............................................................................................................................................................................................................................................................................................................................................................................................................................................ 105
8.2.1 De middelgerelateerde stoornissen .......................................................................................................................................................................................................................................................................................................................................................................................... 105
a. Classificatie van middelen ................................................................................................................................................................................................................................................................................................................................................................................... 106
I. Indeling in middelen volgens werkingsmechanismen ........................................................................................................................................................................................................................................................................................................................................... 106
II. Indeling volgens beleid en preventie .................................................................................................................................................................................................................................................................................................................................................. 108
b. Stoornissen in en door het gebruik van een middel........................................................................................................................................................................................................................................................................................................................................... 108
8.2.2 De niet-middelgerelateerde stoornissen .................................................................................................................................................................................................................................................................................................................................................................................. 109
8.3 Symptomen ................................................................................................................................................................................................................................................................................................................................................................................................................................................. 109
8.3.1 Middelgerelateerde stoornissen................................................................................................................................................................................................................................................................................................................................................................................................ 109
a. Stoornis in het gebruik van middelen ................................................................................................................................................................................................................................................................................................................................................................. 110
b. Middel geïnduceerde stoornissen ....................................................................................................................................................................................................................................................................................................................................................................... 111
I. Intoxicatie............................................................................................................................................................................................................................................................................................................................................................................................... 111
II. Onthouding ........................................................................................................................................................................................................................................................................................................................................................................................... 111
III. Middel geïnduceerde mentale stoornissen ....................................................................................................................................................................................................................................................................................................................................... 112
8.3.2 Niet-middelgerelateerde stoornissen: gokstoornis .................................................................................................................................................................................................................................................................................................................................................................. 113
8.4 Leeftijdsverschillen ..................................................................................................................................................................................................................................................................................................................................................................................................................................... 113
8.4.1 Middelgerelateerde stoornis: Alcohol ....................................................................................................................................................................................................................................................................................................................................................................................... 114
a. Stoornis in het gebruik van alcohol..................................................................................................................................................................................................................................................................................................................................................................... 114
b. Middel geïnduceerd: intoxicatie .......................................................................................................................................................................................................................................................................................................................................................................... 114
c. Middel geïnduceerde: onthouding...................................................................................................................................................................................................................................................................................................................................................................... 114
8.4.2 De gokstoornis ............................................................................................................................................................................................................................................................................................................................................................................................................................ 115
8.5 Prevalentie .................................................................................................................................................................................................................................................................................................................................................................................................................................................. 115
8.5.1 Alcohol ......................................................................................................................................................................................................................................................................................................................................................................................................................................... 115
8.5.2 Tabak ............................................................................................................................................................................................................................................................................................................................................................................................................................................ 116
8.5.3 Cannabis ...................................................................................................................................................................................................................................................................................................................................................................................................................................... 116
8.5.4 Andere illegale drugs .................................................................................................................................................................................................................................................................................................................................................................................................................. 116
8.5.5 Kansspelen .................................................................................................................................................................................................................................................................................................................................................................................................................................. 116
8.6 Culturele verschillen ................................................................................................................................................................................................................................................................................................................................................................................................................................... 116
8.7 Ontstaan en verloop ................................................................................................................................................................................................................................................................................................................................................................................................................................... 117
8.7.1 Neurobiologisch perspectief: belangrijkste breinveranderingen ............................................................................................................................................................................................................................................................................................................................................ 117
a. De verstoring van het beloningssysteem ............................................................................................................................................................................................................................................................................................................................................................ 117
3
, b. Ontstaan van automatismen .............................................................................................................................................................................................................................................................................................................................................................................. 118
c. De afname van het controlerend systeem.......................................................................................................................................................................................................................................................................................................................................................... 119
d. Het ontstaan van craving .................................................................................................................................................................................................................................................................................................................................................................................... 119
e. Het ontstaan van tolerantie ................................................................................................................................................................................................................................................................................................................................................................................ 119
f. Het ontstaan van onthoudingsverschijnselen .................................................................................................................................................................................................................................................................................................................................................... 120
8.7.2 Risico- en beschermende factoren: MMM-model ................................................................................................................................................................................................................................................................................................................................................................... 120
8.7.3 De gokstoornis ............................................................................................................................................................................................................................................................................................................................................................................................................................ 120
8.8 Comorbiditeit .............................................................................................................................................................................................................................................................................................................................................................................................................................................. 121
8.8.1 Middelgerelateerde stoornissen bij alcohol ............................................................................................................................................................................................................................................................................................................................................................................. 121
8.8.2 Gokstoornis ................................................................................................................................................................................................................................................................................................................................................................................................................................. 121
8.9 Diagnostiek ................................................................................................................................................................................................................................................................................................................................................................................................................................................. 122
9) Schizofreniespectrum en andere psychotische stoornissen .....................................................................................................................................................................................................................................................................................................................122
9.1 Subtyperingen ............................................................................................................................................................................................................................................................................................................................................................................................................................................ 122
9.2 Symptomen ................................................................................................................................................................................................................................................................................................................................................................................................................................................. 123
9.2.1 Basissymptomen ......................................................................................................................................................................................................................................................................................................................................................................................................................... 123
a. Positieve en negatieve symptomen .................................................................................................................................................................................................................................................................................................................................................................... 123
b. Uitingsvormen ...................................................................................................................................................................................................................................................................................................................................................................................................... 123
9.2.2 Subtypes ...................................................................................................................................................................................................................................................................................................................................................................................................................................... 126
a. Kortdurende psychotische stoornis ..................................................................................................................................................................................................................................................................................................................................................................... 126
b. Schizofrenie .......................................................................................................................................................................................................................................................................................................................................................................................................... 127
c. Schizofreniforme stoornis .................................................................................................................................................................................................................................................................................................................................................................................... 128
d. Waanstoornis ....................................................................................................................................................................................................................................................................................................................................................................................................... 128
9.3 Leeftijdsverschillen ..................................................................................................................................................................................................................................................................................................................................................................................................................................... 129
9.4 Prevalentie .................................................................................................................................................................................................................................................................................................................................................................................................................................................. 129
9.5 Culturele verschillen ................................................................................................................................................................................................................................................................................................................................................................................................................................... 130
9.6 Ontstaan en verloop ................................................................................................................................................................................................................................................................................................................................................................................................................................... 130
9.6.1 Ontwikkeling en evolutie............................................................................................................................................................................................................................................................................................................................................................................................................ 130
9.6.2 Diathese – stressmodel .............................................................................................................................................................................................................................................................................................................................................................................................................. 131
a. Diathese ................................................................................................................................................................................................................................................................................................................................................................................................................ 131
b. Stress..................................................................................................................................................................................................................................................................................................................................................................................................................... 132
9.6.3 Hedendaagse ontwikkelingen .................................................................................................................................................................................................................................................................................................................................................................................................... 132
a. Psychose als resultaat van disfunctionele coping .............................................................................................................................................................................................................................................................................................................................................. 133
b. Psychose en taaldysfunctie.................................................................................................................................................................................................................................................................................................................................................................................. 133
c. Selienshypothese .................................................................................................................................................................................................................................................................................................................................................................................................. 133
9.7 Comorbiditeit .............................................................................................................................................................................................................................................................................................................................................................................................................................................. 133
9.8 Aandachtspunten ....................................................................................................................................................................................................................................................................................................................................................................................................................................... 134
9.9 Diagnostiek ................................................................................................................................................................................................................................................................................................................................................................................................................................................. 134
9.9.1 Fasengebonden richtlijnen ......................................................................................................................................................................................................................................................................................................................................................................................................... 134
9.9.2 Stappen in de diagnostiek .......................................................................................................................................................................................................................................................................................................................................................................................................... 135
10) Neurocognitieve stoornissen ..................................................................................................................................................................................................................................................................................................................................................................135
10.1 Subtyperingen .......................................................................................................................................................................................................................................................................................................................................................................................................................................... 135
10.2 Symptomen............................................................................................................................................................................................................................................................................................................................................................................................................................................... 136
10.3 Prevalentie ................................................................................................................................................................................................................................................................................................................................................................................................................................................ 137
10.4 Ontstaan en verloop................................................................................................................................................................................................................................................................................................................................................................................................................................. 137
10.4.1 Risico- en uitlokkende factoren ............................................................................................................................................................................................................................................................................................................................................................................................... 137
10.4.2 Verklaringsmodellen ................................................................................................................................................................................................................................................................................................................................................................................................................. 138
a. Ontstekingshypothese ......................................................................................................................................................................................................................................................................................................................................................................................... 138
b. Neurotransmitterhypothese ................................................................................................................................................................................................................................................................................................................................................................................ 138
10.5 Diagnostiek ............................................................................................................................................................................................................................................................................................................................................................................................................................................... 138
11) Voedings- en eetstoornissen ..................................................................................................................................................................................................................................................................................................................................................................139
11.1 Subtyperingen .......................................................................................................................................................................................................................................................................................................................................................................................................................................... 140
11.2 Symptomen............................................................................................................................................................................................................................................................................................................................................................................................................................................... 140
11.2.1 Anorexia Nervosa ..................................................................................................................................................................................................................................................................................................................................................................................................................... 140
11.2.2 Boulimia Nervosa...................................................................................................................................................................................................................................................................................................................................................................................................................... 142
11.2.3 Eetbuistoornis ........................................................................................................................................................................................................................................................................................................................................................................................................................... 143
11.2.4 Eetbuien doorheen de stoornissen ......................................................................................................................................................................................................................................................................................................................................................................................... 143
11.2.5 Signalen in de thuiscontext ...................................................................................................................................................................................................................................................................................................................................................................................................... 144
a. Veranderingen in massa ...................................................................................................................................................................................................................................................................................................................................................................................... 144
b. Gedrag tijdens maaltijden ................................................................................................................................................................................................................................................................................................................................................................................... 144
c. Preoccupatie met eten, gewicht en uiterlijk ....................................................................................................................................................................................................................................................................................................................................................... 145
d. Beweeggedrag ..................................................................................................................................................................................................................................................................................................................................................................................................... 145
e. Andere signalen ................................................................................................................................................................................................................................................................................................................................................................................................... 145
11.2.6 Signalen in de schoolcontext en vrije tijd ............................................................................................................................................................................................................................................................................................................................................................................... 145
a. Schoolcontext ....................................................................................................................................................................................................................................................................................................................................................................................................... 145
b. Vrije tijd................................................................................................................................................................................................................................................................................................................................................................................................................. 145
11.3 Prevalentie ................................................................................................................................................................................................................................................................................................................................................................................................................................................ 146
11.4 Ontstaan en verloop................................................................................................................................................................................................................................................................................................................................................................................................................................. 146
11.4.1 Biologische factoren ................................................................................................................................................................................................................................................................................................................................................................................................................. 146
a. Genetica ................................................................................................................................................................................................................................................................................................................................................................................................................ 146
b. Hersenen ............................................................................................................................................................................................................................................................................................................................................................................................................... 147
11.4.2 Psychologische factoren ........................................................................................................................................................................................................................................................................................................................................................................................................... 147
11.4.3 Socio-culturele factoren ........................................................................................................................................................................................................................................................................................................................................................................................................... 148
11.5 Comorbiditeit............................................................................................................................................................................................................................................................................................................................................................................................................................................ 148
11.5.1 Lichamelijke klachten ............................................................................................................................................................................................................................................................................................................................................................................................................... 148
4
, 11.5.2 Psychologische klachten ........................................................................................................................................................................................................................................................................................................................................................................................................... 148
11.6 Diagnostiek ............................................................................................................................................................................................................................................................................................................................................................................................................................................... 149
12) Slaap- en waakstoornissen .....................................................................................................................................................................................................................................................................................................................................................................149
12.1 Gewone slaap ........................................................................................................................................................................................................................................................................................................................................................................................................................................... 149
12.2 Subtyperingen .......................................................................................................................................................................................................................................................................................................................................................................................................................................... 151
12.3 Symptomen............................................................................................................................................................................................................................................................................................................................................................................................................................................... 152
12.3.1 Insomnia stoornis ..................................................................................................................................................................................................................................................................................................................................................................................................................... 152
12.3.2 Hypersomnolentiestoornis....................................................................................................................................................................................................................................................................................................................................................................................................... 152
12.3.3 Narcolepsie ............................................................................................................................................................................................................................................................................................................................................................................................................................... 153
12.3.4 Circadiane slaap-waakstoornissen .......................................................................................................................................................................................................................................................................................................................................................................................... 153
12.3.5 Non-REM slaaparousalstoornis ............................................................................................................................................................................................................................................................................................................................................................................................... 154
12.3.6 Nachtmerriestoornis ................................................................................................................................................................................................................................................................................................................................................................................................................ 154
12.3.7 REM-slaapgedragstoornis ........................................................................................................................................................................................................................................................................................................................................................................................................ 154
12.4 Prevalentie ................................................................................................................................................................................................................................................................................................................................................................................................................................................ 155
12.5 Ontstaan en verloop................................................................................................................................................................................................................................................................................................................................................................................................................................. 155
12.5.1 Verklaringsmodel voor insomnia ............................................................................................................................................................................................................................................................................................................................................................................................. 156
12.5.2 Verklaringsmodel voor narcolepsie ......................................................................................................................................................................................................................................................................................................................................................................................... 157
12.6 Comorbiditeit............................................................................................................................................................................................................................................................................................................................................................................................................................................ 157
12.6.1 Psychiatrische comorbiditeit.................................................................................................................................................................................................................................................................................................................................................................................................... 157
12.6.2 Medische comorbiditeit ........................................................................................................................................................................................................................................................................................................................................................................................................... 158
12.7 Diagnostiek ............................................................................................................................................................................................................................................................................................................................................................................................................................................... 158
13) Seksualiteitsstoornissen .........................................................................................................................................................................................................................................................................................................................................................................159
13.1 Subtyperingen .......................................................................................................................................................................................................................................................................................................................................................................................................................................... 159
13.2 Symptomen............................................................................................................................................................................................................................................................................................................................................................................................................................................... 160
13.2.1 DSM-5 algemene criteria ......................................................................................................................................................................................................................................................................................................................................................................................................... 160
13.2.2 Seksuele disfuncties ................................................................................................................................................................................................................................................................................................................................................................................................................. 161
a. Seksuele disfuncties bij mannen ......................................................................................................................................................................................................................................................................................................................................................................... 161
I. Vroege ejaculatie ................................................................................................................................................................................................................................................................................................................................................................................... 161
II. Erectiestoornis ...................................................................................................................................................................................................................................................................................................................................................................................... 161
III. Stoornis in seksueel verlangen ........................................................................................................................................................................................................................................................................................................................................................... 162
IV. Voortijdige (vroege) ejaculatie ........................................................................................................................................................................................................................................................................................................................................................... 162
b. Seksuele disfuncties bij vrouwen......................................................................................................................................................................................................................................................................................................................................................................... 163
I. Vrouwelijke orgasmestoornis ............................................................................................................................................................................................................................................................................................................................................................... 163
II. Stoornis in seksueel verlangen/opwinding bij vrouwen .................................................................................................................................................................................................................................................................................................................... 163
III. Genito-pelviene pijn-/penetratiestoornis.......................................................................................................................................................................................................................................................................................................................................... 164
c. Seksuele disfunctie bij mannen en vrouwen ...................................................................................................................................................................................................................................................................................................................................................... 164
13.3 Prevalentie ................................................................................................................................................................................................................................................................................................................................................................................................................................................ 164
13.4 Ontstaan en verloop................................................................................................................................................................................................................................................................................................................................................................................................................................. 165
13.4.1 Seksuele responscyclus ............................................................................................................................................................................................................................................................................................................................................................................................................ 165
13.4.2 Oorzaken van verstoring in de seksuele responscyclus ......................................................................................................................................................................................................................................................................................................................................................... 166
13.5 Comorbiditeit............................................................................................................................................................................................................................................................................................................................................................................................................................................ 166
13.6 Diagnostiek ............................................................................................................................................................................................................................................................................................................................................................................................................................................... 167
14) Parafiele stoornissen ..............................................................................................................................................................................................................................................................................................................................................................................167
14.1 Subtyperingen .......................................................................................................................................................................................................................................................................................................................................................................................................................................... 167
14.2 Symptomen............................................................................................................................................................................................................................................................................................................................................................................................................................................... 168
14.2.1 Voyeuristische stoornis ............................................................................................................................................................................................................................................................................................................................................................................................................ 168
14.2.2 Exhibitionistische stoornis ....................................................................................................................................................................................................................................................................................................................................................................................................... 169
14.2.3 Frotteuristische stoornis .......................................................................................................................................................................................................................................................................................................................................................................................................... 169
14.2.4 Seksuele masochismestoornis ................................................................................................................................................................................................................................................................................................................................................................................................. 169
14.2.5 Seksuele sadismestoornis ........................................................................................................................................................................................................................................................................................................................................................................................................ 170
14.2.6 Pedofiele stoornis ..................................................................................................................................................................................................................................................................................................................................................................................................................... 170
14.2.7 Fetisjistische stoornis ............................................................................................................................................................................................................................................................................................................................................................................................................... 171
14.2.8 Transvestische stoornis ............................................................................................................................................................................................................................................................................................................................................................................................................ 171
14.3 Prevalentie ................................................................................................................................................................................................................................................................................................................................................................................................................................................ 171
14.4 Ontstaan en verloop................................................................................................................................................................................................................................................................................................................................................................................................................................. 172
14.4.1 Leertheoretische modellen ...................................................................................................................................................................................................................................................................................................................................................................................................... 172
14.4.2 Cognitieve modellen................................................................................................................................................................................................................................................................................................................................................................................................................. 172
14.4.3 Hechting- en ontwikkelingsmodellen ...................................................................................................................................................................................................................................................................................................................................................................................... 172
14.4.4 Neurobiologische en hormonale modellen ............................................................................................................................................................................................................................................................................................................................................................................ 172
14.4.5 Sociaal-ecologische modellen .................................................................................................................................................................................................................................................................................................................................................................................................. 173
14.5 Comorbiditeit............................................................................................................................................................................................................................................................................................................................................................................................................................................ 173
14.6 Diagnostiek ............................................................................................................................................................................................................................................................................................................................................................................................................................................... 173
15) Thema specifieke therapieën..................................................................................................................................................................................................................................................................................................................................................................174
15.1 Laagdrempelige initiatieven .................................................................................................................................................................................................................................................................................................................................................................................................................... 176
15.1.1 Informatiekanalen .................................................................................................................................................................................................................................................................................................................................................................................................................... 176
15.1.2 E-mental health ........................................................................................................................................................................................................................................................................................................................................................................................................................ 176
15.1.3 Verenigingen en vrijwilligers .................................................................................................................................................................................................................................................................................................................................................................................................... 177
15.1.4 Outreachend werken ................................................................................................................................................................................................................................................................................................................................................................................................................ 177
15.2 Ambulante en residentiële zorg .............................................................................................................................................................................................................................................................................................................................................................................................................. 178
15.3 Psychotherapeutische behandelvormen ................................................................................................................................................................................................................................................................................................................................................................................................ 178
15.3.1 Mentalisation Based Therapy (MBT) ....................................................................................................................................................................................................................................................................................................................................................................................... 178
15.3.2 Transference focused therapy (TFP) ........................................................................................................................................................................................................................................................................................................................................................................................ 179
15.3.3 Klassieke gedragstherapie ........................................................................................................................................................................................................................................................................................................................................................................................................ 179
15.3.4 Exposure therapie..................................................................................................................................................................................................................................................................................................................................................................................................................... 179
5
, 15.3.5 Narrative exposure therapie (NET) .......................................................................................................................................................................................................................................................................................................................................................................................... 179
15.3.6 Cognitieve gedragstherapie ..................................................................................................................................................................................................................................................................................................................................................................................................... 179
15.3.7 Eye movement desentisation and reprocessing (EMDR) ....................................................................................................................................................................................................................................................................................................................................................... 180
15.3.8 Imaginaire rescripting therapie (ImRs) .................................................................................................................................................................................................................................................................................................................................................................................... 180
15.3.9 Contextuele en acceptatiegerichte therapie .......................................................................................................................................................................................................................................................................................................................................................................... 180
15.3.10 Dialectische gedragstherapie ................................................................................................................................................................................................................................................................................................................................................................................................. 180
15.3.11 Acceptance and commitment therapy (ACT) ....................................................................................................................................................................................................................................................................................................................................................................... 181
15.3.12 Mindfulness based cognitive therapy ................................................................................................................................................................................................................................................................................................................................................................................... 181
15.3.13 Humanistische modellen ....................................................................................................................................................................................................................................................................................................................................................................................................... 181
15.3.14 Systeemmodellen ................................................................................................................................................................................................................................................................................................................................................................................................................... 181
15.3.15 Ecletische en integratieve behandelvormen ........................................................................................................................................................................................................................................................................................................................................................................ 181
15.4 Psychologische interventies..................................................................................................................................................................................................................................................................................................................................................................................................................... 182
15.5 Medische zorg .......................................................................................................................................................................................................................................................................................................................................................................................................................................... 183
15.5.1 Psychofarmaca .......................................................................................................................................................................................................................................................................................................................................................................................................................... 183
a. Antidepressiva ...................................................................................................................................................................................................................................................................................................................................................................................................... 183
b. Stemmingsstabilisatoren ..................................................................................................................................................................................................................................................................................................................................................................................... 184
c. Antipsychotica ...................................................................................................................................................................................................................................................................................................................................................................................................... 185
15.5.2 Neuromodulatie/hersengerichte interventies........................................................................................................................................................................................................................................................................................................................................................................ 186
15.5.3 Chronobiologische en somatische interventies...................................................................................................................................................................................................................................................................................................................................................................... 186
15.5.4 Medische zorg – aanpakken van medische oorzaken ............................................................................................................................................................................................................................................................................................................................................................ 187
16) Hedendaagse tendensen ........................................................................................................................................................................................................................................................................................................................................................................187
16.1 Evidence based werken ........................................................................................................................................................................................................................................................................................................................................................................................................................... 187
16.2 Staging en profiling .................................................................................................................................................................................................................................................................................................................................................................................................................................. 188
16.3 Hypnotherapie .......................................................................................................................................................................................................................................................................................................................................................................................................................................... 189
16.4 Virtual reality ............................................................................................................................................................................................................................................................................................................................................................................................................................................ 189
16.5 Artificiële intelligentie .............................................................................................................................................................................................................................................................................................................................................................................................................................. 189
16.6 Polyvagaaltheorie ..................................................................................................................................................................................................................................................................................................................................................................................................................................... 190
6
,1) Introductie in de pathologie
1.1 Wat het inhoudt
Psychopathologie: Studie v/h geestelijk lijden of de leer v. psychische stoornissen => afwijkende emoties,
gedachten & aandoeningen
Stoornis: E. klinisch vastgestelde aandoening volgens de diagnostische criteria => vaak pas gege wnr h. impact heeft
o/h functioneren
Psychopathologie richt zich op … v. afwijkende emoties, gedachten en aandoeningen:
Beschrijving: gedetailleerd in kaart brengen v. symptomen en kenmerken v. psychische stoornissen
Persoon heeft profiel v. problemen, welke problemen, wat het allemaal inhoudt. => de studie over
wat het inhoudt
Classificatie: systematisch indelen v. psychische aandoeningen in diagnostische categorieën
Alle klachten proberen groeperen term aan proberen geven
Oorzaken: onderzoeken v. biologische, psychologische & sociale factoren die bijdragen a/h ontstaan v.
psychische aandoeningen
=> zoeken naar hoe komt h. dat de problematiek ontstaat
Vb. met heel duidelijke: trauma gerelateerde stoornis, postnatale depressie
Behandelingen: ontwikkelen en evalueren v. effectieve therapieën & interventies om psych. stoornissen
te verlichten of te genezen
=> Hoe kunnen we die mensen helpen
Beschrijving
Psychopathologie
Classificatie
Oorzaken
Behandelingen
➔ Doel psychopathologie = welzijn v. mensen met psychische problemen te verbeteren
Meeste therapieën = ontstaan uit beschrijvingen en classificaties (=> andere onethische experimenten WOII)
1.2 Belangrijke concepten
Symptoom: Uiting v/e onderliggend probleem, waarneembaar of door de patiënt aangegeven klacht. Kan
betrekking hebben op lichamelijke, psychische, sociale en/of existentiële aspecten.
Syndroom: e. verzameling/combinatie v. symptomen die samen e. spec. aandoening vormen. (≠ elk symptoom afz.
= e. probleem) Bij meerdere spec. symptomen die te gelijk optreden kan er e. diagnose worden gesteld.
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, Syndroom
Symptomen
Comorbiditeit: samengaan v. ++ aandoeningen/syndromen, tegelijkertijd voorkomen v. 2 of + psychische en/of
lichamelijke aandoeningen bij 1 persoon. => er is e. primaire stoornis en ook een secundaire/andere aandoening.
vb.: piekeren (primair) en slaapproblemen (secundair)
Primaire stoornis: de stoornis die h. meeste effect heeft o/h functioneren v/d persoon, of de stoornis die er h. 1ste
was.
Secundaire stoornis: = e. gevolg v/d primaire dat deze gevormd wordt.
Comorbiditeit
Syndroom A Syndroom B
(primaire) (secundaire)
1.3 (Ab)normaal gedrag
Psychopathologie = afwijkende emoties, gedachten & gedragingen
wat beschouwd als afwijkend = afh. v. versch. factoren & interpretaties
Hoe gedrag als abnormaal gedefinieerd?
Cultuur
Maatschappelijke normen
Historische context
Norm: wnr de meeste mensen dit ook doen is het de norm
Abnormaal gedrag: vanaf h. ≠ meer voldoet a/d norm
Wnr h. gedrag regelmatig voorkomt bij de persoon
Wnr de persoon zichzelf in gevaar brengt/afremt
Iets uniek dat de persoon doet, uitzonderlijk
1.3.1 Veranderingen in de kijk op (ab)normaal gedrag
Afwijkend gedrag doorheen de tijd beïnvloed door:
Cultuur
Religie
Wetenschap
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, Heeft invloed op hoe gedrag verklaren + welke behandelingen toepassen
Belangrijke veranderingen doorheen de tijd:
Oudheid & middeleeuwen
- Toegeschreven aan 18de - 19de eeuw
bovennatuurlijke
krachten - individuen met ernstige 20ste eeuw
- Klassieke oudheid - psychische problemen =
Hippocrates = opgesloten in instelling - Keerpunt = 21ste eeuw
behandeling door diëten, - 19de eeuw = psychoanalyse
medicijnen en verbeteringen in - psychiatrie beïnvloed - versch. tehrapeutische
lichamelijke oefeningen behandeling -> opkomst door ontwikkeling v. techn. combineren
psychiatrische medicijnen - ++ gepersonaliseerde
ziekenhuizen behandelingen
- opkomst
neurowetenschappen
- nadruk op
biopsychosociaal model
- belang v. preventie
Veranderingen op kijk kan binnen tijdseenheid en tss tijdseenheden
Vb.: homoseksualiteit, trauma- en stressgerelateerde stoornissen
Verschillen in kijk op psychische problemen
Tussen generaties => manier v. kijken bij kinderen, ouders en grootouders
Binnen generaties => verschillen in hoe interpreteren en aanpak tss dezelfde leeftijden
Kijk op psychisch welzijn = gevormd complex samenspel v. individuele, sociale en culturele factoren
= dynamisch beeld!!
1.3.2 Criteria van afwijkend gedrag
6 criteria om v. abnormaal gedrag te spreken:
• Uitzonderlijk: zeldzaam/ongebruikelijk in vgl met wat de meeste mensen doen.
Vb.: stemmen horen & nachten overslaan
• Sociaal afwijkend: afwijken v/d normen en regels v/d samenleving of cultuur waarin h. zich afspeelt
Vb.: stemmen horen
• Foute perceptie/interpretatie v/d realiteit: de werkelijkheid anders ervaren den h. i/d realiteit is.
vb.: denken dat e. bep. bekend persoon verliefd op je is
• Aanzienlijk emotioneel lijden: klachten zorgen voor e. aanzienlijke lijdensdruk.
Vb.: uitgeput, angstig, gespannen
• Ongepast ≈ contraproductief: klachten belemmeren de persoon i/h nrm funcioneren.
Vb.: te laat komen i/d les, nachten overslaan
• Gevaar: gedrag = gevaarlijk voor de persoon zelf of voor anderen.
Vb.: niet kunnen stoppen met middelengebruik
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