Summary

Samenvatting volwassenpsychiatrie

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Course
Psychiatrie, Kinder en Jeugdpsychiatrie (E0C42A)

Institution
Katholieke Universiteit Leuven (KU Leuven)

Dit is een samenvatting van het vak 'volwassenen- en ouderenpsychiatrie'. Het bevat alle leerstof van de powerpoints van prof Claes en prof Vandenbulcke. (Veel pagina's, maar mooi gestructureerd en veel uitleg)

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Uploaded on January 21, 2025
Number of pages 134
Written in 2024/2025
Type Summary

psychiatrie
ouderen
volwassenen
psychose
persoonlijkheidsstoornis
depressie
bipolaire stoornis
eetstoornis
slaapstoornis
seksuele disfunctie
schizofrenie
anorexia nervosa
neurocognitieve aandoeningen

Institution
Katholieke Universiteit Leuven (KU Leuven)
Education
Geneeskunde
Course
Psychiatrie, Kinder en Jeugdpsychiatrie (E0C42A)

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1. Summary - Samenvatting volwassenpsychiatrie
2. Summary - Samenvatting kinder- en jeugdpsychiatrie
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INHOUD

Hoofdstuk 1: inleiding ..........................................................................................................................1
Wat is psychiatrie? ...........................................................................................................................1
Interactief-gelaagd model .............................................................................................................2
Psychiatrisch onderzoek ...................................................................................................................3
Observatie ....................................................................................................................................3
Anamnese ....................................................................................................................................4
Specifieke anamnese ................................................................................................................4
Algemene psychiatrische anamnese ..........................................................................................4
Persoonlijke en familiale psychiatrische voorgeschiedenis ..........................................................7
Somatische anamnese en lichamelijk onderzoek ........................................................................8
Sociale anamnese .....................................................................................................................8
Ontwikkelingsanamnese ............................................................................................................8
Diagnose en classificatie ..................................................................................................................9
DSM-5 classificatie .......................................................................................................................9
Neurobiologische ontwikkelingsstoornissen ...............................................................................9
Psychotische stoornissen ........................................................................................................ 10
Bipolaire stoornissen ............................................................................................................... 10
Depressieve stoornissen .......................................................................................................... 10
Angststoornissen .................................................................................................................... 10
Obsessief-compulsieve stoornissen ......................................................................................... 10
Trauma- en stressorgerelateerde stoornissen ........................................................................... 10
Somatisch-symptoom stoornissen ........................................................................................... 10
Voedings- en eetstoornissen .................................................................................................... 10
Persoonlijkheidsstoornissen .................................................................................................... 11
Neurocognitieve stoornissen.................................................................................................... 11
Hoofdstuk 2: depressieve stemmingsstoornissen ................................................................................ 12
Depressieve stoornis ...................................................................................................................... 12
Kliniek ........................................................................................................................................ 12
Subtypes depressieve stoornis ................................................................................................. 13
Differentiële diagnose ................................................................................................................. 14
Etiologie ..................................................................................................................................... 15
Behandeling ............................................................................................................................... 16
Counseling.............................................................................................................................. 16
Farmacotherapie ..................................................................................................................... 16
Neurostimulatie ...................................................................................................................... 18

Inhoud

, Psychotherapie ....................................................................................................................... 19
Persisterende depressieve stoornis (dysthymie) ............................................................................... 21
Disruptieve stemmingsdisregulatiestoornis ..................................................................................... 21
Premenstruele stemmingsstoornis .................................................................................................. 21
Hoofdstuk 3: bipolaire stoornis ........................................................................................................... 22
Bipolaire stoornis (manisch-depressieve ziekte) ............................................................................... 22
Kliniek (manie) ............................................................................................................................ 22
Subtypes bipolaire stoornis ...................................................................................................... 23
Differentiële diagnose ................................................................................................................. 24
Etiologie ..................................................................................................................................... 25
Behandeling ............................................................................................................................... 25
Counseling.............................................................................................................................. 26
Farmacotherapie ..................................................................................................................... 26
Psychotherapie ....................................................................................................................... 27
Peripartumstoornissen ................................................................................................................... 28
Kraamtranen (maternity blues) .................................................................................................... 28
Peripartum depressie .................................................................................................................. 28
Peripartum psychose (kraambedpsychose) .................................................................................. 29
Hoofdstuk 4: stoornissen in het gebruik van middelen .......................................................................... 30
Alcohol en drugsgerelateerde stoornissen ....................................................................................... 30
Diagnose .................................................................................................................................... 30
Afhankelijkheid ....................................................................................................................... 30
Misbruik .................................................................................................................................. 31
Ongezond gebruik ................................................................................................................... 31
Overkoepelend........................................................................................................................ 31
Epidemiologie ............................................................................................................................. 32
Neurobiologie ............................................................................................................................. 32
Fase 1: initiatie ........................................................................................................................ 32
Fase 2: continuering ................................................................................................................ 32
Gebruik, intoxicatie, ontwenning .................................................................................................. 33
Nicotine .................................................................................................................................. 33
Alcohol (en benzodiazepines: GABA-A receptor agonisten) ........................................................ 33
Cannabis ................................................................................................................................ 34
Cocaïne .................................................................................................................................. 34
MDMA..................................................................................................................................... 35
Methamfetamine ..................................................................................................................... 35
Morfine, heroïne (opiaat) .......................................................................................................... 36

Inhoud

, Xylazine .................................................................................................................................. 37
Behandeling ............................................................................................................................... 38
Crisisinterventie ...................................................................................................................... 38
Farmacotherapie ..................................................................................................................... 39
Psychotherapie ....................................................................................................................... 39
Hoofdstuk 5: psychose ....................................................................................................................... 41
Psychose ....................................................................................................................................... 41
Wanen ....................................................................................................................................... 41
Hallucinaties .............................................................................................................................. 42
Gedesorganiseerd denken ........................................................................................................... 42
Gedesorganiseerd gedrag of abnormale psychomotoriek .............................................................. 43
Differentiële diagnose..................................................................................................................... 43
Schizofrenie ................................................................................................................................... 45
Symptomen ................................................................................................................................ 45
Verloop ...................................................................................................................................... 46
Risicofactoren ............................................................................................................................ 48
Pathogenese .............................................................................................................................. 48
Behandeling ............................................................................................................................... 50
Hoofdstuk 6: neurocognitieve stoornissen .......................................................................................... 54
Cognitieve domeinen ...................................................................................................................... 54
Spectrum van cognitieve veroudering .............................................................................................. 56
Oorzaken van dementie .................................................................................................................. 58
Ziekte van Alzheimer (AD) ............................................................................................................ 58
Oorzaken ................................................................................................................................ 59
Diagnose ................................................................................................................................ 59
Differentiële diagnose .............................................................................................................. 60
Risicofactoren ......................................................................................................................... 61
Prognose ................................................................................................................................ 61
Frontotemporale dementie (FTD) ................................................................................................. 61
Diagnose ................................................................................................................................ 62
Lewy Body dementie (LBD) .......................................................................................................... 63
Oorzaken ................................................................................................................................ 63
Vasculaire dementie ................................................................................................................... 63
Oorzaken ................................................................................................................................ 64
Andere ....................................................................................................................................... 64
Neuropsychiatrische symptomen .................................................................................................... 64
Differentiële diagnose..................................................................................................................... 66

Inhoud

, Behandeling ................................................................................................................................... 66
Algemene principes .................................................................................................................... 66
Minimaliseren van excess disability .......................................................................................... 66
Psychosociaal perspectief op dementie ................................................................................... 67
Inzetten op behoud van levenskwaliteit .................................................................................... 67
Preventie ................................................................................................................................ 67
Euthanasie .............................................................................................................................. 68
Niet-farmacologisch ................................................................................................................... 68
Farmacologisch .......................................................................................................................... 68
Hoofdstuk 7: angststoornissen ........................................................................................................... 72
Inleiding ......................................................................................................................................... 72
Angststoornis ................................................................................................................................. 72
Paniekstoornis ............................................................................................................................ 73
Agorafobie .................................................................................................................................. 73
Sociale angststoornis .................................................................................................................. 74
Specifieke fobie .......................................................................................................................... 74
Gegeneraliseerde angststoornis .................................................................................................. 74
Differentiële diagnose..................................................................................................................... 75
Behandeling ................................................................................................................................... 76
Psychotherapie........................................................................................................................... 76
Farmacotherapie ........................................................................................................................ 76
Hoofdstuk 8: dwangstoornissen ......................................................................................................... 78
Dwangstoornissen ......................................................................................................................... 78
Obsessief-compulsieve stoornis (OCS) ........................................................................................ 78
Neurobiologie ......................................................................................................................... 79
Psychologie ............................................................................................................................ 80
Behandeling ............................................................................................................................ 80
Morfodysfore stoornis ................................................................................................................. 81
Verzamelstoornis ........................................................................................................................ 81
Differentiële diagnose..................................................................................................................... 81
Hoofdstuk 9: ouderen- en neuropsychiatrie ......................................................................................... 82
Aandachtspunten ........................................................................................................................... 82
Depressie ................................................................................................................................... 82
Apathie ...................................................................................................................................... 82
Differentiële diagnose .............................................................................................................. 83
Angst.......................................................................................................................................... 83
Psychose.................................................................................................................................... 83

Inhoud

, Differentiële diagnose .............................................................................................................. 84
Behandeling ............................................................................................................................... 84
Neuropsychiatrie in praktijk ............................................................................................................ 84
Epilepsie .................................................................................................................................... 84
Neurospsychiatrische sympomen als ictale fenomenen ............................................................ 84
Interictale associaties ............................................................................................................. 85
Specifieke aandachtspunten bij epilepsie ................................................................................. 85
Ziekte van Huntington ................................................................................................................. 85
Ziekte van Parkinson ................................................................................................................... 85
Hoofdstuk 10: persoonlijkheidsstoornissen ......................................................................................... 87
Persoonlijkheid .............................................................................................................................. 87
5-factoren model (big-five) .......................................................................................................... 87
7-factoren model (psychobiologisch model van Cloninger) ........................................................... 88
Persoonlijkheidsstoornissen ........................................................................................................... 89
Algemeen ................................................................................................................................... 89
Cluster A: excentriek ................................................................................................................... 90
Paranoïde persoonlijkheidsstoornis ......................................................................................... 90
Schizoïde persoonlijkheidsstoornis .......................................................................................... 90
Schizotypische persoonlijkheidsstoornis .................................................................................. 90
Cluster B: dramatisch ................................................................................................................. 91
Antisociale persoonlijkheidsstoornis ........................................................................................ 91
Borderline persoonlijkheidsstoornis ......................................................................................... 91
Histrionische persoonlijkheidsstoornis ..................................................................................... 91
Narcistische persoonlijkheidsstoornis ...................................................................................... 92
Cluster C: angstig ....................................................................................................................... 92
Vermijdende persoonlijkheidsstoornis ...................................................................................... 92
Afhankelijke persoonlijkheidsstoornis ...................................................................................... 92
Dwangmatige persoonlijkheidsstoornis .................................................................................... 92
Behandeling ............................................................................................................................... 93
Counseling.............................................................................................................................. 93
Psychotherapie ....................................................................................................................... 93
Farmacotherapie ..................................................................................................................... 95
Hoofdstuk 11: trauma en stressorstoornissen ..................................................................................... 96
Inleiding ......................................................................................................................................... 96
Acute stressstoornis ....................................................................................................................... 96
Kwetsbare populatie ................................................................................................................... 97
Begeleiding bij acute stress ......................................................................................................... 97

Inhoud

, Normale of problematische stressverwerking ............................................................................... 97
Posttraumatische stressstoornis..................................................................................................... 98
Kwetsbare populatie ................................................................................................................... 98
Behandeling ............................................................................................................................... 98
Psychotherapie ....................................................................................................................... 98
Farmacotherapie ..................................................................................................................... 99
Aanpassingsstoornissen & burnout ................................................................................................. 99
Burnout ...................................................................................................................................... 99
Stressrespons in het lichaam..................................................................................................... 100
Monitoren stresssysteem .......................................................................................................... 101
Hoofdstuk 12: eetstoornissen ........................................................................................................... 103
Gezond eten ................................................................................................................................ 103
Kinderen................................................................................................................................... 103
Adolescenten ........................................................................................................................... 103
Volwassenen ............................................................................................................................ 103
Eetstoornis .................................................................................................................................. 104
Anorexia Nervosa (AN) .............................................................................................................. 104
Boulimia Nervosa (BN) .............................................................................................................. 105
Eetbuistoornis .......................................................................................................................... 105
Psychologische correlaten ........................................................................................................ 106
Verstoord zelfbeeld ................................................................................................................... 106
Lichamelijke symptomen .......................................................................................................... 107
Differentiële diagnose ............................................................................................................... 108
Behandeling ............................................................................................................................. 108
Psychotherapie ..................................................................................................................... 109
Farmacotherapie ................................................................................................................... 109
Hoofdstuk 13: psychotherapie .......................................................................................................... 110
Principes ..................................................................................................................................... 110
Werkrelatie ............................................................................................................................... 110
Reële relatie ............................................................................................................................. 110
Overdrachtsrelatie .................................................................................................................... 111
Psychotherapeutische interventies ............................................................................................ 111
Psychotherapeutische referentiekaders ........................................................................................ 112
Psychodynamische psychotherapie ........................................................................................... 112
Cognitieve gedragstherapie ....................................................................................................... 113
Cliëntgerichte experiëntiële therapie ......................................................................................... 113
Systeemtherapie....................................................................................................................... 114

Inhoud

, CGT bij depressie (voorbeeld) ....................................................................................................... 114
Fase 1: gedragstherapie ............................................................................................................ 115
Fase 2: cognitieve therapie ........................................................................................................ 115
Hoofdstuk 14: suïcidale patiënt ........................................................................................................ 116
Inleiding ....................................................................................................................................... 116
Risicofactoren .............................................................................................................................. 116
Begeleiding .................................................................................................................................. 116
Veiligheidsplan ......................................................................................................................... 117
Hoofdstuk 15: gedwongen opname ................................................................................................... 118
Criteria ........................................................................................................................................ 118
Procedures .................................................................................................................................. 118
Hoofdstuk 16: slaapstoornissen ....................................................................................................... 120
Normale slaap ............................................................................................................................. 120
Slaapstoornissen ......................................................................................................................... 121
Slaapanamnese ........................................................................................................................ 121
Behandeling ............................................................................................................................. 122
Psychotherapie ..................................................................................................................... 122
Farmacotherapie ................................................................................................................... 122
Hoofdstuk 17: seksuele disfunctie .................................................................................................... 123
Seksuele responscyclus ............................................................................................................... 123
Stoornis in verlangen en opwinding ............................................................................................ 123
Seksuele interesse of opwindingsstoornis (vrouw) ................................................................... 123
Erectiestoornis (man) ............................................................................................................ 124
Orgasme stoornis ..................................................................................................................... 124
Anorgasmie (vrouw) ............................................................................................................... 124
Vertraagde ejaculatie (man) ................................................................................................... 124
Voortijdige ejaculatie (man) ................................................................................................... 124
Genitopelviene pijnstoornis of penetratiestoornis ....................................................................... 125
Dyspareunie (vrouw) .............................................................................................................. 125
Vaginisme (vrouw) ................................................................................................................. 125
Psychotrope stoffen .................................................................................................................. 125
Seksuele anamnese .................................................................................................................. 125
Behandeling ............................................................................................................................. 126
Sensate Focus Therapy .......................................................................................................... 126
Psychotherapie ..................................................................................................................... 127
Farmacotherapie ................................................................................................................... 127

Inhoud

,VOLWASSEN- EN OUDERENPSYCHIATRIE
HOOFDSTUK 1: INLEIDING

WAT IS PSYCHIATRIE?

Psychiatrie = medisch specialisme dat zich bezighoudt met patiëntenzorg, wetenschappelijk onderzoek
en onderwijs in het gebied van psychiatrische aandoeningen

- Problematiek van patiënt niet snel toeschrijven aan een specifieke oorzaak, maar proberen te
begrijpen vanuit verschillende lagen (psychologisch, biologisch, relationeel, sociaal…)
o Interactie met elkaar
o Zoeken naar oorzaken + geschikte behandelingen vanuit interactief-gelaagd model
- Problematiek van patiënt niet alleen proberen verklaren vanuit een diagnostische analyse, maar
ook hem/haar als mens proberen begrijpen
o Erklären vs Verstehen
o Psychiater als persoon

Psychiatrische stoornis = aandoening die zich kenmerkt door afwijkingen van psychische functies en die
gepaard gaan met lijdensdruk en/of sociaal disfunctioneren

- Cognitieve functies: denken
o Bewustzijn, aandacht en oriëntatie
o Geheugen
o Intellectuele functies
o Waarnemen
o Denken
- Affectieve functies: voelen
o Stemming (= basis, verandert niet zomaar door affect)
o Affect (= emotie op een bepaald moment)
- Conatieve functies: willen
o Psychomotoriek
o Motivatie en gedrag

Wanneer is een psychische functie afwijkend?

- Duidelijk
o ‘mijn buurman spuit gifgas langs de televisie in mijn woonkamer binnen op bevel van CIA’
- Minder duidelijk
o ‘iedereen is tegen mij, ze willen mij kapot’
o ‘ik sta er zo slecht voor dat ik beter uit het leven kan stappen’
 Grens tussen normaal en abnormaal is ook maatschappelijk en cultureel bepaald
 Verder in de anamnese verkennen

Hoofdstuk 1: inleiding 1

, INTERACTIEF-GELAAGD MODEL
Al deze factoren in interactie

Probleem

Cluster Niveau Domein Beschrijving

P+3 Zingeving Op welke wijze ervaart de persoon zichzelf als een deel van een groter
geheel dat zin kan geven aan zijn of haar bestaan? In welke mate helpt of
hindert deze visie de patiënt om de wereld te aanvaarden?

P+2 Maatschappelijke Op welke wijze ervaart de persoon zichzelf in een bredere
context maatschappelijke context: professionele ontplooiing, activiteiten in de
SOCIAAL

maatschappij, sociale relaties in de bredere zin. Pathologie / gezondheid
op het niveau van maatschappelijke organisatie (en dus niet alleen op het
niveau van de persoon)

P+1 Partner-, gezins- en Op welke wijze ervaart de persoon zichzelf als speler in nauwe en intieme
familierelaties relaties? Welke vaardigheid is er om dergelijke relaties aan te gaan en te
onderhouden? Ziekte en gezondheid in de dynamiek van het systeem zelf
(en dus niet alleen op het niveau van de persoon)

P Het zelf (individu als Bewustzijn, aandacht, waarneming, denken, stemming, motivatie;
persoon) Veranderingen in deze functies worden, als ze het functioneren hinderen,
PSYCHISCH

door de persoon en/of door de omgeving geduid als symptomen; Deze
vormen de basis om in hun syndromale samenhang te komen tot de
diagnose van een psychiatrisch ziektebeeld volgens de geldende DSM-5
criteria

P-1 Functionele Functie van en connectiviteit tussen systemen (bv neurotransmissie-
hersencircuits; systemen, neurobiologische stress-respons, immuunsysteem, hormonale
orgaansystemen systemen)
BIOLOGISCH

P-2 Neuronale en gliale Trofische toestand van neuronen, celdegeneratie, receptordensiteit en –
cellulaire mechanismen functie, second messenger systemen

P-3 Genetische basis Variaties in het genoom (QTL): duplicaties, deleties, studie van regio’s,
genen, repeat sequenties, single nucleotide polymorfismen , die in verband
werden gebracht met psychopathologische processen en ziektebeelden
Epigenetische patronen (methylatie, histonmodificatie)

Hoofdstuk 1: inleiding 2

, Al deze methoden in interactie (bv depressie behandelen)

Behandeling

Cluster Niveau Domein Beschrijving

P+3 Zingeving Gevoel voor ‘zin van het leven’ versterken via existentiële therapie

P+2 Maatschappelijke Integratie in de maatschappij bevorderen via herstelgerichte werking
SOCIAAL

context

P+1 Partner-, gezins- en Gezinstherapie en relatietherapie
familierelaties
PSYCHISCH

P Het zelf (individu als Individuele psychotherapie
persoon)

P-1 Functionele Neuro-modulatietechnieken
hersencircuits;
orgaansystemen
BIOLOGISCH

P-2 Neuronale en gliale Antidepressiva
cellulaire mechanismen

P-3 Genetische basis /

PSYCHIATRISCH ONDERZOEK

OBSERVATIE
- Uiterlijk
o Conform of jonger dan kalenderleeftijd
o Verzorgd of onverzorgd
o Bijzonderheden kledij, kapsel, make-up
- Contact
o Wijze van begroeten
o Wederkerigheid van contact
o Contactgroei tijdens gesprek
- Houding
o Vriendelijk, coöperatief, kil, prikkelbaar, joviaal, gespannen, dwingend, aanklampend…
- Klachtenpresentatie
o Overdreven, onverschillig
o Emotieloos, zakelijk
- Gevoelens en reacties bij onderzoeker
o Neutraal, sympathie, medeleven, geamuseerd, machteloosheid, irritatie, afstandelijkheid

Hoofdstuk 1: inleiding 3

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