Psychopathologie – Samenvatting –
Deeltentamen 1
Inhoud
Stein – Psychiatric Diagnosis and Treatment in the 21st Century Paradigm Shifts versus Incremental
Integration............................................................................................................................................... 2
Hoofdstuk 7 – Cognitieve Gedragstherapie ............................................................................................ 4
Samenvatting....................................................................................................................................... 8
Hoofdstuk 8 – Interpersoonlijke Psychotherapie (IPT) .......................................................................... 10
Samenvatting..................................................................................................................................... 12
Hoorcollege 1 – 8-2-2024 ...................................................................................................................... 13
Hoofdstuk 9 – Angststoornissen ........................................................................................................... 21
Samenvatting..................................................................................................................................... 24
Hoofdstuk 10 – Stemmingsstoornissen................................................................................................. 25
Samenvatting..................................................................................................................................... 27
Hoorcollege 2 – Stemmingsstoornissen ................................................................................................ 28
Hoorcollege 3 – Angststoornissen......................................................................................................... 37
Roefs et al. – A New Science of Mental Disorders: Using Personalised, Transdiagnostic, Dynamical
Systems to Understand, Model, Diagnose and Treat Psychopathology ................................................ 43
Abstract ............................................................................................................................................. 43
Conclusion ......................................................................................................................................... 43
Hoofdstuk 11 – Posttraumatische-Stressstoornis (PTSS) ...................................................................... 44
Samenvatting..................................................................................................................................... 45
Hoofdstuk 12 – Dissociatieve Stoornissen ............................................................................................ 46
Samenvatting..................................................................................................................................... 48
Hoofdstuk 14 – Obsessieve-Compulsieve en Verwante Stoornissen .................................................... 49
Samenvatting..................................................................................................................................... 50
Hoorcollege 4 – 22-2-2024 .................................................................................................................... 52
Hoorcollege 5 – 23-2-2024 .................................................................................................................... 63
Obsessieve Compulsieve Stoornis (OCS) ........................................................................................... 63
Post Traumatische Stress Stoornis (PTSS) ......................................................................................... 65
Werkgroepen ........................................................................................................................................ 71
1
,Stein – Psychiatric Diagnosis and Treatment in the 21st Century
Paradigm Shifts versus Incremental Integration
Psychiatry has always been characterized by a range of different models of and approaches to mental
disorder, which have sometimes brought progress in clinical practice, but have often also been
accompanied by critique from within and without the field. Psychiatric nosology has been a
particular focus of debate in recent decades; successive editions of the DSM and ICD have strongly
influenced both psychiatric practice and research, but have also led to assertions that psychiatry is in
crisis, and to advocacy for entirely new paradigms for diagnosis and assessment.
- The Diagnostic and Statistical Manual of Mental Disorders (DSM)
- The International Classification of Diseases (ICD)
➔ Psychiatric classification/nosology = the classification and scientific study of mental
disorders.
When thinking about etiology, many researchers currently refer to a biopsychosocial model, but this
approach has received significant critique, being considered by some observers overly eclectic and
vague. Despite the development of a range of evidence-based pharmacotherapies and
psychotherapies, current evidence points to both a treatment gap and a research-practice gap in
mental health.
In this paper, after considering current clinical practice, we discuss some proposed novel perspectives
that have recently achieved particular prominence and may significantly impact psychiatric practice
and research in the future:
- Clinical neuroscience and personalized pharmacotherapy;
- Novel statistical approaches to psychiatric nosology, assessment and research;
- Deinstitutionalization and community mental health care;
- The scale-up of evidence-based psychotherapy;
- Digital phenotyping and digital therapies;
- And global mental health and task-sharing approaches.
We consider the extent to which proposed transitions from current practices to novel approaches
reflect hype or hope. Our review indicates that each of the novel perspectives contributes important
insights that allow hope for the future, but also that each provides only a partial view, and that any
promise of a paradigm shift for the field is not well grounded.
We conclude
- That there have been crucial advances in psychiatric diagnosis and treatment in recent
decades;
- That, despite this important progress, there is considerable need for further improvements
in assessment and intervention;
- And that such improvements will likely not be achieved by any specific paradigm shifts in
psychiatric practice and research, but rather by incremental progress and iterative
integration.
The proposed paradigm of clinical neuroscience criticizes current diagnostic approaches, suggesting
that DSM and ICD constructs lack a sufficient basis in neuroscience.
➔ The Research Domain Criteria (RDoC) project has been launched, emphasizing specific
neurobiological mechanisms underlying mental disorders and focusing on domains of
2
, functioning. The RDoC framework includes dimensions for developmental trajectories and
environmental effects, viewing mental illnesses as neurodevelopmental disorders influenced
by genetic and environmental factors. The RDoC has had an influence on clinical
neuroscience research but there are also notable limitations, such as its overlap with existing
biological psychiatry ideas and potential complexity in understanding specific neurobiological
mechanisms.
➔ Personalized and precision psychiatry are aspirations of clinical neuroscience, with an
emphasis on tailoring interventions to individual patients based on genomic information. The
Clinical Pharmacogenetic Implementation Consortium (CPIC) provides clinical guidelines for
drugs used in psychiatry based on genetic information. "Big data" collaborations and their
contributions to understanding biological pathways across different mental disorders are of
great importance.
➔ There are novel paradigms like the Hierarchical Taxonomy of Psychopathology (HiTOP) and
network analysis as alternatives to traditional disease classifications. HiTOP proposes a
hierarchical framework based on dimensional traits, seeking to move away from categorical
entities. Network analysis, on the other hand, views mental disorders as problems in living,
explaining them through observable interactions between symptoms.
3
, Hoofdstuk 7 – Cognitieve Gedragstherapie
Klassieke conditionering/stimulus-respons-stimulus-stimulus = verschillende prikkels
(gebeurtenissen, omgevingen en situaties) die in eerste instantie niets met elkaar te maken hebben
op een bepaald moment met elkaar in verband worden gebracht
Operante conditionering = men leert dat bepaald gedrag bepaalde gevolgen/consequenties heeft
Extinctie = associaties kunnen worden uitgedoofd door herhaaldelijk de geconditioneerde stimulus
aan te bieden zonder dat de geconditioneerde respons daarop volgt
Cognitieve revolutie = een puur gedragsmatig alternatief voor de psychoanalyse werd bekritiseerd
omdat mentale processen zoals gedachten, opvattingen en interpretaties buiten beschouwing
werden gelaten
Vier niveaus van cognities
➔
- Basisschema’s = fundamentele opvattingen die iemand heeft over zichzelf, over de wereld en
over de toekomst. Van deze opvattingen zijn we ons vaak niet direct bewust (impliciet).
- Conditionele assumpties = veronderstellingen over oorzaak-gevolgrelaties. Ze manifesteren
zich vaak als als-dan-stellingen.
- Strategische ideeën = opvattingen die mensen hebben over hoe ze gevaren het beste het
hoofd kunnen bieden en goed dingen kunnen bereiken.
- Automatische gedachten = de gedachten die meer bewust door iemands hoofd gaan. Er
wordt verondersteld dat automatische gedachten (via de tussenliggende niveaus van
cognities) gestuurd worden door de basisschema’s.
Confirmation bias = de informatieverwerking is bij lang bestaande schema’s namelijk al dusdanig
geautomatiseerd dat men vaak alleen nog maar aandacht heeft voor informatie die het schema
bevestigt, en niet meer stilstaat bij het feit dat er ook informatie bestaat die niet helemaal strookt
met het schema
4
Deeltentamen 1
Inhoud
Stein – Psychiatric Diagnosis and Treatment in the 21st Century Paradigm Shifts versus Incremental
Integration............................................................................................................................................... 2
Hoofdstuk 7 – Cognitieve Gedragstherapie ............................................................................................ 4
Samenvatting....................................................................................................................................... 8
Hoofdstuk 8 – Interpersoonlijke Psychotherapie (IPT) .......................................................................... 10
Samenvatting..................................................................................................................................... 12
Hoorcollege 1 – 8-2-2024 ...................................................................................................................... 13
Hoofdstuk 9 – Angststoornissen ........................................................................................................... 21
Samenvatting..................................................................................................................................... 24
Hoofdstuk 10 – Stemmingsstoornissen................................................................................................. 25
Samenvatting..................................................................................................................................... 27
Hoorcollege 2 – Stemmingsstoornissen ................................................................................................ 28
Hoorcollege 3 – Angststoornissen......................................................................................................... 37
Roefs et al. – A New Science of Mental Disorders: Using Personalised, Transdiagnostic, Dynamical
Systems to Understand, Model, Diagnose and Treat Psychopathology ................................................ 43
Abstract ............................................................................................................................................. 43
Conclusion ......................................................................................................................................... 43
Hoofdstuk 11 – Posttraumatische-Stressstoornis (PTSS) ...................................................................... 44
Samenvatting..................................................................................................................................... 45
Hoofdstuk 12 – Dissociatieve Stoornissen ............................................................................................ 46
Samenvatting..................................................................................................................................... 48
Hoofdstuk 14 – Obsessieve-Compulsieve en Verwante Stoornissen .................................................... 49
Samenvatting..................................................................................................................................... 50
Hoorcollege 4 – 22-2-2024 .................................................................................................................... 52
Hoorcollege 5 – 23-2-2024 .................................................................................................................... 63
Obsessieve Compulsieve Stoornis (OCS) ........................................................................................... 63
Post Traumatische Stress Stoornis (PTSS) ......................................................................................... 65
Werkgroepen ........................................................................................................................................ 71
1
,Stein – Psychiatric Diagnosis and Treatment in the 21st Century
Paradigm Shifts versus Incremental Integration
Psychiatry has always been characterized by a range of different models of and approaches to mental
disorder, which have sometimes brought progress in clinical practice, but have often also been
accompanied by critique from within and without the field. Psychiatric nosology has been a
particular focus of debate in recent decades; successive editions of the DSM and ICD have strongly
influenced both psychiatric practice and research, but have also led to assertions that psychiatry is in
crisis, and to advocacy for entirely new paradigms for diagnosis and assessment.
- The Diagnostic and Statistical Manual of Mental Disorders (DSM)
- The International Classification of Diseases (ICD)
➔ Psychiatric classification/nosology = the classification and scientific study of mental
disorders.
When thinking about etiology, many researchers currently refer to a biopsychosocial model, but this
approach has received significant critique, being considered by some observers overly eclectic and
vague. Despite the development of a range of evidence-based pharmacotherapies and
psychotherapies, current evidence points to both a treatment gap and a research-practice gap in
mental health.
In this paper, after considering current clinical practice, we discuss some proposed novel perspectives
that have recently achieved particular prominence and may significantly impact psychiatric practice
and research in the future:
- Clinical neuroscience and personalized pharmacotherapy;
- Novel statistical approaches to psychiatric nosology, assessment and research;
- Deinstitutionalization and community mental health care;
- The scale-up of evidence-based psychotherapy;
- Digital phenotyping and digital therapies;
- And global mental health and task-sharing approaches.
We consider the extent to which proposed transitions from current practices to novel approaches
reflect hype or hope. Our review indicates that each of the novel perspectives contributes important
insights that allow hope for the future, but also that each provides only a partial view, and that any
promise of a paradigm shift for the field is not well grounded.
We conclude
- That there have been crucial advances in psychiatric diagnosis and treatment in recent
decades;
- That, despite this important progress, there is considerable need for further improvements
in assessment and intervention;
- And that such improvements will likely not be achieved by any specific paradigm shifts in
psychiatric practice and research, but rather by incremental progress and iterative
integration.
The proposed paradigm of clinical neuroscience criticizes current diagnostic approaches, suggesting
that DSM and ICD constructs lack a sufficient basis in neuroscience.
➔ The Research Domain Criteria (RDoC) project has been launched, emphasizing specific
neurobiological mechanisms underlying mental disorders and focusing on domains of
2
, functioning. The RDoC framework includes dimensions for developmental trajectories and
environmental effects, viewing mental illnesses as neurodevelopmental disorders influenced
by genetic and environmental factors. The RDoC has had an influence on clinical
neuroscience research but there are also notable limitations, such as its overlap with existing
biological psychiatry ideas and potential complexity in understanding specific neurobiological
mechanisms.
➔ Personalized and precision psychiatry are aspirations of clinical neuroscience, with an
emphasis on tailoring interventions to individual patients based on genomic information. The
Clinical Pharmacogenetic Implementation Consortium (CPIC) provides clinical guidelines for
drugs used in psychiatry based on genetic information. "Big data" collaborations and their
contributions to understanding biological pathways across different mental disorders are of
great importance.
➔ There are novel paradigms like the Hierarchical Taxonomy of Psychopathology (HiTOP) and
network analysis as alternatives to traditional disease classifications. HiTOP proposes a
hierarchical framework based on dimensional traits, seeking to move away from categorical
entities. Network analysis, on the other hand, views mental disorders as problems in living,
explaining them through observable interactions between symptoms.
3
, Hoofdstuk 7 – Cognitieve Gedragstherapie
Klassieke conditionering/stimulus-respons-stimulus-stimulus = verschillende prikkels
(gebeurtenissen, omgevingen en situaties) die in eerste instantie niets met elkaar te maken hebben
op een bepaald moment met elkaar in verband worden gebracht
Operante conditionering = men leert dat bepaald gedrag bepaalde gevolgen/consequenties heeft
Extinctie = associaties kunnen worden uitgedoofd door herhaaldelijk de geconditioneerde stimulus
aan te bieden zonder dat de geconditioneerde respons daarop volgt
Cognitieve revolutie = een puur gedragsmatig alternatief voor de psychoanalyse werd bekritiseerd
omdat mentale processen zoals gedachten, opvattingen en interpretaties buiten beschouwing
werden gelaten
Vier niveaus van cognities
➔
- Basisschema’s = fundamentele opvattingen die iemand heeft over zichzelf, over de wereld en
over de toekomst. Van deze opvattingen zijn we ons vaak niet direct bewust (impliciet).
- Conditionele assumpties = veronderstellingen over oorzaak-gevolgrelaties. Ze manifesteren
zich vaak als als-dan-stellingen.
- Strategische ideeën = opvattingen die mensen hebben over hoe ze gevaren het beste het
hoofd kunnen bieden en goed dingen kunnen bereiken.
- Automatische gedachten = de gedachten die meer bewust door iemands hoofd gaan. Er
wordt verondersteld dat automatische gedachten (via de tussenliggende niveaus van
cognities) gestuurd worden door de basisschema’s.
Confirmation bias = de informatieverwerking is bij lang bestaande schema’s namelijk al dusdanig
geautomatiseerd dat men vaak alleen nog maar aandacht heeft voor informatie die het schema
bevestigt, en niet meer stilstaat bij het feit dat er ook informatie bestaat die niet helemaal strookt
met het schema
4
