KLINISCHE PSYCHIATRIE
Samenvatting
DOCENT: Prof. Dr. Dirk van West
Iris Vantomme
1ste schakeljaar – Semester 1
2022 – 2023
Psychologie & Educatiewetenschappen
,Inhoudsopgave
COLLEGE 1 - INLEIDING (DSM-5) ..................................................................................................................... 7
1 Psychopathologie/psychiatrische stoornis ................................................................................................ 7
1.1 Psychopathologie ............................................................................................................................ 7
1.2 Psychiatrische stoornis .................................................................................................................... 8
2 Classificatie ............................................................................................................................................... 9
2.1 Algemeen ........................................................................................................................................ 9
2.2 Categoriale, dimensionale en prototypische classificatie ............................................................... 9
2.3 DSM/ICD ........................................................................................................................................ 10
2.4 DSM: Voor-en nadelen .................................................................................................................. 10
2.5 Geschiedenis ................................................................................................................................. 11
3 Diagnostiek ............................................................................................................................................. 11
3.1 Verschillen tussen classificatie en diagnostiek .............................................................................. 11
4 Globale veranderingen DMS-5 ................................................................................................................ 11
5 Opzet DSM-5 ........................................................................................................................................... 12
5.1 Veranderingen deel II .................................................................................................................... 12
5.2 Deel III ........................................................................................................................................... 14
6 Stellingen ................................................................................................................................................ 14
7 Conclusie ................................................................................................................................................. 14
COLLEGE 2 - INLEIDING 2.0 ........................................................................................................................... 15
1 Normaliteit en psychopathologie............................................................................................................ 15
1.1 Normaliteit .................................................................................................................................... 15
2 Probleem van de subjectiviteit ................................................................................................................ 16
2.1 Individuele subjectiviteit ............................................................................................................... 16
2.2 Sociaal-culturele subjectiviteit ...................................................................................................... 16
3 Epidemiologie ......................................................................................................................................... 16
4 Algemene prevalentie ............................................................................................................................. 17
4.1 Prevalentie psychiatrische stoornissen ......................................................................................... 17
5 Etiopathogenese ..................................................................................................................................... 18
5.1 Fysiopathogenese ......................................................................................................................... 18
5.2 Psychopathogenese ...................................................................................................................... 21
6 Het psychiatrisch onderzoek ................................................................................................................... 26
6.1 Anamnese ..................................................................................................................................... 26
6.2 Onderzoek ..................................................................................................................................... 27
6.3 Beeldvorming ................................................................................................................................ 27
COLLEGE 3 – NEUROCOGNITIEVE STOORNISSEN ........................................................................................... 28
1 Neurocognitie: algemeen ....................................................................................................................... 28
1.1 Bevolkingspiramides ..................................................................................................................... 28
1.2 Algemeen – Vergrijzing van de bevolking in België ....................................................................... 28
1.3 Epidemiologie................................................................................................................................ 28
1.4 Het geheugen ................................................................................................................................ 29
2
, 1.5 Ouderdom ..................................................................................................................................... 29
2 Neuropsychologische testing .................................................................................................................. 30
2.1 MMSE ............................................................................................................................................ 30
2.2 Kloktest ......................................................................................................................................... 32
3 Dementie ................................................................................................................................................ 32
3.1 Informatie netwerk ....................................................................................................................... 32
3.2 Geheugen en veroudering ............................................................................................................ 32
3.3 Epidemiologie – Expertisecentrum dementie Vlaanderen ........................................................... 32
3.4 Klinische kenmerken ..................................................................................................................... 33
3.5 Oorzaken ....................................................................................................................................... 35
3.6 Types ............................................................................................................................................. 36
3.7 Etiopathogenesis ........................................................................................................................... 38
3.8 Diagnostiek.................................................................................................................................... 39
3.9 Dementie – Depressie ................................................................................................................... 39
3.10 Behandeling .................................................................................................................................. 40
4 Delirium .................................................................................................................................................. 41
4.1 Epidemiologie................................................................................................................................ 41
4.2 DSM ............................................................................................................................................... 41
4.3 Subtypes ........................................................................................................................................ 42
4.4 Delirium – dementie – depressie .................................................................................................. 42
4.5 Oorzaken delier: I WATCH DEATH ................................................................................................. 43
4.6 Behandeling .................................................................................................................................. 43
5 Amnestische stoornissen......................................................................................................................... 43
COLLEGE 4 - MIDDELENGERELATEERDE EN VERSLAVINGSSTOORNISSEN ....................................................... 44
1 Stoornissen in het gebruik ...................................................................................................................... 44
1.1 Middelenmisbruik ......................................................................................................................... 44
1.2 Middelenafhankelijkheid............................................................................................................... 44
2 Stoornissen door het gebruik .................................................................................................................. 45
2.1 Intoxicatie door een middel .......................................................................................................... 45
2.2 Onthouding van een middel .......................................................................................................... 45
2.3 Psychoactieve stoffen ................................................................................................................... 46
2.4 Alcohol (eenheid) .......................................................................................................................... 47
3 Diagnostiek ............................................................................................................................................. 48
3.1 Diagnostiek.................................................................................................................................... 48
3.2 Belang vroegdetectie en screening ............................................................................................... 48
4 Etiopathogenese ..................................................................................................................................... 49
4.1 Medisch biologisch model............................................................................................................. 49
4.2 Leertheoretisch model .................................................................................................................. 50
5 Prognose ................................................................................................................................................. 50
6 Behandeling ............................................................................................................................................ 51
COLLEGE 5 - SCHIZOFRENIE EN ANDERE PSYCHOTISCHE STOORNISSSEN ....................................................... 52
1 Psychotische stoornissen ........................................................................................................................ 52
2 Schizofrenie ............................................................................................................................................. 52
3
, 2.1 Klinische criteria ............................................................................................................................ 52
2.2 Kenmerken .................................................................................................................................... 53
2.3 Co-morbiditeit, typering, DD, diagnostiek .................................................................................... 57
2.4 Epidemiologie................................................................................................................................ 58
2.5 Etiopathogenese ........................................................................................................................... 59
2.6 Preventie ....................................................................................................................................... 61
2.7 Behandeling .................................................................................................................................. 61
2.8 Prognose, beloop .......................................................................................................................... 64
3 Schizofreniforme stoornis ....................................................................................................................... 64
3.1 Klinische criteria ............................................................................................................................ 64
4 Schizoaffectieve stoornis......................................................................................................................... 65
4.1 Klinische criteria ............................................................................................................................ 65
5 Waanstoornis.......................................................................................................................................... 65
5.1 Klinische criteria ............................................................................................................................ 65
5.2 Varianten ....................................................................................................................................... 65
6 Kortdurende psychotische stoornis ......................................................................................................... 66
6.1 Klinische criteria ............................................................................................................................ 66
7 Gedeelde psychotische stoornis .............................................................................................................. 66
7.1 Klinische criteria ............................................................................................................................ 66
COLLEGE 6 – STEMMINGSSTOORNISSEN ....................................................................................................... 67
1 Definities episodes .................................................................................................................................. 67
1.1 Symptoomcriteria (5 of meer) depressieve episode ..................................................................... 67
1.2 Symptoomcriteria (Hypo)manische episode ................................................................................. 68
1.3 Symptoomcriteria gemengde episode .......................................................................................... 69
2 Kenmerken stemmingsstoornissen ......................................................................................................... 69
2.1 Uni: depressie, dysthymie ............................................................................................................. 69
2.2 Bi: Bip st type 1, 2, clyclothymie ................................................................................................... 71
3 Diagnostiek, DD en comorbiditeit ........................................................................................................... 72
4 Epidemiologie & etiopathogenese .......................................................................................................... 73
4.1 Epidemiologie................................................................................................................................ 73
4.2 Etiopathogenese/fysiopathogese ................................................................................................. 73
4.3 Etiopathogenese/psychopathogenese.......................................................................................... 74
4.4 Verklaringsmodel .......................................................................................................................... 75
5 Prognose depressieve stoornis - beloop .................................................................................................. 75
6 Behandeling ............................................................................................................................................ 76
6.1 Algemeen ...................................................................................................................................... 76
6.2 Psychotherapie.............................................................................................................................. 76
6.3 Psychofarmaca .............................................................................................................................. 77
6.4 Andere ........................................................................................................................................... 77
7 Suïcide ..................................................................................................................................................... 78
7.1 Prevalentie .................................................................................................................................... 78
7.2 Suïcidaal proces............................................................................................................................. 78
7.3 Waarschuwingssignalen ................................................................................................................ 79
7.4 Exploratie suïcidaliteit ................................................................................................................... 80
4
Samenvatting
DOCENT: Prof. Dr. Dirk van West
Iris Vantomme
1ste schakeljaar – Semester 1
2022 – 2023
Psychologie & Educatiewetenschappen
,Inhoudsopgave
COLLEGE 1 - INLEIDING (DSM-5) ..................................................................................................................... 7
1 Psychopathologie/psychiatrische stoornis ................................................................................................ 7
1.1 Psychopathologie ............................................................................................................................ 7
1.2 Psychiatrische stoornis .................................................................................................................... 8
2 Classificatie ............................................................................................................................................... 9
2.1 Algemeen ........................................................................................................................................ 9
2.2 Categoriale, dimensionale en prototypische classificatie ............................................................... 9
2.3 DSM/ICD ........................................................................................................................................ 10
2.4 DSM: Voor-en nadelen .................................................................................................................. 10
2.5 Geschiedenis ................................................................................................................................. 11
3 Diagnostiek ............................................................................................................................................. 11
3.1 Verschillen tussen classificatie en diagnostiek .............................................................................. 11
4 Globale veranderingen DMS-5 ................................................................................................................ 11
5 Opzet DSM-5 ........................................................................................................................................... 12
5.1 Veranderingen deel II .................................................................................................................... 12
5.2 Deel III ........................................................................................................................................... 14
6 Stellingen ................................................................................................................................................ 14
7 Conclusie ................................................................................................................................................. 14
COLLEGE 2 - INLEIDING 2.0 ........................................................................................................................... 15
1 Normaliteit en psychopathologie............................................................................................................ 15
1.1 Normaliteit .................................................................................................................................... 15
2 Probleem van de subjectiviteit ................................................................................................................ 16
2.1 Individuele subjectiviteit ............................................................................................................... 16
2.2 Sociaal-culturele subjectiviteit ...................................................................................................... 16
3 Epidemiologie ......................................................................................................................................... 16
4 Algemene prevalentie ............................................................................................................................. 17
4.1 Prevalentie psychiatrische stoornissen ......................................................................................... 17
5 Etiopathogenese ..................................................................................................................................... 18
5.1 Fysiopathogenese ......................................................................................................................... 18
5.2 Psychopathogenese ...................................................................................................................... 21
6 Het psychiatrisch onderzoek ................................................................................................................... 26
6.1 Anamnese ..................................................................................................................................... 26
6.2 Onderzoek ..................................................................................................................................... 27
6.3 Beeldvorming ................................................................................................................................ 27
COLLEGE 3 – NEUROCOGNITIEVE STOORNISSEN ........................................................................................... 28
1 Neurocognitie: algemeen ....................................................................................................................... 28
1.1 Bevolkingspiramides ..................................................................................................................... 28
1.2 Algemeen – Vergrijzing van de bevolking in België ....................................................................... 28
1.3 Epidemiologie................................................................................................................................ 28
1.4 Het geheugen ................................................................................................................................ 29
2
, 1.5 Ouderdom ..................................................................................................................................... 29
2 Neuropsychologische testing .................................................................................................................. 30
2.1 MMSE ............................................................................................................................................ 30
2.2 Kloktest ......................................................................................................................................... 32
3 Dementie ................................................................................................................................................ 32
3.1 Informatie netwerk ....................................................................................................................... 32
3.2 Geheugen en veroudering ............................................................................................................ 32
3.3 Epidemiologie – Expertisecentrum dementie Vlaanderen ........................................................... 32
3.4 Klinische kenmerken ..................................................................................................................... 33
3.5 Oorzaken ....................................................................................................................................... 35
3.6 Types ............................................................................................................................................. 36
3.7 Etiopathogenesis ........................................................................................................................... 38
3.8 Diagnostiek.................................................................................................................................... 39
3.9 Dementie – Depressie ................................................................................................................... 39
3.10 Behandeling .................................................................................................................................. 40
4 Delirium .................................................................................................................................................. 41
4.1 Epidemiologie................................................................................................................................ 41
4.2 DSM ............................................................................................................................................... 41
4.3 Subtypes ........................................................................................................................................ 42
4.4 Delirium – dementie – depressie .................................................................................................. 42
4.5 Oorzaken delier: I WATCH DEATH ................................................................................................. 43
4.6 Behandeling .................................................................................................................................. 43
5 Amnestische stoornissen......................................................................................................................... 43
COLLEGE 4 - MIDDELENGERELATEERDE EN VERSLAVINGSSTOORNISSEN ....................................................... 44
1 Stoornissen in het gebruik ...................................................................................................................... 44
1.1 Middelenmisbruik ......................................................................................................................... 44
1.2 Middelenafhankelijkheid............................................................................................................... 44
2 Stoornissen door het gebruik .................................................................................................................. 45
2.1 Intoxicatie door een middel .......................................................................................................... 45
2.2 Onthouding van een middel .......................................................................................................... 45
2.3 Psychoactieve stoffen ................................................................................................................... 46
2.4 Alcohol (eenheid) .......................................................................................................................... 47
3 Diagnostiek ............................................................................................................................................. 48
3.1 Diagnostiek.................................................................................................................................... 48
3.2 Belang vroegdetectie en screening ............................................................................................... 48
4 Etiopathogenese ..................................................................................................................................... 49
4.1 Medisch biologisch model............................................................................................................. 49
4.2 Leertheoretisch model .................................................................................................................. 50
5 Prognose ................................................................................................................................................. 50
6 Behandeling ............................................................................................................................................ 51
COLLEGE 5 - SCHIZOFRENIE EN ANDERE PSYCHOTISCHE STOORNISSSEN ....................................................... 52
1 Psychotische stoornissen ........................................................................................................................ 52
2 Schizofrenie ............................................................................................................................................. 52
3
, 2.1 Klinische criteria ............................................................................................................................ 52
2.2 Kenmerken .................................................................................................................................... 53
2.3 Co-morbiditeit, typering, DD, diagnostiek .................................................................................... 57
2.4 Epidemiologie................................................................................................................................ 58
2.5 Etiopathogenese ........................................................................................................................... 59
2.6 Preventie ....................................................................................................................................... 61
2.7 Behandeling .................................................................................................................................. 61
2.8 Prognose, beloop .......................................................................................................................... 64
3 Schizofreniforme stoornis ....................................................................................................................... 64
3.1 Klinische criteria ............................................................................................................................ 64
4 Schizoaffectieve stoornis......................................................................................................................... 65
4.1 Klinische criteria ............................................................................................................................ 65
5 Waanstoornis.......................................................................................................................................... 65
5.1 Klinische criteria ............................................................................................................................ 65
5.2 Varianten ....................................................................................................................................... 65
6 Kortdurende psychotische stoornis ......................................................................................................... 66
6.1 Klinische criteria ............................................................................................................................ 66
7 Gedeelde psychotische stoornis .............................................................................................................. 66
7.1 Klinische criteria ............................................................................................................................ 66
COLLEGE 6 – STEMMINGSSTOORNISSEN ....................................................................................................... 67
1 Definities episodes .................................................................................................................................. 67
1.1 Symptoomcriteria (5 of meer) depressieve episode ..................................................................... 67
1.2 Symptoomcriteria (Hypo)manische episode ................................................................................. 68
1.3 Symptoomcriteria gemengde episode .......................................................................................... 69
2 Kenmerken stemmingsstoornissen ......................................................................................................... 69
2.1 Uni: depressie, dysthymie ............................................................................................................. 69
2.2 Bi: Bip st type 1, 2, clyclothymie ................................................................................................... 71
3 Diagnostiek, DD en comorbiditeit ........................................................................................................... 72
4 Epidemiologie & etiopathogenese .......................................................................................................... 73
4.1 Epidemiologie................................................................................................................................ 73
4.2 Etiopathogenese/fysiopathogese ................................................................................................. 73
4.3 Etiopathogenese/psychopathogenese.......................................................................................... 74
4.4 Verklaringsmodel .......................................................................................................................... 75
5 Prognose depressieve stoornis - beloop .................................................................................................. 75
6 Behandeling ............................................................................................................................................ 76
6.1 Algemeen ...................................................................................................................................... 76
6.2 Psychotherapie.............................................................................................................................. 76
6.3 Psychofarmaca .............................................................................................................................. 77
6.4 Andere ........................................................................................................................................... 77
7 Suïcide ..................................................................................................................................................... 78
7.1 Prevalentie .................................................................................................................................... 78
7.2 Suïcidaal proces............................................................................................................................. 78
7.3 Waarschuwingssignalen ................................................................................................................ 79
7.4 Exploratie suïcidaliteit ................................................................................................................... 80
4
