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Psychiatrie - samenvatting
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  • Course
  • Psychiatrie - geestelijke gezondheid
  • Institution
  • Universiteit Gent (UGent)

Dit een een samenvatting van de PPT, de lessen (met extra notities) en eventuele extra lectuur waarnaar werd verwezen tijden de lessen. Er is telkens ook aangeduid wat zeker te kennen is (ster en fluo). Als je tight-budget bent, mag je mij altijd sturen via FB en dan kunnen we een aangepaste prij...

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Document information

  • April 30, 2023
  • 90
  • 2021/2022
  • Summary

Subjects

  • psychiatrie
  • geestelijke gezondheid
  • problemen van geestelijke gezondheid

Written for

  • Universiteit Gent (UGent)
  • Geneeskunde
  • Psychiatrie - geestelijke gezondheid
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Psychiatrie
Inhoud
1. Schizofrenie-spectrum en andere psychotische stoornissen .......................................................... 9
1.1 Symptomen ............................................................................................................................. 9
1.1.1 Wanen: + symptoom ....................................................................................................... 9
1.1.2 Hallucinaties: + symptoom .............................................................................................. 9
1.1.3 Gedesorganiseerd denken (formele stoornissen): + symptoom ................................... 10
1.1.4 Ernstige gedesorganiseerde of abnormale psychomotoriek ........................................ 11
1.1.5 Negatieve symptomen .................................................................................................. 11
1.1.6 Opmerkingen ................................................................................................................. 12
1.2 Classificatie ............................................................................................................................ 12
1.2.1 Schizofrenie ................................................................................................................... 12
1.2.2 Schizofreniforme stoornis ............................................................................................. 13
1.2.3 Kortdurende psychotische stoornis............................................................................... 13
1.2.4 Waanstoornis ................................................................................................................ 13
1.2.5 Schizo-affectieve stoornis.............................................................................................. 13
1.2.6 Psychotische stoornis door een middel......................................................................... 13
1.2.7 Psychotische stoornis door een somatische aandoening ............................................. 14
1.2.8 Katatonie ....................................................................................................................... 14
1.3 Terminologie: schizofrenie .................................................................................................... 14
1.4 Ziektebeloop v Schizofrenie .................................................................................................. 14
1.5 Etiologie v Schizofrenie ......................................................................................................... 15
1.5.1 Genetica......................................................................................................................... 16
1.5.2 Environmental hypothese (cannabis en migratie!) ....................................................... 16
1.5.3 Ontwikkelingshypothese ............................................................................................... 17
1.5.4 Toxiciteit (oa drugs) ....................................................................................................... 17
1.6 Behandeling v Schizofrenie ................................................................................................... 17
1.6.1 Historische evolutie ....................................................................................................... 17
1.6.2 Medicamenteuze behandeling ...................................................................................... 17
1.6.3 Psycho-Educatie ............................................................................................................ 19
1.6.4 Cognitieve gedragstherapie (CBT) ................................................................................. 19
1.6.5 Familiezorg .................................................................................................................... 20
1.6.6 Rehabilitatie .................................................................................................................. 20
2. Depressieve stoornissen................................................................................................................ 20


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,2.1 Introductie ............................................................................................................................. 20
2.2 Indeling depressieve stoornissen .......................................................................................... 21
2.3 Klinische beelden v depressieve stoornissen ........................................................................ 21
2.3.1 Majeur depressieve stoornis ......................................................................................... 22
2.3.2 Persisterende depressieve stoornis (Dysthyme stoornis) ............................................. 22
2.3.3 Premenstruele dysfore stoornis .................................................................................... 22
2.3.4 Depressieve stemmingsstoornis door somatische aandoening .................................... 22
2.3.5 Depressieve stoornis dr middel/GM ............................................................................. 23
2.4 Diagnostiek depressieve stoornis .......................................................................................... 23
2.5 Epidemiologie depressieve stoornis...................................................................................... 23
2.6 Etiopathogenese depressieve stoornissen ............................................................................ 23
2.6.1 Neurobiologische factoren ............................................................................................ 23
2.6.2 Psychologische factoren ................................................................................................ 24
2.6.3 Sociale factoren ............................................................................................................. 24
2.6.4 Model vd etiopathogenese v depressieve stoornissen ................................................. 24
2.7 Behandeling van depressieve stoornissen ............................................................................ 25
2.7.1 Psycho-educatie bij depressieve stoornissen ................................................................ 25
2.7.2 Neurobiologische behandeling depressieve stoornissen .............................................. 25
2.7.3 Medicamenteuze behandeling depressieve stoornissen (zie ook tutorial) .................. 26
A. Tricyclische antidepressiva ................................................................................................ 26
B. SSRI: Selectieve Serotonine Reuptake Inhibitoren ............................................................ 27
C. Nieuwe generatie SNRI: Serotonerge en Noradrenerge Reuptake Inhibitoren ................ 28
D. NDRI: Noradrenaline Dopamine Reuptake Inhibitoren..................................................... 28
2.7.4 Neurobiologische niet-farmacologische behandeling v depressieve stoornissen ........ 28
2.7.5 Psychologische behandeling van depressieve stoornissen ........................................... 28
2.8 Beloop depressieve stoornissen ............................................................................................ 28
2.9 Depressie in de huisartsgeneeskunde ................................................................................... 31
2.9.1 Epidemiologie depressie ............................................................................................... 31
2.9.2 Hoe de diagnose depressie stellen? .............................................................................. 31
A. Eraan denken: vage klacht  depressie ........................................................................... 31
B. 2 gerichte kernvragen........................................................................................................ 31
C. Andere mogelijke verklaringen ......................................................................................... 31
2.9.3 Hoe de ernst inschatten? .............................................................................................. 32
2.9.4 Indicaties voor medicamenteuze aanpak? .................................................................... 33
2.9.5 Medicamenteuze aanpak in de eerste lijn? .................................................................. 33
A. Bijwerkingen ...................................................................................................................... 33

2

, B. Keuze tss SSRI en TCA ........................................................................................................ 34
C. Uitleg aan ptn .................................................................................................................... 34
D. Follow-up ........................................................................................................................... 34
2.9.6 Wanneer de patiënt verwijzen? .................................................................................... 34
3. Bipolaire stoornissen ..................................................................................................................... 35
3.1 Inleiding ................................................................................................................................. 35
3.1.1 Manische episode .......................................................................................................... 35
3.1.2 Manische vs hypomane episode ................................................................................... 36
3.2 Klinische beelden bipolaire stoornis ..................................................................................... 36
3.3 Epidemiologie van bipolaire stoornis .................................................................................... 36
3.4 Diagnostiek van bipolaire stoornis ........................................................................................ 37
3.5 Differentiaal diagnostiek ....................................................................................................... 38
3.6 Etiopathogenese.................................................................................................................... 38
3.6.1 Neurologische factoren ................................................................................................. 38
3.6.2 Psychologische en sociale factoren ............................................................................... 38
3.7 Behandeling bipolaire stoornis.............................................................................................. 38
3.7.1 Medicamenteuze behandeling ...................................................................................... 38
A. Middelen bij verschillende episodes vd bipolaire stoornis ............................................... 38
B. Aanvang en duurtijd medicamenteuze behandeling ........................................................ 39
C. Lithium behandeling .......................................................................................................... 39
D. Valporaat (depakine) behandeling .................................................................................... 40
E. Probleem van non-compliance.......................................................................................... 40
3.7.2 Psychoeducatie .............................................................................................................. 40
4. Angststoornissen ........................................................................................................................... 41
4.1 Inleiding ................................................................................................................................. 41
4.2 Syndromen ............................................................................................................................ 41
4.2.1 Paniekstoornissen ......................................................................................................... 41
A. PaniekAANVAL ................................................................................................................... 42
B. PaniekSTOORNIS................................................................................................................ 42
4.2.2 Agorafobie ..................................................................................................................... 42
4.2.3 Sociale angststoornis ..................................................................................................... 43
4.2.4 Specifieke fobie ............................................................................................................. 44
4.2.5 Gegeneraliseerde angststoornis (GAD) ......................................................................... 45
4.2.6 Separatie angststoornis ................................................................................................. 45
4.2.7 Selectief mutisme .......................................................................................................... 45
4.3 Diagnostiek ............................................................................................................................ 46

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, 4.4 Differentiaal diagnose ........................................................................................................... 46
4.5 Epidemiologie angst stoornissen........................................................................................... 46
4.6 Etiopathogenese van angststoornissen................................................................................. 46
4.6.1 Neurobiologische factoren ............................................................................................ 46
4.6.2 Psychologische factoren ................................................................................................ 47
4.7 Behandeling angststoornis .................................................................................................... 47
4.7.1 Psycho-educatie ............................................................................................................ 47
4.7.2 Farmacologische behandeling ....................................................................................... 47
4.7.3 Psychotherapeutische behandeling .............................................................................. 48
4.8 Beloop angst stoornis ............................................................................................................ 48
5. Obsessieve-compulsieve en verwante stoornissen (dwangstoornissen)...................................... 48
5.1 Indeling .................................................................................................................................. 48
5.2 Obsessieve-Compulsieve Stoornis (OCD) .............................................................................. 48
5.2.1 Inleiding OCD ................................................................................................................. 48
5.2.2 Syndroom OCD .............................................................................................................. 48
5.2.3 Diagnose en DD OCD ..................................................................................................... 49
5.2.4 Epidemiologie en beloop OCD....................................................................................... 49
5.2.5 Etipathogenese OCD...................................................................................................... 50
A. Neurobiologische factoren ................................................................................................ 50
B. Psychologische factoren .................................................................................................... 50
5.2.6 Behandeling OCD ........................................................................................................... 50
A. Neurobiologische behandeling OCD.................................................................................. 50
B. Psychologische behandeling.............................................................................................. 50
5.2.7 Beloop OCD ................................................................................................................... 50
5.3 Morfodysfore stoornis (Body Dysmorphic Disorder) ............................................................ 50
5.4 Verzamelstoornis (Hoarding Disorder).................................................................................. 51
5.5 Trichotillomania (haaruittrekstoornis) .................................................................................. 51
5.6 Excoriatiestoornis (huidpulkstoornis, Skin Picking Disorder) ................................................ 51
6. Trauma en stressorgerelateerde stoornissen ............................................................................... 51
6.1 Inleiding ................................................................................................................................. 51
6.2 Klinische beelden................................................................................................................... 52
6.2.1 Reactieve hechtingsstoornis.......................................................................................... 52
6.2.2 Ontremd-sociaalcontact stoornis .................................................................................. 52
6.2.3 Post-traumatische-stressstoornis (PTSS)....................................................................... 52
A. DSM5 criteria ..................................................................................................................... 52
B. Bemerkingen ..................................................................................................................... 53

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