Theme 5:
Psychiatry II
Summary
1
,Inhoud
Week 17: MUS (medically unexplained symptoms), PPS (persistent physical symptoms) and somatic
symptom disorder..................................................................................................................................4
Introduction........................................................................................................................................7
Somatic symptom and related disorders............................................................................................9
Syndromes......................................................................................................................................9
Development, course and impact.................................................................................................11
Diagnosis.......................................................................................................................................11
Differential diagnosis....................................................................................................................12
Epidemiology................................................................................................................................12
Aetiopathogenesis........................................................................................................................12
Treatment.....................................................................................................................................13
Factitious disorders..........................................................................................................................15
Syndromes....................................................................................................................................15
Development, course and impact.................................................................................................15
Diagnosis.......................................................................................................................................15
Differential diagnosis....................................................................................................................15
Aetiopathogenesis........................................................................................................................16
Treatment.....................................................................................................................................16
Functional neurological disorder......................................................................................................17
History..........................................................................................................................................17
Definition of FND..........................................................................................................................17
Pathophysiology...........................................................................................................................18
Treatment.....................................................................................................................................18
Occupational medicine.....................................................................................................................20
The insurance physician and the assessment of occupational disability......................................20
The absenteeism and occupational disability in social context....................................................20
Week 18: Psychosis..............................................................................................................................22
Psychosis spectrum disorders...........................................................................................................22
Introduction..................................................................................................................................22
Syndromes....................................................................................................................................22
Development, course and impact.................................................................................................26
Diagnosis.......................................................................................................................................27
Differential diagnosis....................................................................................................................27
Epidemiology................................................................................................................................28
Aetiopathogenesis........................................................................................................................28
2
, Treatment.....................................................................................................................................29
Psychiatry and the law......................................................................................................................32
The medical treatment contracts act (WGBO)..............................................................................32
The psychiatric hospitals (Compulsory admission) act (Wet BOPZ)..............................................33
Medicines in psychiatry....................................................................................................................35
Antidepressants............................................................................................................................35
Antipsychotics...............................................................................................................................36
Benzodiazepines...........................................................................................................................37
New pharmaceuticals, like es-ketamine and psylocibin................................................................37
Week 19: Stagnation............................................................................................................................38
Personality disorders........................................................................................................................38
Introduction..................................................................................................................................38
Syndromes....................................................................................................................................38
Development, course and impact.................................................................................................44
Diagnosis.......................................................................................................................................44
Differential diagnosis....................................................................................................................45
Epidemiology................................................................................................................................45
Aetiopathogenesis........................................................................................................................46
Treatment.....................................................................................................................................47
Neurodevelopmental disorders........................................................................................................49
Introduction..................................................................................................................................49
Syndromes....................................................................................................................................49
Development, course and impact.................................................................................................54
Diagnosis.......................................................................................................................................55
Differential diagnosis....................................................................................................................55
Epidemiology................................................................................................................................56
Aetiopathogenesis........................................................................................................................56
Treatment.....................................................................................................................................57
3
, Week 17: MUS (medically unexplained symptoms), PPS
(persistent physical symptoms) and somatic symptom
disorder
MUS = physical symptoms that last for longer than a few weeks and which cannot be
satisfactorily explained after adequate medical examination.
40% of consultations about certain symptoms cannot be explained by a medical condition
MUS = not a specific disease focuses on the symptoms that cause persistent functional
impairment
Steps in treatment:
1. The GP treats the patient
2. The GP works together with or sends the patient to other primary care providers
physiotherapists or psychologists
3. Treatment provided by multidisciplinary teams or treatment centres
After 12-15 months: symptoms improved in 50-75% of patients 10-30% have an increase
in symptoms
A good doctor-patient relationship is important improves prognosis
Relationship is often pressured due to rising frustration
Non-specific symptoms:
Fatigue
Headache
Dizziness
Lack of concentration
Memory problems
Assessment of MUS is based on 5 dimensions: SCEGS
1. Somatic tells the patient that the symptoms and their burden are taken seriously
4
Psychiatry II
Summary
1
,Inhoud
Week 17: MUS (medically unexplained symptoms), PPS (persistent physical symptoms) and somatic
symptom disorder..................................................................................................................................4
Introduction........................................................................................................................................7
Somatic symptom and related disorders............................................................................................9
Syndromes......................................................................................................................................9
Development, course and impact.................................................................................................11
Diagnosis.......................................................................................................................................11
Differential diagnosis....................................................................................................................12
Epidemiology................................................................................................................................12
Aetiopathogenesis........................................................................................................................12
Treatment.....................................................................................................................................13
Factitious disorders..........................................................................................................................15
Syndromes....................................................................................................................................15
Development, course and impact.................................................................................................15
Diagnosis.......................................................................................................................................15
Differential diagnosis....................................................................................................................15
Aetiopathogenesis........................................................................................................................16
Treatment.....................................................................................................................................16
Functional neurological disorder......................................................................................................17
History..........................................................................................................................................17
Definition of FND..........................................................................................................................17
Pathophysiology...........................................................................................................................18
Treatment.....................................................................................................................................18
Occupational medicine.....................................................................................................................20
The insurance physician and the assessment of occupational disability......................................20
The absenteeism and occupational disability in social context....................................................20
Week 18: Psychosis..............................................................................................................................22
Psychosis spectrum disorders...........................................................................................................22
Introduction..................................................................................................................................22
Syndromes....................................................................................................................................22
Development, course and impact.................................................................................................26
Diagnosis.......................................................................................................................................27
Differential diagnosis....................................................................................................................27
Epidemiology................................................................................................................................28
Aetiopathogenesis........................................................................................................................28
2
, Treatment.....................................................................................................................................29
Psychiatry and the law......................................................................................................................32
The medical treatment contracts act (WGBO)..............................................................................32
The psychiatric hospitals (Compulsory admission) act (Wet BOPZ)..............................................33
Medicines in psychiatry....................................................................................................................35
Antidepressants............................................................................................................................35
Antipsychotics...............................................................................................................................36
Benzodiazepines...........................................................................................................................37
New pharmaceuticals, like es-ketamine and psylocibin................................................................37
Week 19: Stagnation............................................................................................................................38
Personality disorders........................................................................................................................38
Introduction..................................................................................................................................38
Syndromes....................................................................................................................................38
Development, course and impact.................................................................................................44
Diagnosis.......................................................................................................................................44
Differential diagnosis....................................................................................................................45
Epidemiology................................................................................................................................45
Aetiopathogenesis........................................................................................................................46
Treatment.....................................................................................................................................47
Neurodevelopmental disorders........................................................................................................49
Introduction..................................................................................................................................49
Syndromes....................................................................................................................................49
Development, course and impact.................................................................................................54
Diagnosis.......................................................................................................................................55
Differential diagnosis....................................................................................................................55
Epidemiology................................................................................................................................56
Aetiopathogenesis........................................................................................................................56
Treatment.....................................................................................................................................57
3
, Week 17: MUS (medically unexplained symptoms), PPS
(persistent physical symptoms) and somatic symptom
disorder
MUS = physical symptoms that last for longer than a few weeks and which cannot be
satisfactorily explained after adequate medical examination.
40% of consultations about certain symptoms cannot be explained by a medical condition
MUS = not a specific disease focuses on the symptoms that cause persistent functional
impairment
Steps in treatment:
1. The GP treats the patient
2. The GP works together with or sends the patient to other primary care providers
physiotherapists or psychologists
3. Treatment provided by multidisciplinary teams or treatment centres
After 12-15 months: symptoms improved in 50-75% of patients 10-30% have an increase
in symptoms
A good doctor-patient relationship is important improves prognosis
Relationship is often pressured due to rising frustration
Non-specific symptoms:
Fatigue
Headache
Dizziness
Lack of concentration
Memory problems
Assessment of MUS is based on 5 dimensions: SCEGS
1. Somatic tells the patient that the symptoms and their burden are taken seriously
4
