Clinical Assessment and Decision

Making
 INDEX

Requirements........................................................................................................................... 3
Week 1...................................................................................................................................... 3
Lecture 1............................................................................................................................... 3
Lecture 2............................................................................................................................... 9
Kennistoets 1.......................................................................................................................... 13
Week 2.................................................................................................................................... 21
Lecture 3............................................................................................................................. 21
Week 3.................................................................................................................................... 26
Lecture 4............................................................................................................................. 26

2
Requirements
- Toetsen moet 70% goed van zijn  1 op 20 nov, 1 op 30 nov.
- Practicum  9 jan. Deadline
- Participatie  10%

Make a test after the 2nd and 4th college. (read manual for chapters).
Watch lectures back.
Go to the practicum meetings from week 47 on.

Week 1
Lecture 1
Clinical assessment
Synonyms of clinical assessment in mental health care are:
 Psychological assessment
 Psychodiagnostics

Assessment entails solving the problem of someone’s psychological disorder by making

decisions about its presentation, by formulating and testing hypotheses about what it is and
how it is caused, by gathering and integrating information from many sources.
o Shared decision-making process = When a clinician share his findings from
hypotheses with the client in a way that the relevant indications for treatment of care
ensue.

Psychological assessment:
Types of questions:
1. Classification
- E.g., Does the person have PTSD or dementia?
- Classification does NOT explain the classification.

2. Explanation
- E.g., why does the client refuse to eat? Which cognitive impairments underlie the
dysfunction?

3. Predication and indication

- What is the core of the symptomatology?
- E.g., will CGT help? Can the person live at home?
- Assessment answers these questions.

4. Evaluation
- Was the intervention successful?

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What you need for assessment:
- Knowledge about
 About psychopathplpgy and (neuro)psychological theory
 Instruments and their psychometric qualities
 Treatment protocols
 Care and support options

- Required skills
 (self) reflection
 Building therapeutic alliance
 Conversational skills
 Test skills

Roadmap for assessment

Important questions:
- Can you accept the referral? (based on time, problems, deficits)
- Is there an emergency?  immediate action/classification process with waiting-list.
- Is it useful to include an explanatory analysis (when classification is not clear
enough)?

The toolkit for assessment:

- Observation
 Look at behavior signs that go with psychopathology.
 The way the client presents symptoms (coherent or not?)

- Interview
 About current and past situations.
 Usually, structured interview

- Tests (instruments)
 Why use a specific test?
 Which test should you use?
 How to interpret the results?
 we have the COTAN database.

COTAN database
Stands for Dutch Committee on Tests and Testing (Commissie Testaangelegenheden van het
NIP)
Criteria:

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 - Availability
- Adaptation/translation for the Netherlands
- Standardization
- Validity (construct & criterion)
- Reliability
- Norms

Example: Wechsler Intelligence test for children (WISC-V-NL)

 items are the same in every culture.

 predicts school results.

Another example: Beck Depression inventory (BDI-2-NL)

Example: Rorschach test

Abnormality
- Cultural frame of reference is important.
 Views of abnormal vs. normal varies over the years.
 e.g., DSM-2 considered hemophilia as a disorder.

- Changing view on abnormality (like normalizing hemophilia) is not universal.

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You can interpret abnormality with a:

 ???

Disorders and personality

o Vulnerability hypothesis = certain personality traits make one vulnerable for the
development of disorders.
o Scar hypothesis = a specific disorder (e.g., autism) affects one’s personality.
o Spectrum hypothesis = personality and disorders to be considered a continuum

Referral stage
Usually the general practioner (GP) (huisarts) gives a referral.

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Presenting complaints
Goals of the first meeting:
- Find out what the complaints are
- Find out what the clients question is
- Shape the relationship:
 Be authentic
 Show empathy
 unconditional positive regard
- keep your own boundaries (transference = e.g., client falls in love with you /
countertransference = putting own feelings on patient, e.g., disliking patient)
- share expectations and provide information (shared-decision making)

phases in the roadmap:

- is there an emergency? (suicide risk, threat, health hazard)
 if yes, then act.

Compulsory mental healthcare

The compulsory mental healthcare act (dutch:Wvggz)
Applies to people in whom a psychological disorder results in behavior that can lead to
serious harm for themselves or for others. This can only be applied when voluntary care to
eliminate serious harm is not possible. It can only be imposed if it is:
- the only way of eliminating serious harm
- proportionate (not excessive for the serious harm that needs to be resolved)
- effective (yielding results)

this is not for people with intellectual disabilities or dementia

- the care and compulsion act applies to them (psychogeriatric and intellectually
disabled person)  in dutch Wzd.

Procedures:
The Wvggz has two procedures that can result in compulsory medical care:
- a care authorization via a judge (zorgmachtiging)
- a crisis measure via the mayor (crisismaatregel)
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classification
If we know the symptoms we can classify the disorder with for example:
- DSM-5-TR  most used
- ICD (International Statistical Classification of diseases and related health problems
 Classifies under a label (checklist)
 Label does not refer to an existing entity (consensus based) – syndrome vs.
disease.
 Heterogeneous categories

- Prototypes can lead to wrong classifications.

Classification
How to do it properly: using the Structured Clinical Interview for DSM-5 (SCID) to ensure all
possible disorders evaluated.
- SCID takes 45 min. – 2 hours

Shorter versions of the SCID:

- SCID-5-S questionnaire (self-report screening), 10-20 min.
- Mini international Neuropsychiatirc interview (MINI), takes 15-20 min.
 There are multiple kinds of MINI, depending on the symptoms.
- Short version have the risk of narrowing by ignoring other classifications.

Other risks of short versions:

- ‘just ticking boxes’  we need complex thinking.
- We have to take into account, gender, cultural diversity, age.

Case example:
31 year old man with learning difficulties. He got involved in criminal activities and spent
time in junivile detention. Started using cannabis at 13 and drinking alcohol. Has used
cocaine, GHB. Is now clean, expect alcohol and cannabis. He had difficulty keeping jobs.
Single with one daughter. He is now in addiction care. He stopped treatment and relapsed.
- Hypotheses= Substance use and addictive disorders + neurocognitive disorder,
development disorder etc.
- Now only putting labels on it, so more explanatory psychodiagnostics is required. By
only labeling you don’t now how these problems were caused.

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Lecture 2
Psychological assessment
Another way of representing symptoms and disorders: networks
- Statistical techniques are used to identity network structures among psychiatrics
symptoms from empirical data.

Network graph of the correlational relationships between 55 items (symptoms) of the

Comprehensive Psychopathological Rating Scale (CPRS) which form a 6-cluster structure.
Example:

-
- Comorbidity is accounted for
- Transdiagnostic
- Core vs. bridge symptoms accounted for.

In clinical practice however, this is not as easy to use. To apply it into clinical practice: HITOP:
Hierarchical taxonomy of psychopathology
- Model of how psychopathology works
- In the model, you go from a general (P) factore (suspectibility to develop disorder) to
specific symptoms like internalizing problems vs. external problems.

Advantages of HITOP:
- Look back at lecture slide HITOP
- No diagnosis only explanatory.

Disadvantages:
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 - Not complete (not all disorders included)

HITOP vs. DSM-5 approach

Zie lecture

Explanatory analysis
Is it useful:
- Yes, if:
 There is no standard for the diagnosed disorder
 There are several standard treatments for the diagnosed disorder.
 More than one disorder has been diagnosed.
 A (standard) treatment has already been implemented but has not worked.
 A classification at a descriptive level is non-informative (e.g.,
strength/weakness)
 You want to foster the therapeutic alliance.

- Otherwise: no  continue to Predication and Indication.

Explantion of disorders:
Plausible explanation for agoraphobia:
- “of course she developed agoraphobia after been robbed at gunpoint!”
- However, plausibility is NOT the same ad truth.
- Not everybody who is robbed developed agoraphobia
- Not everybody with agorapohobia was robbed.
 you need = more information, testing hypothesis, validating suspicion.

Very useful to use a story (narrative) by/about the client with the following characteristics:
1. It contains orientation, complication (unusual event), evaluation and conclusion.
2. Is told by someone else
3. Is about individual experiences
4. It contains extra, un-essential information
5. It help understand the storytellers experiences.
- So this helps to understand the client, but is not necessarily valid or reliable.

Explanation serves a goal of:

- Clinical utility (informs treatment choice, represents essentials
- Theoretical explanatory model of the identified problem  identify which elements
in the model apply to the client  draw up individual explanatory model.
A. Behavior
B. Factors
C. Explanatory mechanisms

Example: Bulimia Nervosa:

On behavioral level, bulimia nervosa is characterized by at least once a week during 3
months:

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 - Overeating or binge eating, with loss of control
- Purging, use of laxatives, excessive sporting, extreme weight loss.

Elements in individual model for Sophia with BN:

- Important question for treatment choice: which factors are modifiable?

Another example of explanatory model for patient A.B. earlier (substance use)

- Question: how can you test this?

Testing the explanatory model:

??

Prediction and indication

- Zie lecture

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Treatment protocol for BM

Systematic treatment selection

The systematic treatment selection takes into account:
- Characteristics of the client
- Client’s presenting complaints
- Clients preferences
- ‘best practice’
- Shared decision making

Shared decision making

Decision about treatment is made together;

The report
A report describes the finding of the assessment.
- Starts with referral question.

Form depends on context:

- Short vs. elaborate/extensive.
- As much as possible written for client.
- With appendix in table form

BAPD guidelines:
- Explicitly the ethics and evaluation of the process.
- Max 10 pages including references and raw test scores.

Conclusion

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Kennistoets 1

1.
 While protocols provide structured guidelines based on research, they may not account
for the unique characteristics and preferences of every individual. Human variability and
diverse circumstances mean that a rigid adherence to protocols may not always result in the
most effective treatment.

 correct answer = no, because treatment is an interpersonal process.

2.
 Explanation: The DSM is a classification system and diagnostic manual for mental health
disorders. It provides a common language and set of criteria for mental health professionals
to communicate about mental health conditions. While it includes diagnostic criteria, it is not
primarily focused on specific interventions or driven by a specific theoretical approach. It
serves as a standardized tool for clinicians to diagnose and categorize mental health
disorders based on observable symptoms and criteria.

3.
 Explanation: Focusing on protective factors acknowledges and reinforces the strengths
and resources that a client possesses, which can empower them in taking an active role in
their treatment. It emphasizes a positive and collaborative approach, fostering a sense of
agency and responsibility on the part of the client. This approach is consistent with a
strength-based perspective in therapy, promoting resilience and well-being.

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 4.
 Explanation: Self-report measures and clinical interviews serve different purposes in
psychological assessment. While self-reports provide valuable information about individuals'
subjective experiences, clinical interviews allow for a more dynamic and interactive
exploration of the client's issues. Both have their strengths and limitations, and the
integration of multiple sources of information, including self-reports and clinical interviews, is
often recommended for a comprehensive understanding of an individual's psychological
functioning. Therefore, it is not accurate to say that there is a "limited added value" of self-
report measures over clinical interviews, as each method contributes unique insights to the
assessment process.

5.
 Explanation: Explanatory models often consider different types of factors, and contextual
factors are typically considered to be relatively stable or unchangeable. Contextual factors
may include aspects of a person's environment, culture, or social circumstances that may
influence their mental health but are not easily altered. On the other hand, precipitating
factors (such as life events) and biological factors (such as genetics) are often seen as
contributors to mental health that may or may not be changeable, depending on the specific
circumstances. Psychological factors can also be subject to change through therapeutic
interventions and personal growth.

6.
 Explanation: Collaborative empiricism is a therapeutic approach that involves the
collaborative effort of both the clinician and the client to understand and make sense of the
client's experiences. It emphasizes the importance of jointly exploring and testing
hypotheses about thoughts, feelings, and behaviors. In the context of creating individual
explanatory models, collaborative empiricism encourages an open and shared dialogue
between the clinician and the client to co-construct a comprehensive understanding of the
client's concerns and experiences. This approach promotes a partnership in which both
parties contribute their expertise and perspectives to inform the therapeutic process.

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 7.
 Explanation: Systematic treatment selection involves considering various factors to
determine the most appropriate treatment for a particular client. The client's complaints, or
the specific issues they are presenting, are a crucial factor in this process. Other factors may
also be considered, such as the client's characteristics, preferences, and the available
evidence-based treatments. While the clinician's expertise is important, it is not the only
factor; the focus is on tailoring the treatment to the specific needs and concerns of the
individual client.

8.
 Explanation: Malingering refers to the intentional exaggeration, feigning, or dishonesty by
an individual about their symptoms or complaints, often for external motives such as gaining
secondary benefits like financial compensation, avoiding work, or obtaining medication. It
involves a deliberate attempt to deceive the assessor regarding the severity or nature of
symptoms. It is essential for clinicians to be aware of the possibility of malingering during
assessments, particularly in legal or compensation contexts.

9.
 Explanation: The 'scar' hypothesis suggests that experiencing a clinical syndrome or
mental health disorder can leave a lasting impact on an individual's personality development.
In other words, the challenges, stressors, or disruptions associated with a clinical syndrome
may contribute to the shaping of one's personality traits over time. This hypothesis
emphasizes the bidirectional influence between mental health and personality, suggesting
that clinical experiences can leave a "scar" on a person's personality development.

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 10.
 Explanation: In Pennington & Hastie's Story Model, the three principles are consistency,
coverage, and coherence. These principles help explain when a clinician is likely to have faith
in a client's story:
1) Consistency: The information provided by the client is consistent with other
information known or expected.
2) Coverage: The client's story is comprehensive and covers all the essential elements
and details expected in a coherent narrative.
3) Coherence: The story is logically and causally coherent, making sense in terms of the
events and experiences described.

"Uniqueness" is not typically identified as a separate principle in the Story Model. The focus
is on the three Cs: Consistency, Coverage, and Coherence.

 correct answer: consistency (it’s the same as coherence)

11.
 Explanation: In categorical representations of mental disorders, the three common
assumptions are:
- Homogeneity within categories: Assumes that individuals within a specific diagnostic
category share similar symptoms or characteristics.
- Mutually exclusive categories: Assumes that individuals can be placed into one and
only one diagnostic category.
- Clear distinction between disorder and normal behavior: Assumes that there is a
clear and distinct boundary between what is considered disordered and what is
considered normal behavior.
The idea that "a disorder is more or less present" is more consistent with dimensional
approaches, which consider mental health issues as existing on a continuum rather than in
discrete categories.

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 12.
 Explanation: In this context, "typical Borderliner" suggests a prototype or a stereotypical
representation of an individual with borderline personality traits. A prototype is a cognitive
representation or mental image of a category or concept, and in this case, it refers to a
perceived typical example of someone with characteristics associated with Borderline
Personality Disorder. Stigma, classification, and prejudice are related concepts but do not
directly capture the idea of a typical representation or prototype.

13.
 Explanation: The network approach is focused on understanding the relationships and
interactions between symptoms and disorders in a network structure. While it can inform
treatment strategies by identifying key symptoms or targets, it does not necessarily provide
concrete tools for a protocolized treatment. The network approach is more about
understanding the interconnectedness of symptoms and exploring dynamic relationships
within a system, rather than prescribing specific treatment protocols. Treatment decisions
often involve a combination of clinical judgment, empirical evidence, and individualized
considerations, which may be informed by the network approach but are not directly derived
from it.

14.
 Explanation:
- Reliability is concerned with the consistency or stability of test scores over time and
across different conditions. A reliable test produces consistent results when
administered under the same conditions.
- Validity is concerned with whether a test measures what it claims or intends to
measure. It assesses the accuracy of the inferences or interpretations made from the
test scores. A valid test accurately measures the construct or behavior it is intended
to measure.
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 15.
 Explanation: The question is seeking to predict the likely usefulness of Eye Movement
Desensitization and Reprocessing (EMDR) in a specific case of trauma. It is asking whether
EMDR will be beneficial in this particular situation, indicating a predictive element related to
the potential effectiveness of the intervention.

16.
 Explanation: In a polythetic classification system, individuals can be diagnosed with a
particular disorder even if they do not share the same set of symptoms. The diagnosis is
based on meeting a certain number of criteria from a list, allowing for variability in the
specific symptoms displayed by individuals with the same disorder label. This approach
recognizes the heterogeneity within diagnostic categories, acknowledging that different
individuals may manifest distinct symptoms yet still be classified under the same diagnostic
category.

17.
 Explanation: The client has both obsessive-compulsive disorder (OCD) and a minor
neurocognitive disorder following a traumatic brain injury. Recognizing that traumatic brain
injury is a somatic disorder is relevant because it involves physical damage to the brain and
can have implications for cognitive functioning and mental health. An explanatory analysis
would explore how the traumatic brain injury interacts with and influences the presentation
of OCD and the cognitive impairment. Understanding the interplay between these conditions

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is essential for developing a comprehensive treatment plan and addressing the client's
complex clinical picture.

 correct answer = Valid and reliable assessment of the symptoms is not possible.

18.
 Explanation: The empirical cycle is a systematic process used in scientific inquiry. It
typically involves the following steps:
1) Observation: Noticing and describing a phenomenon or pattern.
2) Induction: Formulating a hypothesis or generalization based on observed patterns.
3) Deduction: Deriving specific predictions or expectations from the general hypothesis.
4) Testing: Conducting experiments or gathering data to test the predictions.
5) Evaluation: Assessing the results of the tests and drawing conclusions about the
hypothesis.
This sequence reflects the iterative nature of scientific inquiry, where observations and
evaluations inform further hypotheses and testing.

19.
 Explanation: While a psychological assessment report typically includes demographic
variables, qualitative observations, and diagnostic information (such as DSM classification, if
applicable), it often does not include raw scores from psychological tests. Instead, the report
is more likely to present standardized scores, percentiles, or other derived scores that
facilitate interpretation. Raw scores alone may not provide meaningful information without
appropriate interpretation and context.

 correct answer = The report must contain a DSM classification

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 20.
 Explanation: An explanatory analysis is typically conducted when there is a need to
understand and explain complex clinical presentations, especially when more than one
disorder has been diagnosed, a treatment has already been implemented but has not
worked, or there is no standard treatment for the diagnosed disorder. The indication itself,
however, always requires an explanation or understanding, so it would not be a reason not to
conduct an explanatory analysis.

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Week 2
Lecture 3

2 failed attempts
(1)Prediction referral: which patients can go from basic MHC  to specilazed MHC
- There were clear predictive variables (suicidality, previous care, severity)
- Model to predict is insufficient
 Sensitivity too low
 Too many false negatives

(2) Prediction of long treatment duration:

- Clear predictive variables. (GAF, severity)
- Model to predict is insufficient:
 Sensitivity far too low
 Too many false negatives

So, what was overlooked in these two attempts?

 the decisions of the therapist (referral and treatment termination)

Decisions
Daniel Kahneman = consider decision as a product. Ask yourself, how is it made? And in
which context?

Clinical decision making

Many decisions need to be made in the assessment process:
- Can I accept the referral?
- Which classification fits the symptoms?
- Do I need an explanation?
- will this treatment work?
- What instruments should I use to test my hypothesis?

Why do we need tests or other instruments?

Decision making is often NOR a rational process. People make many systematic mistakes in:
- interpretation of research results
- assessing a diagnosis.
- Choosing an intervention

Why do we study decision making?

- To understand variability in decision making and inaccurate decisions
- To understand poor inter-rater reliability for assessment and diagnosis of
psychopathology

Dual process theory: System 1 and system 2

Dual process theory (also called system 1 and system 2.
System 1:
- Works automatically and quickly
- Based on impressions, intuitions, intentions, and feelings

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 - Requires little effort to use.
- Limited control.

System 2:
- Conscious attention for mental effort, the rational
- Requires a lot of energy and effort
- Is used to suppress/correct the impressions of system 1
- Provides self-control.

External influences in the decision process

- The clinician
- The setting
- The context of diagnostic reasoning
- The context of the client

These influences introduce biases.

Heuristics
It is hard to integrate many different cues
- People tend to use heuristics = cognitive simplification techniques (shortcuts)

Most important heuristics:

1. Representativeness = making judgement of similarity: “it looks like…”
2. Availability: using information, which is most available, most easy to remind.
3. Anchoring = adjusting an estimation to a given ‘anchor’.

Clinical decision making: heuristics

what is right/wrong with such heuristics?
- Right:
 Efficient
- Wrong:
 Potentially biased
 Imprecision (e.g., forgetting base rates)
 Commission (including irrelevant information)
 Omission (excluding relevant information)

Errors due to heuristics lead to biases.

Biases among clinicians:
1. Confirmation bias = only information that supports the referral is weighted
2. Hindsight bias = confirmation of a situation a posteriori, after the event  e.g., ‘of
course she stopped the treatment”
3. Overconfidence effect = excessive confidence in a positive test result by ignoring a
priori probabilities.

The clinician
The clinician has his/hers own;
- Background, own frame of reference

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 - Experience
- Understanding of the symptoms
- Fatigue

The setting and context

Research of primary care VS. specialist care VS clinic showed:
- GP and psychiatrist not only give different answers (treatment advices) because they
have different expertise, but also because they have different questions due to other
roles, and they use different clinical decision procedures.

Clinical decision making: is using clinical intuition wrong?

Clinicians are people, and therefore use:
- Heuristics = shortcuts through information, not taking everything into account, omit
aspects.
- Intuition = canned knowledge, automatic response, incorporates all aspects.
 Operate partially without people’s awareness and result in feelings, signals or
interpretations.

What drives people’s decision?

Expected utility theory = we are rational decision makers and should weight the utilities of
outcomes by their probability of occurrence.
- Economic models
- Based on the notion that people are utility maximisers.
- When making decisions, we know the outcome and we can weigh the outcome so we
know if we want to go through with the decision.

Kahneman & Tverky: the failure of Bernoulli

Kahneman & Tverky compare the Econs VS. Humans:
- Econs = rational (system 2)
 Decision based on probability of outcomes & maximizing utilites

- Humans = limited why thinking that what you see is all (System 1)
 Biases & heuristics.

Example

 their happiness is determined by change in wealth.

 difference in reference point

Kahneman & Tverky: the prospect theory

the fourfold pattern of risk attitudes depend on:

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 - Whether outcomes are gains or losses (in stead of property)
 Relative to a reference point
 More sensitivity to changes near the reference point
 Loss aversion
- Whether probabilities are small or medium-to large.

Example

- Expected value risky option 1: win €3200

- Expected value risky option 2: lose €3200
- People are have loss aversion.

Prospect theory:
4 kinds of emotions.

1. High probability of gain = risk aversion (fear of disappointment)

2. low probability of gain = risk seeking (hope for big profit)  lottery
3. high probability of loss = risk seeking (hope for avoidance of loss)
4. low probability of loss = risk aversion (fear of great loss)  insurance companies

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Prospect theory:

Summary:
- decision is a product of quasi-rational process (dual process theory)
- people use heuristics, shortcuts
 useful
 but leads to biases
- decision making under uncertainty is described by the prospect theory:
 gain VS. losses
 high VS. low probability

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Week 3
Lecture 4

Practicum bijeenkomst 1

ZSO 1.1
Samenvatting casus 1:
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Naomi, een 15-jarig meisje, ondergaat een psychiatrisch onderzoek wegens langdurige
verlegenheid. Ze ervaart constante spanning en vermijdt buitenshuis te praten, bang voor
oordelen en aanvallen. Het begon als plagen op de kleuterschool, escaleerde tot pesten in de
brugklas, met nachtmerries en suïcidale gedachten tot gevolg. Overgeplaatst naar een
nieuwe school verbeterde het pesten, maar haar angstsymptomen verergerden. Naomi zit
vaak 'opgesloten' thuis, vermijdt publieke ruimtes en worstelt met het idee van
zelfstandigheid. Ouders dachten dat verlegenheid zou overgaan, maar de ggz werd
ingeschakeld na beperkingen in prestaties en sociaal isolement op school.

Casus 1 – Verlegenheid in de adolescentie

1) Tot welke DSM-classificatie kom je?
Sociale Angststoornis (SAS)

2) Is hier sprake van een angststoornis of een depressieve stoornis? Licht je antwoord
toe.
Op basis van de beschrijving lijkt er voornamelijk sprake te zijn van een angststoornis,
met name sociale angststoornis. Hoewel er vermeldingen zijn van suïcidale
gedachten, lijken deze meer gerelateerd aan de sociale angst dan aan een
depressieve stoornis.

3) Er lijkt sprake van comorbiditeit. Naomi lijkt in aanmerking te komen voor een
cluster van drie DSM-5 classificaties, die vaak comorbide zijn. Aan welke andere
twee classificaties zou je kunnen denken? Licht je antwoord toe.
- Posttraumatische stressstoornis (PTSS), gezien Naomi wordt geplaagd en gepest op
school, wat kan leiden tot traumatische ervaringen.
- Mogelijk ook een aanpassingsstoornis (adjustment disorder), gezien de verandering
van school en de gevolgen daarvan op haar angstsymptomen.

4) Welke systemische factoren zouden een rol kunnen spelen bij het ontstaan en/of in
standhouden van de klachten?
- Gezinssituatie: De luidruchtige, assertieve moeder en de lange werkuren van de
succesvolle vader kunnen bijdragen aan de sociale druk op Naomi.
- Schoolomgeving: Pesten op de oude school en de overplaatsing naar een nieuwe
school hebben mogelijk invloed op haar symptomen.

5) De ouders hebben lang gewacht met het zoeken van hulp voor Naomi. Welke
heuristiek(en) zou(den) een rol gespeeld kunnen hebben bij het besluit geen hulp in
te roepen? Licht je antwoord toe.

Samenvatting casus 2

Casus 2 – Een kort lontje

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 1) Tot welke DSM-classificatie kom je?
2) Uit welke symptoomcategorieën vertoont de heer Reinhold symptomen?
3) Stel de heer Reinhold had zich niet gemeld bij een militaire ggz-instelling, maar een
gewone algemene ggz-instelling. Zou je dan eerder aan een andere classificatie
hebben gedacht? Waarom wel/niet?
4) Welke informatie mis je in deze casus?
5) Welke triggers kunnen een rol spelen bij de verergering van symptomen?
6) Op welke comorbide problematiek zou je bedacht kunnen zijn?

ZSO 1.2

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