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Hoorcolleges psychopatholoie
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Overzichtelijke aantekeningen van alle hoorcollege psychopathologie
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InhoudsopgaveHC 1 Introductie college................................................................................................................................. 6
Symptomen ordenen............................................................................................................................................7
Limitaties RDoC................................................................................................................................................8
Limitaties HiTOP...............................................................................................................................................8
Limitaties netwerk modellen...........................................................................................................................8
Take home message........................................................................................................................................9
HC 2A DSM-5 Onderzoeksagenda................................................................................................................. 10
DSM-5-TR en de ICD-11......................................................................................................................................10
Assessment tools in section 3 of DSM-5-TR.......................................................................................................11
Klinische stadiering en profilering......................................................................................................................11
HC 2B Transdiagnostiek................................................................................................................................ 12
Unified protocol..................................................................................................................................................14
My size fits me....................................................................................................................................................14
HC3 Depressie.............................................................................................................................................. 16
Wat verstaan we onder depressie......................................................................................................................16
Risicofactoren, comorbiditeit, prognose............................................................................................................16
Depressie behandelen........................................................................................................................................17
CGT.................................................................................................................................................................17
Negatieve cognities........................................................................................................................................17
IPT..................................................................................................................................................................18
Hoe kunnen we psychotherapie optimaliseren?................................................................................................18
Sessiefrequentie............................................................................................................................................18
De rol van kwaliteit van therapie..................................................................................................................19
Gepersonaliseerd werken..............................................................................................................................19
Hoe werkt therapie?......................................................................................................................................20
HC 4 Netwerktheorie................................................................................................................................... 21
HC 5 Angststoornissen................................................................................................................................. 23
Definitie angststoornissen en overzicht van soorten angststoornissen.............................................................23
Overlap (cruciale elementen) en verschillen tussen angststoornissen..............................................................23
Comorbiditeit......................................................................................................................................................24
Etiologie & instandhoudende processen............................................................................................................24
Interpretatie bias...........................................................................................................................................25
Vermijding en veiligheidsgedrag...................................................................................................................25
Behandeling........................................................................................................................................................26
Clip Suïcide.................................................................................................................................................. 27
Terminology.......................................................................................................................................................27
Prevalence rates.................................................................................................................................................27
, Risk factors.........................................................................................................................................................27
Risk populations.................................................................................................................................................29
Prediction of suicide...........................................................................................................................................29
Current suicide prevention strategies................................................................................................................29
HC 6 OCS & PTSS.......................................................................................................................................... 31
Obsessieve compulsieve stoornis (OCS).............................................................................................................31
Prevalentie.....................................................................................................................................................32
Comorbiditeit.................................................................................................................................................32
Posttraumatische stressstoornis (PTSS).............................................................................................................33
HC 7 Autisme............................................................................................................................................... 37
Kader..................................................................................................................................................................37
Gedragscriteria...................................................................................................................................................37
Sociale communicatie.........................................................................................................................................38
Wederkerigheid.............................................................................................................................................38
Non-verbale communicatie...........................................................................................................................38
Vriendschappen/relaties...............................................................................................................................39
Beperkt, repetitief gedrag..................................................................................................................................39
Gedragsroutines, rituelen, moeite met veranderingen................................................................................39
Beperkte, gefixeerde interesses....................................................................................................................39
Over- en ondergevoeligheid voor sensorische prikkels................................................................................39
Autisme bij vrouwen...........................................................................................................................................40
Gevolgen van ‘er niet bijhoren’.....................................................................................................................40
Sensorische vaardigheden.............................................................................................................................42
Therapievormen:...........................................................................................................................................42
Gefixeerde interesses....................................................................................................................................43
HC 8 Forensische psychologie....................................................................................................................... 44
Risk-need-responsivity model.............................................................................................................................44
Risicofactoren:...............................................................................................................................................44
Behoefte:.......................................................................................................................................................44
Responsiviteit:...............................................................................................................................................44
Veelvoorkomende stoornissen in de forensische setting...................................................................................44
Narcistische persoonlijkheidsstoornis...........................................................................................................45
Antisociale persoonlijkheidsstoornis.............................................................................................................45
Borderline persoonlijkheidsstoornis..............................................................................................................45
Psychopathie..................................................................................................................................................46
Diagnostiek en risicotaxatie...............................................................................................................................46
Behandeling........................................................................................................................................................47
Moeilijkheden................................................................................................................................................47
HC 9 Psychosomatiek................................................................................................................................... 49
Terminologie......................................................................................................................................................49
Verschijningsvormen..........................................................................................................................................49
Lichaam-geest dualisme................................................................................................................................49
Biopsychosociale model................................................................................................................................49
Verklaringsmodellen..........................................................................................................................................51
Somatosensorische amplificatie....................................................................................................................51
, Centrale sensitisatie.......................................................................................................................................51
Niet-westerse modellen................................................................................................................................51
Kwetsbare persoonlijkheidsontwikkeling......................................................................................................51
Classificatie (DSM-5)..........................................................................................................................................52
Somatisch-systeemstoornis (SSS) en verwante stoornissen.........................................................................52
Conversiestoornis (functioneel-neurologische-symptoomstoornis).............................................................52
Behandeling........................................................................................................................................................53
L-MBT.............................................................................................................................................................53
ACT.................................................................................................................................................................54
HC 10 Eetstoornissen................................................................................................................................... 55
Anorexia nervosa................................................................................................................................................55
Boulimia nervosa................................................................................................................................................56
Eetbuistoornis.....................................................................................................................................................56
ARFID (vermijdend/restrictieve voedselinnamestoornis)...................................................................................57
Pica en ruminatiestoornis...................................................................................................................................57
Oorzaken............................................................................................................................................................57
Signalen van een eetstoornis.............................................................................................................................58
Behandeling AN..................................................................................................................................................59
Behandeling BN, BED en ARFID..........................................................................................................................59
Klinische kenmerken van eetstoornissen...........................................................................................................59
Persoonlijkheidskenmerken...............................................................................................................................60
Denkstijlen en cognitief functioneren................................................................................................................60
Set shifting.....................................................................................................................................................61
Centrale coherentie.......................................................................................................................................61
Behandeling – Cognitieve Remediatie Therapie (CRT)..................................................................................62
Emotieregulatie..................................................................................................................................................63
.................................................................................................................................................................... 63
HC 11 Psychose............................................................................................................................................ 64
Verkennen van het psychosespectrum...............................................................................................................64
Eerste diagnostische handvaten........................................................................................................................64
Verdere diagnostische handvaten:....................................................................................................................64
Psychotische ervaringen: hallucinaties..............................................................................................................64
Psychotische ervaringen: wanen........................................................................................................................65
Psychotische ervaringen: desorganisatie...........................................................................................................65
Wat is psychose nou eigenlijk?...........................................................................................................................65
Stadiëring van psychoses...................................................................................................................................65
Waarom?............................................................................................................................................................66
Onderzoeksbevindingen.....................................................................................................................................67
Diagnostiek.........................................................................................................................................................67
Hoe behandel je UHR (ultra high risk)?..............................................................................................................67
, Behandeling psychose........................................................................................................................................67
CGT bij psychose:................................................................................................................................................68
HC 12 Diagnostiek en behandeling van de bipolaire stoornis........................................................................69
Relevantie van juiste diagnostiek.......................................................................................................................69
Is het label überhaupt wel nodig/relevant?..................................................................................................69
Bipolaire depressie.............................................................................................................................................69
De manie en hypomanie....................................................................................................................................69
Herkennen van een bipolaire stoornis bij volwassenen.....................................................................................72
Differentiaal diagnostiek....................................................................................................................................72
Behandeling ZIE SLIDES VOOR OVERIGE INFO..................................................................................................72
Psychologische thema’s.....................................................................................................................................73
HC 13 Verslaving.......................................................................................................................................... 74
Wat is verslaving?..............................................................................................................................................74
Verslaving: hoe werkt het in het brein...............................................................................................................74
Attitude hulpverleners en stigma.......................................................................................................................76
Behandeling........................................................................................................................................................76
HC 14 Persoonlijkheidsstoornissen............................................................................................................... 78
Persoonlijkheid...................................................................................................................................................78
Persoonlijkheidsstoornis.....................................................................................................................................78
Epidemiologie.....................................................................................................................................................79
Verklaringsmodellen......................................................................................................................................79
Emotieregulatie.............................................................................................................................................79
DSM vs ICD.....................................................................................................................................................80
Cluster A - buitenbeentjes..................................................................................................................................80
Paranoïde PS..................................................................................................................................................80
Schizoïde PS...................................................................................................................................................80
Schizotypische PS...........................................................................................................................................81
Cluster B – lastpakken........................................................................................................................................81
Borderline PS.................................................................................................................................................81
Antisociale PS.................................................................................................................................................81
Narcistische PS...............................................................................................................................................82
Histrionische PS.............................................................................................................................................82
Cluster C – angsthazen.......................................................................................................................................82
Afhankelijke PS..............................................................................................................................................83
Vermijdende PS.............................................................................................................................................83
Dwangmatige PS............................................................................................................................................83
Diagnostiek.........................................................................................................................................................84
Behandeling........................................................................................................................................................84
HC 15 Neuropsychiatrie................................................................................................................................ 86
Gilles de la tourette............................................................................................................................................87
Slaapproblemen.................................................................................................................................................88
Hormonen...........................................................................................................................................................88
,Ouderenpsychiatrie............................................................................................................................................89
, HC 1 Introductie college
We zien een toename van psychische klachten in de maatschappij. Hierom is het belangrijk
om te begrijpen waar die problemen vandaan komen.
Ook in de GGZ zijn er enorme wachtlijsten. Dit komt onder andere doordat de
behandelingen die we geven maar beperkt werken. Dit heeft te maken met dat we nog lang
niet alles van psychopathologie begrijpen en de maatschappij aanzienlijk complexer wordt.
Het is veel meer dan vroege een prestatiemaatschappij geworden waardoor de psychische
ongezondheid zou zijn toegenomen.
Voor het eerst in heel veel jaar is er weer discussie gaande over wat psychopathologie nou
eigenlijk is, mag je het wel een stoornis noemen en wat moeten we met alle diagnoses die
we hebben.
Psychopathologie is heel erg ingewikkeld en we moeten accepteren dat we mensen niet
volledig gaan begrijpen. Psychopathologie is wel het doen van een poging om mensen te
begrijpen.
Psychopathologie bestaat ook uit classificeren (iemand heeft iets wel of niet), hier is gelukkig
wel discussie over. De zorgverzekering eist een classificatie voordat je mag beginnen met de
behandeling die gepast is bij de classificatie. Nu wordt er vaak door de zorgverlener gekeken
op een manier naar een classificatie die past bij de geschikte behandeling voor de cliënt.
Voorheen namen behandelaren teveel de tijd en gingen te lang door met een
behandeling/patiënt. Door een classificatie, hoopten zorgverzekeraars dit tegen te gaan. Dit
werkt niet omdat we mensen zijn met allemaal verschillende specifieke kenmerken.
Een inclusieve samenleving betekent dat we oke moeten zijn met dat iedereen anders moet
zijn. Het begrip van de omgeving is best wel genegeerd.
In tegenstelling tot andere organen, wordt je brein wel beïnvloed door de omgeving en
cultuur.
De DSM heeft ons heel veel opgeleverd:
- Een universele taal
- Ordening van symptomen
Inmiddels zitten we op 491 diagnoses, dit is wel heel veel. Waarschijnlijk meer dan nodig is.
Diagnoses zijn pure labels.
Over de tijd heen is de psychologie heel erg veranderd. Veranderingen over de tijd;
1. Psychodynamische stroming introspectie, subjectief
2. Behaviorisme kijken naar gedrag, emoties en cognities werden vergeten
3. Humanistische stroming kijken naar de mensen, geen label plakken, cliënt-
therapeut relatie
4. Cognitieve stroming hoe iemand denkt doet ertoe
5. Biologische stroming alles begrijpen met het brein
Alle stroming ageren tegen elkaar. Alle stromingen zijn er nog steeds. We moeten niet tegen
elkaar vechten, want geen enkele stroming kan alle stoornissen verklaren.
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