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Multidisciplinaire richtlijn Depressie (1)

Multidisciplinaire richtlijn Depressie (1)

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Published by: featherjewglow on Nov 19, 2009
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MULTIDISCIPLINAIRE RICHTLIJN DEPRESSIE
Versie 1.0
Landelijke Stuurgroep Multidisciplinaire Richtlijnontwikkeling in de GGZMultidisciplinaire Richtlijn voor de diagnostiek en behandeling van volwassen cliënten met een depressie (2005)Uitgever: Trimbos-instituut, Utrecht (art. no.: AF0605)Datum Goedkeuring01-03-2007VerantwoordingLandelijke Stuurgroep/Trimbos-instituut
 
Inhoudsopgave
Algemene inleiding............................................................................................................................................1
Aanleiding................................................................................................................................................1Richtlijnontwikkeling GGZ.......................................................................................................................1Fasen in het zorgproces voor personen met een stemmingsstoornis.....................................................1Taken en disciplines in het zorgproces...................................................................................................2Doelstelling..............................................................................................................................................2Toepassing van richtlijnen.......................................................................................................................3Patiëntenvertegenwoordigers..................................................................................................................3Richtlijngebruikers...................................................................................................................................3
Specifieke inleiding............................................................................................................................................4
Probleemomschrijving en uitgangsvragen..............................................................................................4Oorspronkelijke uitgangsvragen..............................................................................................................4Diagnostiek.......................................................................................................................................4Biologische therapie..........................................................................................................................4Psychologische/psychotherapeutische interventies..........................................................................5Praktisch ondersteunende interventies.............................................................................................5Samenstelling werkgroep........................................................................................................................5Werkwijzewerkgroep..............................................................................................................................5Wetenschappelijke onderbouwing...........................................................................................................6Kosteneffectiviteit....................................................................................................................................6Implementatie en indicatorontwikkeling...................................................................................................7Juridische betekenis van richtlijnen.........................................................................................................7Herziening...............................................................................................................................................7
Diagnostiek.........................................................................................................................................................9
Uitgangsvr agen.......................................................................................................................................9Zoekstrategie.........................................................................................................................................10Patiëntenperspectief..............................................................................................................................10Typen depressie....................................................................................................................................11Depressieve stoornis......................................................................................................................11Dysthymie.......................................................................................................................................12Depressieve stoornis: subtypen......................................................................................................12Criteriavoor de subtypen van de depressieve stoornis..................................................................12Onder scheid met bipolaire en cyclothyme stoornissen...................................................................13Beloopvor men van dedepressieve stoornis.........................................................................................14Indeling inernst voor de klinische praktijk.............................................................................................14Classificatie...........................................................................................................................................15Differentiele diagnostiek van depressie.................................................................................................16Andere, minder ernstige psychische stoornissen..................................................................................16Depressie........................................................................................................................................16Stressgerelateerde stoornissen......................................................................................................17Aanpassingsstoornis.......................................................................................................................17Rouwreactie....................................................................................................................................18Andere psychiatrische stoornissen........................................................................................................18Angststoor nissen............................................................................................................................18Psychotische stoornissen...............................................................................................................19Beginnende dementie.....................................................................................................................19Stemmingsstoornissen door gebruik van (genees)middelen................................................................19Persoonlijkheidsproblematiek ( dan wel persoonlijkheidsstoornissen)..................................................20Somatische aandoeningen....................................................................................................................20Gevolgen vandepressie voor hetfunctioneren op levensgebieden......................................................21Het ontstaan van depressie...................................................................................................................22Fysiopathogenese...........................................................................................................................22Psychopathogenese.......................................................................................................................22Het voortbestaan van depressies..........................................................................................................22Patiëntgebonden factoren...............................................................................................................23Hulpverlenergebonden factoren......................................................................................................23Het recidiverenvan depressies.............................................................................................................23Meetinstrumentarium.............................................................................................................................23Screening........................................................................................................................................24
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Inhoudsopgave
Diagnostiek
Classificatie.....................................................................................................................................26Ernstbepaling..................................................................................................................................28
Indicatie voor behandeling..............................................................................................................................31
Uitgangsvragen....................................................................................................................................31Patiëntenperspectief..............................................................................................................................31Indicatie voor behandeling....................................................................................................................32Eerste-stap-behandelingen...................................................................................................................32
Biologische behandeling van depressie........................................................................................................34
Uitgangsvr agen.....................................................................................................................................34Zoekstrategie.........................................................................................................................................34Patiëntenperspectief..............................................................................................................................34Indicatie voor behandeling met antidepressiva.....................................................................................35Eerstekeuzemiddelen............................................................................................................................36Voortzetting van de behandeling na herstel..........................................................................................39Sint-janskr uid.........................................................................................................................................40Lichttherapie..........................................................................................................................................40Beleid bij nonrespons vier weken na de eerste stap.............................................................................41Medicamenteuze vervolgstappen bij nonrespons op de eerste stap....................................................42Lithiumadditie bij nonrespons op de eerste (of volgende) stap.............................................................44KlassiekeMAO-remmers bij nonrespons op de eerste (of volgende) stap...........................................45Biologische behandelingsmogelijkheden bij een psychotischedepressie............................................45Antidepressiva bij de behandeling van de dysthyme stoornis...............................................................46Benzodiazepinen bij de behandeling van depressie.............................................................................47Elektroconvulsietherapie bij de depressieve stoornis............................................................................48
Psychologische/psychotherapeutische interventies...................................................................................50
Uitgangsvr agen.....................................................................................................................................50Zoekstrategie.........................................................................................................................................50Patiëntenperspectief ten aanzien van psychologische/psychotherapeutische interventies..................51Duurzaameffectieve psychologische/ psychotherapeutische interventies...........................................51Duurzaamheid van de resultaten..........................................................................................................53Psychotherapie versus medicatie..........................................................................................................54Simultanecombinatiebehandelingen....................................................................................................57Sequentiële (combinatie) behandelingen met medicatie en psychotherapie........................................58Chronische depressies inclusief dysthymie...........................................................................................58
Uitgangsvr agen.....................................................................................................................................61Patiëntenperspectief ten aanzien van steunende en structurerende interventies..........................61Praktische ondersteunende 'cognitieve' interventies.............................................................................62Bibliotherapie/zelfhulp en psycho-educatie.....................................................................................62Counseling/casework......................................................................................................................63Counselingen psycho-educatie in relatie tot therapietrouw...........................................................64Combinaties van bovengenoemde interventies..............................................................................65Supportgroepen..............................................................................................................................66Het effectvan praktische en sociale interventies............................................................................67Diagnostiek eninterventies door maatschappelijk werk........................................................................67Achtergrond....................................................................................................................................68Overeenkomsten en verschillen tussen de interventies..................................................................68Diagnostiek in het maatschappelijk werk........................................................................................68Interventies maatschappelijk werk..................................................................................................68Vaktherapieën.......................................................................................................................................71Psychomotorische therapie.............................................................................................................71Muziekther apie................................................................................................................................71Dramather apie................................................................................................................................72Beeldende therapie.........................................................................................................................72Algemene samenvating vaktherapieën...........................................................................................72Verpleegkundige interventies................................................................................................................77
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