Skip to main content
SpringerLink
Log in

De ontwikkeling van een biopsychisch model van psychose

  • Artikelen
  • Published:
Tijdschrift voor Psychotherapie

Samenvatting

De kennis rond de biologie en de psychologie van psychose groeit en een biopsychisch model met de interactie van deze verschillende domeinen in de psychose begint zich af te tekenen. Sensitisatie van het dopaminesysteem leidt ertoe dat er vaker perceptuele aberraties en gedachte-intrusies optreden en gebeurtenissen met grote persoonlijke betekenis ervaren worden. Redeneertendensen die de prodromale toestand kenmerken beïnvloeden het betekenisgevingsproces. Snelle conclusies, overmatige causaliteit veronderstellen, de neiging bevestigende informatie te zoeken en situaties te vermijden die strijdige informatie kunnen aanleveren, leiden bij een deel van deze kwetsbare mensen tot waanvorming en psychose.

Medicamenteuze en psychologische behandeling zijn complementair. Medicatie neemt de voortgaande aberraties weg en vermindert de intrusies en de hoge mate van angst, maar verandert niet de inhoud van waanopvattingen. Cognitieve gedragstherapie kan de narratieve waanverklaring voor de psychotische verschijnselen helpen veranderen. Complotten worden in een breder perspectief gezet door aanvullende en soms strijdige informatie, en stemmen worden niet langer toegeschreven aan kwaadwillende anderen. Stemmen kunnen dan opgevat worden als een hinderlijke, maar onschuldige innerlijke ervaring.

The development of a biopsychic model of psychosis

The knowledge of the biology and psychology of psychosis is growing, and a biopsychological model with the interactions of these different domains in psychoses is emerging. Sensitisation of the dopamine system results in an increase in perceptual aberrations and thought intrusions and the experience of great personal interest in trivial experiences (salience). Biases in reasoning that characterise the late prodromal state, impact the process of giving meaning to experiences. Hasty conclusions, overrating causality, a bias towards confirmation and the avoidance of situations that might contradict suspicious thoughts cause some of these vulnerable people to develop delusions and psychosis.

Medication and cognitive behavioural therapy (CBT) are complementary in nature. Antipsychotic medication takes away ongoing aberrations and diminishes intrusions and fear, but does not change the content of delusions. CBT can help to change the narrative delusional explanations. Conspiracies can be put into perspective by bringing in more and sometimes contradictory information. Voices will no longer be seen as caused by malevolent others, but as annoying, though innocent internal psychological phenomena.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Notes

  1. Een voorbeeld van de trainingsmaterialen is te downloaden vanaf www.uke.uni-hamburg.de/kliniken/psychiatrie/index_17380.php.

  2. De handleiding voor de therapeut en het werkboek voor de stemmenhoorder zijn te downloaden vanaf www.gedachtenuitpluizen.nl.

Literatuur

  • Albus, M., Hubmann, W., Mohr, F., Hecht, S., Hinterberger-Weber, P., Seitz, N. N., et al. (2006). Neurocognitive functioning in patients with first-episode schizophrenia : results of a prospective 5-year follow-up study. Eur Arch Psychiatry Clin Neurosci, 256(7), 442-451.

    Google Scholar 

  • Baker, C. A., & Morrison, A. P. (1998). Cognitive processes in auditory hallucinations: attributional biases and metacognition. Psychol Med, 28(5), 1199-1208.

    Google Scholar 

  • Baxter, L. R., Jr., Schwartz, J. M., Bergman, K. S., Szuba, M. P., Guze, B. H., Mazziotta, J. C., et al. (1992). Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder. Arch Gen Psychiatry, 49(9), 681-689.

    Google Scholar 

  • Beck, A. (1952). Successful outpatient psychotherapy of a chronic schizophrenic with a delusion based on borrowed guilt. Psychiatry, 15, 305-312.

    Google Scholar 

  • Bentall, R. P., Kaney, S., & Dewey, M. E. (1991). Paranoia and social reasoning: an attribution theory analysis. Br J Clin Psychol, 30 ( Pt 1), 13-23.

    Google Scholar 

  • Birchwood, M., & Chadwick, P. (1997). The omnipotence of voices: testing the validity of a cognitive model. Psychol Med, 27(6), 1345-1353.

    Google Scholar 

  • Birchwood, M., Meaden, A., Trower, P., Gilbert, P., & Plaistow, J. (2000). The power and omnipotence of voices: subordination and entrapment by voices and significant others. Psychol Med, 30(2), 337-344.

    Google Scholar 

  • Bleuler, E. (1911). Dementia Preacox oder der Gruppe der Schizophrenien. In G. Aschaffenburg (Ed.), Handbuch der Geisteskrankheiten. Leipzig: Deuticke.

  • Brewin, C. R. (2006). Understanding cognitive behaviour therapy: A retrieval competition account. Behav Res Ther, 44(6), 765-784.

    Google Scholar 

  • Chadwick, P., & Birchwood, M. (1994). The omnipotence of voices. A cognitive approach to auditory hallucinations. Br J Psychiatry, 164(2), 190-201.

    Google Scholar 

  • Eastvold, A. D., Heaton, R. K., & Cadenhead, K. S. (2007). Neurocognitive deficits in the (putative) prodrome and first episode of psychosis. Schizophr Res, 93(1-3), 266-277.

    Google Scholar 

  • Ensum, I., & Morrison, A. P. (2003). The effects of focus of attention on attributional bias in patients experiencing auditory hallucinations. Behav Res Ther, 41(8), 895-907.

    Google Scholar 

  • Franck, N., Rouby, P., Daprati, E., Dalery, J., Marie-Cardine, M., & Georgieff, N. (2000). Confusion between silent and overt reading in schizophrenia. Schizophr Res, 41(2), 357-364.

    Google Scholar 

  • Freeman, D., Garety, P. A., Fowler, D., Kuipers, E., Bebbington, P. E., & Dunn, G. (2004). Why do people with delusions fail to choose more realistic explanations for their experiences? An empirical investigation. J Consult Clin Psychol, 72(4), 671-680.

    Google Scholar 

  • Furmark, T., Tillfors, M., Marteinsdottir, I., Fischer, H., Pissiota, A., Langstrom, B., et al. (2002). Common changes in cerebral blood flow in patients with social phobia treated with citalopram or cognitive-behavioral therapy. Arch Gen Psychiatry, 59(5), 425-433.

    Google Scholar 

  • Garcia-Montes, J. M., Perez-Alvarez, M., Soto Balbuena, C., Perona Garcelan, S., & Cangas, A. J. (2006). Metacognitions in patients with hallucinations and obsessive-compulsive disorder: the superstition factor. Behav Res Ther, 44(8), 1091-1104.

  • Garety, P. A., Hemsley, D. R., & Wessely, S. (1991). Reasoning in deluded schizophrenic and paranoid patients. Biases in performance on a probabilistic inference task. J Nerv Ment Dis, 179(4), 194-201.

    Google Scholar 

  • Gilleen, J., & David, A. S. (2005). The cognitive neuropsychiatry of delusions: from psychopathology to neuropsychology and back again. Psychol Med, 35(1), 5-12.

    Google Scholar 

  • Goldapple, K., Segal, Z., Garson, C., Lau, M., Bieling, P., Kennedy, S., et al. (2004). Modulation of cortical-limbic pathways in major depression: treatment-specific effects of cognitive behavior therapy. Arch Gen Psychiatry, 61(1), 34-41.

    Google Scholar 

  • Gorman, J. M., Kent, J. M., Sullivan, G. M., & Coplan, J. D. (2000). Neuroanatomical hypothesis of panic disorder, revised. Am J Psychiatry, 157(4), 493-505.

    Google Scholar 

  • Harrison, P. J. (2007). Schizophrenia susceptibility genes and neurodevelopment. Biol Psychiatry, 61(10), 1119-1120.

    Google Scholar 

  • Harvey, A., Watkins, E., Mansell, W., & Shafran, R. (2004). Cognitive behavioural processes across psychological disorders: A transdiagnostic approach to research and treatment. Oxford: Oxford University Press.

  • Heilbrun, A. B., Jr. (1980). Impaired recognition of self-expressed thought in patients with auditory hallucinations. J Abnorm Psychol, 89(6), 728-736.

    Google Scholar 

  • Heinrichs, R. (2001). In search of madness: schizophrenia and neuroscience. Oxford: Oxford University Press.

  • Hoff, A. L., Svetina, C., Shields, G., Stewart, J., & DeLisi, L. E. (2005). Ten year longitudinal study of neuropsychological functioning subsequent to a first episode of schizophrenia. Schizophr Res, 78(1), 27-34.

    Google Scholar 

  • Huq, S., Garety, P., & Hemsley, D. (1988). Probabilistic judgements in deluded and non-deluded subjects. The Quarterly Journal of Experimental Psychology A: Human Experimental Psychology, 40(4-A), 801-812.

    Google Scholar 

  • Kapur, S. (2003). Psychosis as a state of aberrant salience: a framework linking biology, phenomenology, and pharmacology in schizophrenia. Am J Psychiatry, 160(1), 13-23.

    Google Scholar 

  • Kapur, S., Agid, O., Mizrahi, R., & Li, M. (2006). How antipsychotics work-from receptors to reality. NeuroRx, 3(1), 10-21.

  • Kapur, S., Mizrahi, R., & Li, M. (2005). From dopamine to salience to psychosis--linking biology, pharmacology and phenomenology of psychosis. Schizophr Res, 79(1), 59-68.

    Google Scholar 

  • Keefe, R. S., Arnold, M. C., Bayen, U. J., McEvoy, J. P., & Wilson, W. H. (2002). Source-monitoring deficits for self-generated stimuli in schizophrenia: multinomial modeling of data from three sources. Schizophr Res, 57(1), 51-67.

    Google Scholar 

  • Kraepelin, E. (1896). Lehrbuch der Psychiatrie (5th ed.). Leipzig: Barth.

  • Laroi, F., & Van der Linden, M. (2005). Metacognitions in proneness towards hallucinations and delusions. Behav Res Ther, 43(11), 1425-1441.

    Google Scholar 

  • Laroi, F., Van der Linden, M., & Marczewski, P. (2004). The effects of emotional salience, cognitive effort and meta-cognitive beliefs on a reality monitoring task in hallucination-prone subjects. Br J Clin Psychol, 43(Pt 3), 221-233.

    Google Scholar 

  • Lencz, T., Smith, C. W., McLaughlin, D., Auther, A., Nakayama, E., Hovey, L., et al. (2006). Generalized and specific neurocognitive deficits in prodromal schizophrenia. Biol Psychiatry, 59(9), 863-871.

    Google Scholar 

  • Maher, B. (1988). Anomalous experience and delusional thinking: the logic of explanations. In T. Oltmanns & B. Maher (Eds.), Delusional Beliefs (pp. 15-33). New York: John Wiley.

  • Moore, S. C., & Sellen, J. L. (2006). Jumping to conclusions: a network model predicts schizophrenic patients' performance on a probabilistic reasoning task. Cogn Affect Behav Neurosci, 6(4), 261-269.

    Google Scholar 

  • Moritz, S., & Woodward, T. S. (2007). Metacognitive training in schizophrenia: from basic research to knowledge translation and intervention. Curr Opin Psychiatry, 20(6), 619-625.

    Google Scholar 

  • Moritz, S., Woodward, T. S., & Ruff, C. C. (2003). Source monitoring and memory confidence in schizophrenia. Psychol Med, 33(1), 131-139.

    Google Scholar 

  • Morrison, A. P., & Wells, A. (2003). A comparison of metacognitions in patients with hallucinations, delusions, panic disorder, and non-patient controls. Behav Res Ther, 41(2), 251-256.

    Google Scholar 

  • Nopoulos, P., Flashman, L., Flaum, M., Arndt, S., & Andreasen, N. (1994). Stability of cognitive functioning early in the course of schizophrenia. Schizophr Res, 14(1), 29-37.

    Google Scholar 

  • Pukrop, R., Schultze-Lutter, F., Ruhrmann, S., Brockhaus-Dumke, A., Tendolkar, I., Bechdolf, A., et al. (2006). Neurocognitive functioning in subjects at risk for a first episode of psychosis compared with first- and multiple-episode schizophrenia. J Clin Exp Neuropsychol, 28(8), 1388-1407.

    Google Scholar 

  • Reitan, R. (1958). Validity of the trail Making Test as an indication of organic brain damage. Percept. Motor Skills, 8, 127-130.

    Google Scholar 

  • Rund, B. R., Melle, I., Friis, S., Johannessen, J. O., Larsen, T. K., Midboe, L. J., et al. (2007). The course of neurocognitive functioning in first-episode psychosis and its relation to premorbid adjustment, duration of untreated psychosis, and relapse. Schizophr Res, 91(1-3), 132-140.

    Google Scholar 

  • Rutschmann, J., Cornblatt, B., & Erlenmeyer-Kimling, L. (1986). Sustained attention in children at risk for schizophrenia: findings with two visual continuous performance tests in a new sample. J Abnorm Child Psychol, 14(3), 365-385.

    Google Scholar 

  • Seeman, P., Schwarz, J., Chen, J. F., Szechtman, H., Perreault, M., McKnight, G. S., et al. (2006). Psychosis pathways converge via D2high dopamine receptors. Synapse, 60(4), 319-346.

    Google Scholar 

  • Tien, A. Y. (1991). Distributions of hallucinations in the population. Soc Psychiatry Psychiatr Epidemiol, 26(6), 287-292.

    Google Scholar 

  • Van Dael, F., Versmissen, D., Janssen, I., Myin-Germeys, I., van Os, J., & Krabbendam, L. (2006). Data gathering: biased in psychosis? Schizophr Bull, 32(2), 341-351.

    Google Scholar 

  • Van der Gaag, M., & Korrelboom, K. (2006). Competitive Memory Therapy (COMET bij auditieve hallucinaties. In M. Van der Gaag, F. Withaar & C. Slooff (Eds.), Cognitieve gedragstherapeutische behandelingen bij mensen met een psychose (Vol. 4, pp. 95-111). Den Haag: Kenniscentrum Schizofrenie Nederland.

  • Van der Gaag, M., & Korrelboom, K. (2007a). Competitive Memory Training (COMET) Behandelprotocol voor overheersende stemmen. Therapeut werkboek. Oegstgeest: Cognitie en Psychose.

  • Van der Gaag, M., & Korrelboom, K. (2007b). Competitive Memory Training (COMET) Behandelprotocol voor overheersende stemmen. Werkboek patiënt. Oegstgeest: Cognitie en Psychose.

  • Wang, Q., Chan, R., Sun, J., Yao, J., Deng, W., Sun, X., et al. (2007). Reaction time of the Continuous Performance Test is an endophenotypic marker for schizophrenia: a study of first-episode neuroleptic-naive schizophrenia, their non-psychotic first-degree relatives and healthy population controls. Schizophr Res, 89(1-3), 293-298.

    Google Scholar 

  • Werkgroep Schizofrenie. (2005). Multidisciplinaire Richtlijn Schizofrenie. Houten: Ladenius Communicatie BV.

Download references

Author information

Authors and Affiliations

  1. www.bsl.nl/shop/tijdschrift-v-psychotherapie-0165-1188.html

    Mark van der Gaag

Authors
  1. Mark van der Gaag
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark van der Gaag.

Additional information

prof. dr. mark van der gaag is hoofdonderzoeker van Parnassia Psychiatrie te Den Haag en hoogleraar Klinische psychologie aan de Vrije Universiteit te Amsterdam.

Oude Haagweg 357, 2552 ES Den Haag.

About this article

Cite this article

van der Gaag, M. De ontwikkeling van een biopsychisch model van psychose. PSIE 34, 260–274 (2008). https://doi.org/10.1007/BF03078431

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03078431

Search

Navigation