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Klinische Psychiatrie - Samenvatting
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Dit zijn alle colleges en lesnotities (incl. alle informatie op de slides) van het vak Klinische Psychiatrie, aangevuld met illustraties ter verduidelijking.
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Klinische PsychiatriePROF. DR. D. VAN WEST
Academiejaar 2021-2022
Vrije Universiteit Brussel
, Inhoudstafel
COLLEGE 1: INLEIDING (DSM-5) ...................................................................................................... 1
1. Inleiding ............................................................................................................................... 1
1.1 Psychopathologie .................................................................................................................................. 1
1.2 Psychiatrische stoornis........................................................................................................................... 2
1.2.1 Het bio-psycho-(cultureel)-sociaal model .................................................................................................................... 2
2. Classificatie........................................................................................................................... 3
2.1 Algemeen .............................................................................................................................................. 3
2.2 DSM/ICD................................................................................................................................................ 3
2.3 Voor-en nadelen ..................................................................................................................................... 4
2.4 Geschiedenis ......................................................................................................................................... 4
3. Diagnostiek ........................................................................................................................... 4
4. Globale veranderingen DSM-5 ................................................................................................. 5
5. Opzet DSM-5 (I-II-III) ............................................................................................................... 6
5.1 Deel II .................................................................................................................................................... 6
5.2 Deel III ................................................................................................................................................... 6
6. Stellingen.............................................................................................................................. 7
7. Conclusie .............................................................................................................................. 7
COLLEGE 2: INLEIDING .................................................................................................................. 8
1. Normaliteit en psychopathologie ............................................................................................ 8
1.1 Normaliteit ............................................................................................................................................ 8
1.2 Criteria normaliteit ................................................................................................................................ 8
1.3 Probleem van subjectiviteit .................................................................................................................... 8
2. Epidemiologie ....................................................................................................................... 9
2.1 Wat is epidemiologie? ............................................................................................................................. 9
2.2 Beloop in de epidiomologie (belangrijk!): 4 types...................................................................................... 9
2.3 Belangrijke factoren in epidemiologie...................................................................................................... 9
3. Algemene prevalentie .......................................................................................................... 10
3.1 Cijfers ................................................................................................................................................. 10
3.2 Prevalentie Psychiatrische stoornissen .................................................................................................. 10
4. Geschiedenis van de psychiatrie (niet kennen) ....................................................................... 11
4.1 Hippocrates (ca. 460-366 v.C.) ............................................................................................................... 11
4.2 Exorcisme en heksenvervolgingen (“drijftest”) (ca. Middeleeuwen/Dark Ages) ......................................... 11
4.3 Gekkenhuizen ...................................................................................................................................... 11
4.4 Vanaf 1800: hervormingen .................................................................................................................... 11
Klinische Psychiatrie – AJ2021-2022
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, 4.5 Tweede wereldoorlog ........................................................................................................................... 12
4.6 De antipsychiatrische beweging (ca. 1970): door de minder humane omstandigheden ............................... 12
4.7 Evidence-based medicine...................................................................................................................... 12
4.8 Samengevat ........................................................................................................................................ 12
5. Etiopathogenese (EXAMEN) .................................................................................................. 13
5.1 Fysiopathogenese (neurobiologische mechanismen) .............................................................................. 13
5.1.1 Genetica (heritabiliteit) ................................................................................................................................................ 13
5.1.2 Neurotransmitters........................................................................................................................................................ 18
5.2 Psychopathogenese (psychische mechanismen) ..................................................................................... 19
5.2.1 Psychologisch perspectief ........................................................................................................................................... 19
5.2.2 Psychische functies ...................................................................................................................................................... 19
5.2.3 Stoornis in het psychisch functioneren ...................................................................................................................... 20
6. Het Psychiatrisch Onderzoek ................................................................................................ 22
6.1 Anamnese............................................................................................................................................ 22
6.2 Onderzoek ........................................................................................................................................... 22
7. Beeldvorming ...................................................................................................................... 23
COLLEGE 3: NEUROCOGNITIEVE STOORNISSEN ............................................................................. 24
1. Neurocognitieve stoornissen: wat?........................................................................................ 26
1.1 Epidemiologie: Algemeen – Vergrijzing van de bevolking in België............................................................ 26
1.2 Fysiologisch gegeven: het geheugen & geheugenfuncties ........................................................................ 26
1.3 Ouderdom ........................................................................................................................................... 26
1.4 Neuropsychologische testen = SCREENING ............................................................................................. 27
1.4.1 MMSE: mini-mental state examination = vroegtijdige detectie ................................................................................. 27
1.4.2 Kloktest ......................................................................................................................................................................... 28
2. Dementie ............................................................................................................................ 28
2.1 Informatie netwerk .............................................................................................................................. 28
2.2 Geheugen en veroudering ..................................................................................................................... 28
2.3 Epidemiologie – Expertisecentrum dementie Vlaanderen ........................................................................ 28
2.4 Klinische kenmerken = DIAGNOSTIEK (spec. voor Alzheimer) .................................................................. 29
2.4.1 Oriëntatieproblemen ................................................................................................................................................... 29
2.4.2 Geheugenstoornissen .................................................................................................................................................. 29
2.4.3 Stoornis in abstract denken en het oordeelsvermogen............................................................................................. 29
2.4.4 Corticale functiestoornissen = SPECIFIEK ALZHEIMER .............................................................................................. 30
2.4.5 Gedragsveranderingen (secundair gelinkt) ................................................................................................................ 30
2.4.6 Bijkomende symptomen (secundair gelinkt) ............................................................................................................. 30
2.5 Indeling .............................................................................................................................................. 31
2.5.1 Ziekte van Alzheimer (belangrijkste type) .................................................................................................................. 31
2.5.2 Vasculaire dementie..................................................................................................................................................... 32
2.5.3 Frontotemporale dementie ......................................................................................................................................... 33
2.5.4 Dementie met Lewy Bodies (DLB) ............................................................................................................................... 33
2.5.5 Andere vormen van dementie: Parkinson .................................................................................................................. 33
2.5.6 Andere vormen van dementie: De ziekte van Jacob Creutzfeldt............................................................................... 33
Klinische Psychiatrie – AJ2021-2022
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, 2.5.7 Andere vormen van dementie: Aids ............................................................................................................................ 33
2.6 Diagnostiek ......................................................................................................................................... 34
2.7 Dementie – depressie ........................................................................................................................... 34
2.8 Behandeling ........................................................................................................................................ 35
2.8.1 Overzicht....................................................................................................................................................................... 35
2.8.2 Behandeling psychiatrische symptomen ................................................................................................................... 35
3. Delirium .............................................................................................................................. 36
3.1 Epidemiologie ...................................................................................................................................... 36
3.2 DSM .................................................................................................................................................... 36
3.3 Subtypes ............................................................................................................................................. 36
3.4 Delirium-dementie-depressie ................................................................................................................ 36
3.5 Oorzaken delirium: I WATCH DEATH ....................................................................................................... 37
3.6 Behandeling ........................................................................................................................................ 37
4. Amnestische stoornissen ...................................................................................................... 37
COLLEGE 4: MIDDELENGERELATEERDE EN VERSLAVINGSSTOORNISSEN .......................................... 38
1. Stoornissen in het gebruik .................................................................................................... 38
1.1 Misbruik van een middel: DSM ............................................................................................................... 38
1.2 Middelenafhankelijkheid ...................................................................................................................... 38
2. Stoornissen door het gebruik ................................................................................................ 39
2.1 Intoxicatie door een middel .................................................................................................................. 39
2.2 Onthouding van een middel .................................................................................................................. 39
3. Psychoactieve stoffen .......................................................................................................... 39
3.1 Alcohol ............................................................................................................................................... 40
3.1.1 Eenheid ......................................................................................................................................................................... 40
3.1.2 Alcoholgebruik ............................................................................................................................................................. 40
3.2 Drugs .................................................................................................................................................. 41
3.2.1 Stoornissen door het gebruik ..................................................................................................................................... 41
4. Diagnostiek ......................................................................................................................... 42
5. Ethiopathogenese ................................................................................................................ 42
6. Aan middelen gebonden stoornissen ..................................................................................... 43
6.1 Ethiopathogenesis ............................................................................................................................... 43
6.2 Prognose ............................................................................................................................................. 43
6.3 Behandeling ........................................................................................................................................ 44
6.3.1 Preventie....................................................................................................................................................................... 44
6.3.2 Behandeling - algemeen .............................................................................................................................................. 44
College 5: schizofrenie en andere psychotische stoornissen ........................................................... 45
1. Schizofrenie (spectrum!) ...................................................................................................... 45
1.1 Klinische criteria .................................................................................................................................. 45
Klinische Psychiatrie – AJ2021-2022
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