Hoorcollege 1 Psychopathologie 2023 Universiteit Utrecht

Hoorcollege 1- introductie psychopathologie

DSM geschiedenis:

  • 1880: 7 diagnoses: manie, melancholie, monomanie, paresis, dementie, dipsomanie, en epilepsie 
  • 1911 DSM 1: 106 diagnoses 
  • DSM 2: 182 diagnoses 
  • DSM 3: 265 diagnoses 
  • DSM 4: 374 diagnoses 2013
  • DSM 5: 491 diagnoses

stromingen binnen psychologie:

  • psychodynamische stroming
  • behaviorism
  • humanistische stroming
  • cognitieve stroming
  • biologische stroming

taken therapeuten

  • orde te scheppen in symptomen
  • te begrijpen waarom (luxerende en instandhoudende factoren)
  • te bepalen waar de nood zit en wat beste aangrijpingspunt is

DSM classificaties: labels om symptomen te ordenen

  • persoonskenmerk → symptoom=uitingsvorm → label
  • vb controlegedrag→ dwangmatig controleren, behoefte aan orde etc → bvb label: OCS. 
  • Een bepaald persoonskenmerk hoeft niet altijd negatief te zijn, zo kan bijvoorbeeld controlegedrag ook leiden tot beter presteren

DSM limitaties

  • comorbiditeit
  • afbakening onduidelijk omdat er veel overlap is
  • versnippering
  • puur gericht op symptomen en niet op onderliggende aetiologie

DSM classificatie werkt het best als:

  • iedere classificatie uniek is
  • iedere classificatie stabiel is
  • ze alles weten te verklaren

Alternatieven voor DSM

  • Research domain criteria (RDOC): symptoomclusters linken aan neurobiologie. 
  • Hierarchical Taxonomy of psychopathology (HITOP): psychopathologie spectra
  • Netwerktheorie: focus op de samenhang van symptomen onderling en dus niet op een achterliggende construct, zoals diagnose, ziekte, latente factor

RDOC limitaties:

  • Neurobiologische constructen zijn weinig specifiek 
  • Neurobiologische constructen verklaren maar klein deel 
  • Dimensies te vaag en complex 
  • Wel goede bouwblokken voor onderzoek naar onderliggende neurobiologie

HITOP limitaties:

  • Combinaties van uitersten op een spectrum niet mogelijk 
  • Verschil symptomen en maladaptieve traits onduidelijk 
  • Wel goed overzicht van samenhang tussen stoornissen

Netwerkmodel limitaties:

  • Het gaat puur om correlaties tussen symptomen die gecorrigeerd zijn voor andere onderlinge correlaties
  • geen causaliteit!
  • wel inzichtgevend: samenhang, overlap, individuele aangrijpingspunten
     

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