PSYCHIATRIE
Diagnostiek en classificatie .......................................................................................................... 8
DSM-classificatiesysteem ........................................................................................................... 8
Stress-kwetsbaarheidsmodel .....................................................................................................11
Cognitief gedragstherapeutisch probleemsamenhang ...................................................................12
Neurobiologische basisprincipes .................................................................................................13
Corticosubcorticale netwerken ...................................................................................................13
Communicatie binnen en buiten de hersenen ...............................................................................14
Epidemiologie .............................................................................................................................15
Prevalentie ...............................................................................................................................15
Impact .....................................................................................................................................15
Gevolgen ..................................................................................................................................16
Behandeling ..............................................................................................................................17
Psychiatrische anamnese ............................................................................................................18
Algemeen .................................................................................................................................18
Speciële anamnese ...................................................................................................................19
ATCD .......................................................................................................................................19
Sociale anamnese .....................................................................................................................20
Psychiatrisch onderzoek: status mentalis .....................................................................................20
Bijkomend (somatisch) onderzoek ...............................................................................................27
Psychologische/klinische testing .................................................................................................28
Geestelijke gezondheidszorg .......................................................................................................30
Wat is gezondheid en GGZ? ........................................................................................................30
Geschiedenis van de GGZ ...........................................................................................................30
Organisatie ...............................................................................................................................31
Community Mental Health Care (CMHC) ......................................................................................35
Casuïstiek: psychiatrische symptomatologie ...............................................................................38
Het psychiatrisch verslag............................................................................................................38
Fragment 1 ...............................................................................................................................38
Casus 20 ..................................................................................................................................38
Casus 3 ....................................................................................................................................39
Psychotische stoornissen: kliniek, epidemiologie, neurobiologie ..................................................40
Psychotische stoornissen ...........................................................................................................40
Schizofrenie ..............................................................................................................................40
Verloop van schizofrenie ............................................................................................................43
Andere psychotische stoornissen ................................................................................................45
1
, Pathogenese van schizofrenie .....................................................................................................46
Schizofrenie als immuunstoornis.................................................................................................50
Psychotische stoornissen: behandeling .......................................................................................52
Farmacologische behandeling: antipsychotica .............................................................................52
Nonfarmacologische interventies ................................................................................................55
Casuïstiek: psychose...................................................................................................................56
Casus 1 ....................................................................................................................................56
Casus 2 ....................................................................................................................................56
Casus 3 ....................................................................................................................................56
Casus 4 ....................................................................................................................................57
Casus 5 ....................................................................................................................................57
Casus 6 ....................................................................................................................................57
Depressieve stemmingsstoornissen: diagnostiek en classificatie .................................................59
Algemeen .................................................................................................................................59
Symptomen depressief syndroom ...............................................................................................59
Epidemiologie ...........................................................................................................................61
Diagnostiek ...............................................................................................................................61
Classificatie ..............................................................................................................................63
Verloop ....................................................................................................................................64
Differentiële diagnostiek .............................................................................................................65
Suïcidaliteit ...............................................................................................................................65
Depressieve stemmingsstoornissen: epidemiologie, etiologie en behandeling ..............................67
Epidemiologie ...........................................................................................................................67
Pathofysiologie ..........................................................................................................................67
Behandeling ..............................................................................................................................70
Bipolaire stoornissen: algemeen ..................................................................................................74
Prevalentie ...............................................................................................................................74
Symptomatologie ......................................................................................................................74
Type I versus type II ....................................................................................................................76
Verloop van de aandoening .........................................................................................................79
Diagnostiek ...............................................................................................................................79
Etiopathogenese .......................................................................................................................80
Bipolaire stoornissen: behandeling ..............................................................................................82
Algemeen .................................................................................................................................82
Medicatie .................................................................................................................................82
Andere interventies ....................................................................................................................86
Casuïstiek stemming & angst .......................................................................................................87
2
, Casus 1 ....................................................................................................................................87
Casus 2 ....................................................................................................................................87
Casus 3 ....................................................................................................................................87
Casus 4 ....................................................................................................................................88
Casus 5 ....................................................................................................................................88
Casus 6 ....................................................................................................................................89
Angst- en dwangstoornissen ........................................................................................................90
Inleiding: emoties en angst .........................................................................................................90
Angststoornissen .......................................................................................................................90
Obsessieve-compulsieve stoornis (OCD) en verwante stoornissen..................................................96
Behandeling (angststoornissen en OCD) ......................................................................................99
Psychiatrie in het algemeen ziekenhuis ...................................................................................... 104
Inleiding ................................................................................................................................. 104
Somatisch-psychiatrische comorbiditeit .................................................................................... 104
Setting.................................................................................................................................... 105
Capita selecta psychiatrie in het AZ ........................................................................................... 105
Delirium .................................................................................................................................... 108
Diagnose en klinische eigenschappen........................................................................................ 108
Epidemiologie en etiopathogenese ............................................................................................ 109
Medisch management.............................................................................................................. 110
Rol van antipsychotica in behandeling ....................................................................................... 111
Klinische casus ....................................................................................................................... 112
Ouderenpsychiatrie ................................................................................................................... 113
Inleiding – verouderingsprocessen ............................................................................................. 113
Diagnostiek ............................................................................................................................. 113
Klinische beelden .................................................................................................................... 114
Inleiding in kinder- en jeugdpsychiatrie ...................................................................................... 116
Specificiteit kinder- en jeugdpsychiatrie ..................................................................................... 116
Definitie psychiatrische stoornis bij kinderen en jongeren ............................................................. 116
Benaderingen .......................................................................................................................... 116
Het kinderpsychiatrisch onderzoek ............................................................................................ 116
Ontwikkelingspychopathologie – kinderpsychiatrische stoornissen ............................................... 118
Ontwikkelingsstoornissen in kinder- en jeugdpsychiatrie ............................................................ 119
ADHD (attention deficit hyperactivity disorder) ............................................................................ 119
ASS – autismespectrumstoornis ................................................................................................ 123
Externaliserende stoornissen: gedragsstoornissen ..................................................................... 127
Terminologie ........................................................................................................................... 127
3
, Algemeen ............................................................................................................................... 127
Oppositionele-opstandige stoornis (ODD) .................................................................................. 127
Normoverschrijdend-gedragsstoornis (CD) ................................................................................. 128
Etiopathogenese ..................................................................................................................... 130
Preventie ................................................................................................................................ 131
Behandeling ............................................................................................................................ 132
Internaliserende stoornissen ..................................................................................................... 133
Trauma ................................................................................................................................... 133
Zelfverwondend gedrag ............................................................................................................ 138
Suïcide ................................................................................................................................... 141
Somatisch-symptoomstoornis en verwante stoornissen ............................................................. 143
Somatisatie ............................................................................................................................ 143
Diagnostiek ............................................................................................................................. 144
Etiologische factoren ............................................................................................................... 147
Psychologische verklaringsmodellen ......................................................................................... 147
Psychosociale factoren ............................................................................................................ 148
Algemeen beleid en aanpak ...................................................................................................... 148
Nagebootste stoornissen ........................................................................................................... 152
Definitie .................................................................................................................................. 152
Epidemiologie ......................................................................................................................... 152
Diagnostiek ............................................................................................................................. 152
Etiopathogenese ..................................................................................................................... 153
Aanpak en behandeling ............................................................................................................ 153
Slaap- en waakstoornissen: insomnie ........................................................................................ 154
Diagnostische criteria .............................................................................................................. 154
Klinische benadering ................................................................................................................ 154
Therapie ................................................................................................................................. 155
Slaap-waakstoornissen: parasomnia ......................................................................................... 158
Algemeen ............................................................................................................................... 158
Stoornis van arousal van nonREMslaap ...................................................................................... 158
Stoornis van de REMslaap ........................................................................................................ 160
Andere ................................................................................................................................... 161
Ontwikkelingsstoornissen bij volwassenen ................................................................................ 162
ADHD bij volwassenen ............................................................................................................. 162
Autismespectrumstoornis in de volwassenheid .......................................................................... 164
Psychotherapie ......................................................................................................................... 169
Algemeen ............................................................................................................................... 169
4
Diagnostiek en classificatie .......................................................................................................... 8
DSM-classificatiesysteem ........................................................................................................... 8
Stress-kwetsbaarheidsmodel .....................................................................................................11
Cognitief gedragstherapeutisch probleemsamenhang ...................................................................12
Neurobiologische basisprincipes .................................................................................................13
Corticosubcorticale netwerken ...................................................................................................13
Communicatie binnen en buiten de hersenen ...............................................................................14
Epidemiologie .............................................................................................................................15
Prevalentie ...............................................................................................................................15
Impact .....................................................................................................................................15
Gevolgen ..................................................................................................................................16
Behandeling ..............................................................................................................................17
Psychiatrische anamnese ............................................................................................................18
Algemeen .................................................................................................................................18
Speciële anamnese ...................................................................................................................19
ATCD .......................................................................................................................................19
Sociale anamnese .....................................................................................................................20
Psychiatrisch onderzoek: status mentalis .....................................................................................20
Bijkomend (somatisch) onderzoek ...............................................................................................27
Psychologische/klinische testing .................................................................................................28
Geestelijke gezondheidszorg .......................................................................................................30
Wat is gezondheid en GGZ? ........................................................................................................30
Geschiedenis van de GGZ ...........................................................................................................30
Organisatie ...............................................................................................................................31
Community Mental Health Care (CMHC) ......................................................................................35
Casuïstiek: psychiatrische symptomatologie ...............................................................................38
Het psychiatrisch verslag............................................................................................................38
Fragment 1 ...............................................................................................................................38
Casus 20 ..................................................................................................................................38
Casus 3 ....................................................................................................................................39
Psychotische stoornissen: kliniek, epidemiologie, neurobiologie ..................................................40
Psychotische stoornissen ...........................................................................................................40
Schizofrenie ..............................................................................................................................40
Verloop van schizofrenie ............................................................................................................43
Andere psychotische stoornissen ................................................................................................45
1
, Pathogenese van schizofrenie .....................................................................................................46
Schizofrenie als immuunstoornis.................................................................................................50
Psychotische stoornissen: behandeling .......................................................................................52
Farmacologische behandeling: antipsychotica .............................................................................52
Nonfarmacologische interventies ................................................................................................55
Casuïstiek: psychose...................................................................................................................56
Casus 1 ....................................................................................................................................56
Casus 2 ....................................................................................................................................56
Casus 3 ....................................................................................................................................56
Casus 4 ....................................................................................................................................57
Casus 5 ....................................................................................................................................57
Casus 6 ....................................................................................................................................57
Depressieve stemmingsstoornissen: diagnostiek en classificatie .................................................59
Algemeen .................................................................................................................................59
Symptomen depressief syndroom ...............................................................................................59
Epidemiologie ...........................................................................................................................61
Diagnostiek ...............................................................................................................................61
Classificatie ..............................................................................................................................63
Verloop ....................................................................................................................................64
Differentiële diagnostiek .............................................................................................................65
Suïcidaliteit ...............................................................................................................................65
Depressieve stemmingsstoornissen: epidemiologie, etiologie en behandeling ..............................67
Epidemiologie ...........................................................................................................................67
Pathofysiologie ..........................................................................................................................67
Behandeling ..............................................................................................................................70
Bipolaire stoornissen: algemeen ..................................................................................................74
Prevalentie ...............................................................................................................................74
Symptomatologie ......................................................................................................................74
Type I versus type II ....................................................................................................................76
Verloop van de aandoening .........................................................................................................79
Diagnostiek ...............................................................................................................................79
Etiopathogenese .......................................................................................................................80
Bipolaire stoornissen: behandeling ..............................................................................................82
Algemeen .................................................................................................................................82
Medicatie .................................................................................................................................82
Andere interventies ....................................................................................................................86
Casuïstiek stemming & angst .......................................................................................................87
2
, Casus 1 ....................................................................................................................................87
Casus 2 ....................................................................................................................................87
Casus 3 ....................................................................................................................................87
Casus 4 ....................................................................................................................................88
Casus 5 ....................................................................................................................................88
Casus 6 ....................................................................................................................................89
Angst- en dwangstoornissen ........................................................................................................90
Inleiding: emoties en angst .........................................................................................................90
Angststoornissen .......................................................................................................................90
Obsessieve-compulsieve stoornis (OCD) en verwante stoornissen..................................................96
Behandeling (angststoornissen en OCD) ......................................................................................99
Psychiatrie in het algemeen ziekenhuis ...................................................................................... 104
Inleiding ................................................................................................................................. 104
Somatisch-psychiatrische comorbiditeit .................................................................................... 104
Setting.................................................................................................................................... 105
Capita selecta psychiatrie in het AZ ........................................................................................... 105
Delirium .................................................................................................................................... 108
Diagnose en klinische eigenschappen........................................................................................ 108
Epidemiologie en etiopathogenese ............................................................................................ 109
Medisch management.............................................................................................................. 110
Rol van antipsychotica in behandeling ....................................................................................... 111
Klinische casus ....................................................................................................................... 112
Ouderenpsychiatrie ................................................................................................................... 113
Inleiding – verouderingsprocessen ............................................................................................. 113
Diagnostiek ............................................................................................................................. 113
Klinische beelden .................................................................................................................... 114
Inleiding in kinder- en jeugdpsychiatrie ...................................................................................... 116
Specificiteit kinder- en jeugdpsychiatrie ..................................................................................... 116
Definitie psychiatrische stoornis bij kinderen en jongeren ............................................................. 116
Benaderingen .......................................................................................................................... 116
Het kinderpsychiatrisch onderzoek ............................................................................................ 116
Ontwikkelingspychopathologie – kinderpsychiatrische stoornissen ............................................... 118
Ontwikkelingsstoornissen in kinder- en jeugdpsychiatrie ............................................................ 119
ADHD (attention deficit hyperactivity disorder) ............................................................................ 119
ASS – autismespectrumstoornis ................................................................................................ 123
Externaliserende stoornissen: gedragsstoornissen ..................................................................... 127
Terminologie ........................................................................................................................... 127
3
, Algemeen ............................................................................................................................... 127
Oppositionele-opstandige stoornis (ODD) .................................................................................. 127
Normoverschrijdend-gedragsstoornis (CD) ................................................................................. 128
Etiopathogenese ..................................................................................................................... 130
Preventie ................................................................................................................................ 131
Behandeling ............................................................................................................................ 132
Internaliserende stoornissen ..................................................................................................... 133
Trauma ................................................................................................................................... 133
Zelfverwondend gedrag ............................................................................................................ 138
Suïcide ................................................................................................................................... 141
Somatisch-symptoomstoornis en verwante stoornissen ............................................................. 143
Somatisatie ............................................................................................................................ 143
Diagnostiek ............................................................................................................................. 144
Etiologische factoren ............................................................................................................... 147
Psychologische verklaringsmodellen ......................................................................................... 147
Psychosociale factoren ............................................................................................................ 148
Algemeen beleid en aanpak ...................................................................................................... 148
Nagebootste stoornissen ........................................................................................................... 152
Definitie .................................................................................................................................. 152
Epidemiologie ......................................................................................................................... 152
Diagnostiek ............................................................................................................................. 152
Etiopathogenese ..................................................................................................................... 153
Aanpak en behandeling ............................................................................................................ 153
Slaap- en waakstoornissen: insomnie ........................................................................................ 154
Diagnostische criteria .............................................................................................................. 154
Klinische benadering ................................................................................................................ 154
Therapie ................................................................................................................................. 155
Slaap-waakstoornissen: parasomnia ......................................................................................... 158
Algemeen ............................................................................................................................... 158
Stoornis van arousal van nonREMslaap ...................................................................................... 158
Stoornis van de REMslaap ........................................................................................................ 160
Andere ................................................................................................................................... 161
Ontwikkelingsstoornissen bij volwassenen ................................................................................ 162
ADHD bij volwassenen ............................................................................................................. 162
Autismespectrumstoornis in de volwassenheid .......................................................................... 164
Psychotherapie ......................................................................................................................... 169
Algemeen ............................................................................................................................... 169
4
