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samenvatting pathologie en psychiatrie kinderen en jongeren, deel 2 volledig

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Psychopathologie en psychiatrie, deel 2 (P0W61A)

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Katholieke Universiteit Leuven (KU Leuven)

dit is een volledige samenvatting van de lessen en bijhorende nota's van het opo pathologie en psychiatrie kinderen en jongeren, deel 2

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Institution
Katholieke Universiteit Leuven (KU Leuven)
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1ste Masterjaar Pedagogische Wetenschappen
Course
Psychopathologie en psychiatrie, deel 2 (P0W61A)

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AJ 22-23

Psychopathologie deel 2
P0W61A
ANKE VAN DER SCHOOT

,Inhoudsopgave
1. Inleiding ................................................................................................................................................... 6
1.1 Multilevel – multifactoriële etiopathogenese ........................................................................................ 6
1.2 Ontwikkeling: transactionaliteit ............................................................................................................ 6
1.2.1 Ontwikkeling: .................................................................................................................................... 7
1.3 Kinder- en jeugdpsychiatrische beelden ................................................................................................ 7
1.3.1 Over “stoornissen” ............................................................................................................................ 7
1.3.2 Kinder- en jeugdpsychiatrische beelden ........................................................................................... 8

2 Gedrags”stoornissen” .............................................................................................................................. 9
2.1 Casussen ................................................................................................................................................ 9
2.1.1 Casus 1: Kenny 17 jaar....................................................................................................................... 9
2.1.2 Casus 2: Geoffrey 10 jaar .................................................................................................................. 9
2.1.3 Casus 3: Evert 14 jaar ....................................................................................................................... 9
2.2 Fenomenologie ...................................................................................................................................... 9
2.2.1 Korte herhaling fenomenologie ...................................................................................................... 10
2.3 Psychiatrie en psychopathologie K&J deel 1 ........................................................................................ 10
2.4 Vaststellingen in de praktijk ................................................................................................................ 11
2.5 Oppositioneel opstandig gedrag: genetica .......................................................................................... 12
2.5.1 In- en uitzoomend: ODD .................................................................................................................. 12
2.6 Conduct disorder: genetica en omgeving ............................................................................................ 13
2.6.1 Inzoomend: conduct disorder: 1 of meer dimensie(s) .................................................................... 13
2.6.2 Uitzoomend: conduct disorder en andere stoornissen ................................................................... 13
2.6.3 Conduct disorder: specifieke genen? .............................................................................................. 14
2.6.4 ODD/Conduct disorder: omgevingsrisico’s (+/- 40-60%) ................................................................ 14
2.6.5 conduct disorder: Gen-omgevingsinteracties? MAO-A................................................................... 14
2.6.6 Conduct disorder: epigenetica? ...................................................................................................... 15
2.6.7 Conduct disorder: neuro-anatomie ................................................................................................. 15
2.6.8 Neurocognitieve deficits ................................................................................................................. 19
2.6.9 CD: hypothetische integratie ........................................................................................................... 19
2.6.10 behandeling ................................................................................................................................ 19
2.7 Besluit .................................................................................................................................................. 20

3 ADHD: aandachtsdeficiëntie/hyperactiviteitsstoornis ........................................................................... 21
3.1 Van kind tot volwassene ...................................................................................................................... 21
3.1.1 aandachtsdeficiëntie-/ hyperactiviteitsstoornis (attention deficit/hyperactivity disorder) ........... 21
3.1.2 ADHD: 3 presentaties ...................................................................................................................... 21
3.1.3 ADHD en ONTWIKKELING ................................................................................................................ 22
3.1.4 Predictie persistentie ...................................................................................................................... 24
3.1.5 ADHD Van kindertijd tot volwassenheid ......................................................................................... 24
3.1.6 Persistentie in klinische groepen..................................................................................................... 25
3.2 2. Hoe ontstaat ADHD op kinderleeftijd .............................................................................................. 26
3.2.1 Etiologie: erfelijkheid van ADHD is zeer hoog ! ............................................................................... 26
3.2.2 ADHD en MEDICATIE ....................................................................................................................... 29
3.2.3 ADHD: VAN GENEN NAAR GEDRAG................................................................................................. 29
3.2.4 Contextafhankelijkheid & heterogeniteit ........................................................................................ 30
3.2.5 ONDERLINGE RELATIE van geassocieerde DEFICITS ........................................................................ 31
3.2.6 ADHD: CATEGORIE OF DIMENSIE(S) ................................................................................................ 33
3.2.7 BEHANDELING ................................................................................................................................. 34

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, 3.2.8 BESLUIT: medicatie overwegen in balans tussen potentieel schadelijke effecten van gedrag versus
behandeling .................................................................................................................................................. 37
3.2.9 BESLUIT............................................................................................................................................ 38

4 Tics en tourette ...................................................................................................................................... 39
4.1 Fenomenologie .................................................................................................................................... 39
4.1.1 Fenomenologie: samenvatting ........................................................................................................ 39
4.1.2 Tics en “premonitory urges” ........................................................................................................... 39
4.1.3 Flooding ........................................................................................................................................... 40
4.1.4 Ernstinschatting: Yale Global Tic Severity Scale .............................................................................. 40
4.1.5 Cofenomenen en comorbiditeiten .................................................................................................. 40
4.2 TICS EN TOURETTE ETIOLOGIE ............................................................................................................. 41
4.2.1 Primaire / Secundaire tics ............................................................................................................... 41
4.2.2 Tics en Tourette: Genetica .............................................................................................................. 41
4.2.3 Tics en Tourette : waar gaat het fout ? ........................................................................................... 42
4.2.4 Tics en Tourette: neurotransmissie ................................................................................................. 42
4.2.5 Neuro-anatomie: grijze stof ............................................................................................................ 43
4.2.6 Neuro-anatomie: connectiviteit (witte stof) ................................................................................... 43
4.2.7 Hypotheses: tics als leereffecten en/of tekort aan inhibitie ........................................................... 43
4.2.8 Geassocieerde fenomenen.............................................................................................................. 44
4.2.9 Medische behandeling van tics / Tourette ...................................................................................... 44
4.2.10 Psycho-educatie ouders, jongere................................................................................................ 45
4.2.11 John’s not mad ............................................................................................................................ 45
4.2.12 Psycho-educatie leeftijdsgenoten, leerkrachten ........................................................................ 45
4.2.13 CBIT (Comprehensive Behavioural Intervention for Tics) ........................................................... 46
4.2.14 Exposure & Response Prevention Therapy ................................................................................. 46
4.2.15 Farmacologische behandeling: α-2 agonisten ............................................................................ 46
4.2.16 Farmacologische behandeling: antipsychotica ........................................................................... 47
4.2.17 Farmacologische behandeling: anticonvulsiva ........................................................................... 47
4.2.18 Beslisboom .................................................................................................................................. 47
4.2.19 Expert voorkeursbehandeling ..................................................................................................... 47
4.2.20 Comorbiditeit .............................................................................................................................. 48
4.2.21 Meer ingrijpende behandelingen: .............................................................................................. 48

5 Anorexia Nervosa in de adolescentie ..................................................................................................... 49
5.1 Algemeenheden ................................................................................................................................... 49
5.1.1 1. Historiek: eerste beschrijvingen .................................................................................................. 49
5.1.2 2. HEDEN: DIAGNOSTIEK: DSM-5 .................................................................................................... 51
5.1.3 3. Diagnostiek: geassocieerde problemen/pathologie.................................................................... 51
5.1.4 3. Neurobiologie en eetlust: ............................................................................................................ 53
5.1.5 4. Het anorectische brein ................................................................................................................ 53
5.1.6 6. RISICOFACTOREN......................................................................................................................... 54
5.1.7 8. Specifieke uitdagingen ................................................................................................................ 55
5.2 II. PEDIATRISCHE GEVOLGEN EN MANAGEMENT ................................................................................ 58
5.3 III. Kinderpsychiatrische behandeling ................................................................................................. 59
5.3.1 7. Behandeling: principes ................................................................................................................ 60
5.3.2 Opportuniteit : een volledig organisatiemodel ............................................................................... 63

6 Autismespectrumstoornis: ASS .............................................................................................................. 64
6.1 Onderliggende mechanismen van ontwikkelingsstoornissen, bv ASS ................................................. 64
6.2 Diagnostische criteria in de DSM-5 ...................................................................................................... 65
6.2.1 A-criterium: Sociale communicatie ................................................................................................ 65
6.2.2 B-criterium: Restricted, repetitive patterns of behaviour & interests: RRBI’s ............................... 65

2

, 6.3 Vaak voorkomende Verschillen op neurocognitief niveau ................................................................... 65
6.4 Geschiedenis van autismeresearch: voortschrijdend inzicht ............................................................... 66
6.4.1 Autisme als ontwikkelingsstoornis .................................................................................................. 67
6.4.2 Waarom denken we aan biologische mechanismen? ..................................................................... 67
6.5 Samenloop van omstandigheden ........................................................................................................ 68
6.6 Onderliggende mechanismen van ontwikkelingsstoornissen, bv ASS Niet universeel, en zelden
specifiek ............................................................................................................................................................ 68
6.6.1 Ontstaan op verschillende leeftijden .............................................................................................. 68
6.7 Autisme & genetica ............................................................................................................................. 69
6.7.1 Begrippen: Herhalingsrisico: ........................................................................................................... 69
6.7.2 Heritabiliteit* ASS: .......................................................................................................................... 70
6.7.3 Genetische mechanismen in een lichaamscel ................................................................................. 71
6.8 Epigenetica .......................................................................................................................................... 72
6.8.1 DNA methylering: de eenvoudigste vorm van methylering ............................................................ 72
6.8.2 Het immuunsysteem en autisme: ................................................................................................... 73
6.9 Hersenanatomie/ Hersenwerking ........................................................................................................ 73
6.9.1 Heel veel onderzoek; zeer weinig theorieën ................................................................................... 73
6.10 Interventies bij autisme / A.S.S. ........................................................................................................... 74
6.10.1 Geen “behandeling” naar herstel. .............................................................................................. 74
6.10.2 Verduidelijken van omgeving en tijd .......................................................................................... 74
6.10.3 Ondersteuning van de communicatie ......................................................................................... 74
6.10.4 Stimuleren, vroeg-interventies ................................................................................................... 74
6.10.5 Begrijpen van gedragsproblemen ............................................................................................... 75
6.10.6 Medicatie .................................................................................................................................... 75
6.10.7 Hoe worden psychofarmaca toegediend ? ................................................................................. 75

7 Biologische aspecten van Stemmingsstoornissen .................................................................................. 75
7.1 Klinisch beeld in depressieve stoornissen ............................................................................................ 76
7.1.1 Depressieve stoornissen in DSM-5: Soorten ................................................................................... 76
7.1.2 Voorkomen MDD ............................................................................................................................ 79
7.2 Algemene ontwikkeling van de hersenen ............................................................................................ 82
7.2.1 Ontwikkeling van de hersenen ........................................................................................................ 82
7.3 Pathogenese/ –fysiologie depressieve stoornissen .............................................................................. 83
7.3.1 Genetische factoren ........................................................................................................................ 83
7.3.2 Omgevingsfactoren ......................................................................................................................... 84
7.3.3 Pathogenese/-fysiologie van depressieve stoornissen ................................................................... 85
7.4 Besluit .................................................................................................................................................. 89

8 Somatisch-symptoom stoornis en verwanten ........................................................................................ 89
8.1 Holistische geneeskunde ...................................................................................................................... 89
8.2 Somatische geneeskunde..................................................................................................................... 89
8.3 Psychiatrie ........................................................................................................................................... 90
8.4 Psychosomatische aandoeningen ........................................................................................................ 90
8.5 Somatisch-Symptoom Stoornis en verwanten ..................................................................................... 90
8.6 DSM-5 definitie Somatisch-Symptoom Stoornis .................................................................................. 91
8.7 DSM-5 types SSS en verwanten ........................................................................................................... 91
8.8 Algemene symptomatologie : onderlinge relatie ................................................................................ 92

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