Sessie 3. Angst bij de ziekte van Parkinson - ParkinsonNet
Sessie 3. Angst bij de ziekte van Parkinson - ParkinsonNet
Sessie 3. Angst bij de ziekte van Parkinson - ParkinsonNet
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<strong>Angst</strong><br />
en <strong>de</strong> <strong>ziekte</strong> <strong>van</strong><br />
<strong>Parkinson</strong><br />
te veel of te weinig<br />
controle<br />
Annelien Duits<br />
Harriët Smeding<br />
©2012 <strong>Parkinson</strong>Net congres<br />
www.smedingneuropsychologie.nl
Wat moet <strong>de</strong>ze workshop brengen,<br />
zodat je zegt:<br />
“dat was <strong>de</strong> moeite waard”?<br />
Smeding neuropsychologie<br />
©2012 <strong>Parkinson</strong>Net congres
Schrikken<br />
<strong>Angst</strong><br />
Nu<br />
Toekomst<br />
In je lijf<br />
In je hoofd<br />
Sterke,<br />
directe<br />
lichamelijke sensaties<br />
Latere,<br />
diffuse<br />
lichamelijke reacties<br />
Smeding neuropsychologie<br />
©2012 <strong>Parkinson</strong>Net congres
Vi<strong>de</strong>o angst <strong>bij</strong> PD<br />
Dhr O 2:15-3:55<br />
Smeding neuropsychologie<br />
©2012 <strong>Parkinson</strong>Net congres
<strong>Angst</strong>stoornissen DSM-IV<br />
• Paniekstoornis met agorafobie<br />
• Paniekstoornis zon<strong>de</strong>r agorafobie<br />
• Gegeneraliseer<strong>de</strong> angststoornis<br />
• PTSS<br />
• Obsessief compulsieve stoornis<br />
• Sociale angst<br />
• <strong>Angst</strong> NAO<br />
Smeding neuropsychologie<br />
©2012 <strong>Parkinson</strong>Net congres
©2012 <strong>Parkinson</strong>Net congres<br />
ANGST <strong>bij</strong> <strong>Parkinson</strong><br />
• 40 % <strong>van</strong> <strong>de</strong> patienten<br />
• Persisterend versus episodisch<br />
• Co-morbiditeit met <strong>de</strong>pressie<br />
• Overlap met autonome en cognitieve<br />
disfuncties<br />
• Relatie subjectieve gezondheid!
©2012 <strong>Parkinson</strong>Net congres<br />
<strong>Angst</strong>stoornissen obv DSM-IV<br />
Table 1. Current and lifetime prevalence of DSM-IV-TR anxiety disor<strong>de</strong>rs in PD<br />
DSM-IV-TR anxiety disor<strong>de</strong>r<br />
Current prevalence [%<br />
(n)]<br />
Lifetime prevalence [%<br />
(n)]<br />
Any anxiety disor<strong>de</strong>r 43 (55) 49 (63)<br />
Two or more anxiety disor<strong>de</strong>rs 13 (17) 20 (25)<br />
Panic disor<strong>de</strong>r 7.1 (9) 10 (13)<br />
Agoraphobia without panic 1.6 (2) 4 (5)<br />
Social phobia 7.9 (10) 8.7 (11)<br />
Specific phobia 13 (17) 19 (24)<br />
Obsessive-compulsive disor<strong>de</strong>r 0.8 (1) 1.6 (2)<br />
Generalized anxiety disor<strong>de</strong>r <strong>3.</strong>2 (4) <strong>3.</strong>2 (4)<br />
Posttraumatic stress disor<strong>de</strong>r 0.0 (0) 1.6 (2)<br />
Anxiety disor<strong>de</strong>r NOS 25 (32) 30 (38)
©2012 <strong>Parkinson</strong>Net congres<br />
Met name angst NOS<br />
• motorische fluctuaties<br />
• anticipatie-angst (b.v.angst voor vertrek)<br />
• buitensporig piekeren<br />
• paniekerig / fobisch / vermijding
©2012 <strong>Parkinson</strong>Net congres<br />
On<strong>de</strong>rliggen<strong>de</strong> mechanismen<br />
• Vrees en vermijding (leertheorie)<br />
• Verhoog<strong>de</strong> arousal<br />
• <strong>Angst</strong> voor controleverlies<br />
• Selectieve bias<br />
• Communicatiestoornissen<br />
• Executieve stoornissen
©2012 <strong>Parkinson</strong>Net congres<br />
Interview: micro- en macroanalyse<br />
Microanalyse <strong>van</strong> <strong>de</strong> klachten<br />
Omstandighe<strong>de</strong>n<br />
en faciliteren<strong>de</strong><br />
factoren<br />
Gedachten en<br />
sensaties<br />
Vermijdingsgedrag<br />
en consequenties
©2012 <strong>Parkinson</strong>Net congres<br />
Meetinstrumenten angst <strong>bij</strong> <strong>Parkinson</strong><br />
• Hamilton Anxiety Rating Scale<br />
• Beck Anxiety Inventory<br />
• State Trait Anxiety Inventory<br />
• Hospital Anxiety and Depression Scale
International Classification of Functioning (ICF),<br />
Disability and Health<br />
©2012 <strong>Parkinson</strong>Net congres
Psychotherapie <strong>bij</strong> PD<br />
Cognitieve Gedragtherapie (CGT):<br />
behan<strong>de</strong>ling angst en <strong>de</strong>pressie<br />
Psychodrama:<br />
het behou<strong>de</strong>n <strong>van</strong> sociale rollen (Sproesser e.a., 2010)<br />
Mindfulness-based cognitieve therapie:<br />
veran<strong>de</strong>ren of vasthou<strong>de</strong>n <strong>van</strong> bestaan<strong>de</strong><br />
coping stijl in <strong>de</strong> context <strong>van</strong> verlies<br />
(Fitzpatrick e.a. 2010)<br />
©2012 <strong>Parkinson</strong>Net congres
CGT <strong>bij</strong> PD<br />
•Feeney e.a., 2005 n=4 9 sessions CBT in a group: effect on anxiety and <strong>de</strong>pression<br />
untill 1 month after treatment<br />
•Secker & Brown, 2005 n=30 12-14 sessions CBT in caregivers of patients (no-treatment<br />
control group) with effect on subjective general health,<br />
strain and bur<strong>de</strong>n 3 months after treatment<br />
•Dobkin e.a., 2006 n=3 12-14 sessions CBT in a group (incl. 3-4 sessions of<br />
psychoeducation of partners) with effect on <strong>de</strong>pression untill<br />
1 month after treatment<br />
•Dobkin e.a., 2007 n=15 individual method in line with Dobkin e.a., 2006 and effect<br />
on <strong>de</strong>pression, negative cognitions and social support untill<br />
1 month after treatment<br />
•Macht e.a., 2007 n=3 <strong>de</strong>tailed report of CBT for all cases<br />
•Veazy e.a., 2009 n=10 individual method with 1 session CBT and 8 FU by telephone<br />
(control group only 8 telephone support sessions). No difference in<br />
anxiety and <strong>de</strong>pression<br />
•Farabaugh e.a., 2010 n=8 12 sessions CBT individual with effect on <strong>de</strong>pression after<br />
last session<br />
•Dobkin e.a., 2011 n=80 10 sessions CBT individual and 4 seperate sessions for<br />
80 caregivers (control group only clinical monitoring). Effect<br />
on <strong>de</strong>pression, anxiety, social function and <strong>de</strong>crease in<br />
negative thoughts at 1 month<br />
©2012 <strong>Parkinson</strong>Net congres
©2012 <strong>Parkinson</strong>Net congres<br />
Psychosociale interventies <strong>bij</strong> PD<br />
Relaxatie<br />
training<br />
Psychoeducatie<br />
Stress<br />
management &<br />
social<br />
competence<br />
Quality of life, sociale<br />
participatie
8 sessions of PEPP<br />
©2012 <strong>Parkinson</strong>Net congres
Progressive relaxation method Jacobson<br />
©2012 <strong>Parkinson</strong>Net congres
©2012 <strong>Parkinson</strong>Net congres<br />
ReSET; Strategische Executieve Training<br />
(Vlagsma, Duits, Smeding, Visser, Spikman, 2011)<br />
Cognitieve revalidatiebehan<strong>de</strong>ling<br />
voor <strong>Parkinson</strong>patienten met stoornissen in <strong>de</strong><br />
executieve functies
Behan<strong>de</strong>ling <strong>van</strong> angst<br />
Cognitieve gedragstherapie = het uitdagen <strong>van</strong><br />
gedachten<br />
Smeding neuropsychologie<br />
©2012 <strong>Parkinson</strong>Net congres
Behan<strong>de</strong>ling <strong>van</strong> angst<br />
Na<strong>de</strong>len CBT:<br />
• Niet echt geloven nieuwe gedachten<br />
• Bij PD niet op alternatieven komen<br />
• Veel huiswerk<br />
Smeding neuropsychologie<br />
©2012 <strong>Parkinson</strong>Net congres
ACT<br />
Controle is het probleem, laten gaan<br />
is het alternatief<br />
Smeding neuropsychologie<br />
©2012 <strong>Parkinson</strong>Net congres
melk<br />
Smeding<br />
©2012 <strong>Parkinson</strong>Net congres
melk<br />
wit<br />
Smeding<br />
©2012 <strong>Parkinson</strong>Net congres
melk melk melk …….<br />
Smeding neuropsychologie<br />
©2012 <strong>Parkinson</strong>Net congres
“Mislukt”<br />
<strong>de</strong>fusietechniek<br />
Smeding neuropsychologie<br />
©2012 <strong>Parkinson</strong>Net congres
Oplossingsgerichte psychotherapie<br />
Uitgaan <strong>van</strong> situatie die je wil bereiken<br />
Met<br />
• Erkennen <strong>van</strong> probleem<br />
• Won<strong>de</strong>rvraag<br />
• Uitzon<strong>de</strong>ringen zoeken<br />
• Schalen<br />
• Feedback<br />
Smeding neuropsychologie<br />
©2012 <strong>Parkinson</strong>Net congres
De won<strong>de</strong>rvraag<br />
vi<strong>de</strong>o<br />
Smeding neuropsychologie<br />
©2012 <strong>Parkinson</strong>Net congres
Oplossingsgerichte psychotherapie ≠<br />
goed nieuwsshow<br />
Smeding neuropsychologie<br />
©2012 <strong>Parkinson</strong>Net congres
Casus angst <strong>bij</strong> PD<br />
vi<strong>de</strong>o<br />
Smeding neuropsychologie<br />
©2012 <strong>Parkinson</strong>Net congres
Smeding<br />
neuropsychologie<br />
www.smedingneuropsychologie.nl<br />
©2012 <strong>Parkinson</strong>Net congres
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