Disclosure belangen spreker

Transcriptie

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2 Disclosure belangen spreker (potentiële) belangenverstrengeling Voor bijeenkomst mogelijk relevante relaties met bedrijven Sponsoring of onderzoeksgeld Honorarium of andere (financiële) vergoeding Aandeelhouder Andere relatie, namelijk Geen / Zie hieronder Bedrijfsnamen

3 50 jaar geleden Rümke: De basis van elke deskundige behandeling behoort de diagnose te zijn, dat is de theorie, die de dokter heeft opgesteld over de ziektetoestand waarin deze concrete patiënt zich bevindt.

4 50 jaar geleden Rümke: Wanneer het onderzoek zo compleet mogelijk is gedaan, is het onze eerste taak een diagnose te stellen. Het is in het algemeen raadzaam dit niet dadelijk te doen, wanneer wij tenminste over tijd beschikken en weten, dat de patiënt niet onmiddellijk in gevaar is.

5 50 jaar geleden Rümke: Hebben wij een zo uitgebreid mogelijk anamnestisch materiaal en de gegevens van ons onderzoek verzameld, dan trachten wij allereerst te weten te komen tot welke rubriek de patiënt behoort.

6 50 jaar geleden Rümke: Een rubriek is geen diagnose. Hebben wij vastgesteld in welke rubriek de patiënt behoort, dan weten wij in het algemeen iets over de patiënt, maar ontgaat ons nog al het individuele van deze concrete patiënt.

7 50 jaar geleden Sterk: veel aandacht voor het individuele aspect van de patiënt. Zwak: veel ruimte voor de individuele invulling van diagnostiek door de professional.

8 30 jaar geleden

9 30 jaar geleden Sterk: veel betere overeenstemming tussen professionals (maar nog altijd laag..). Zwak: weinig ruimte voor rechtdoen aan individuele variatie (afvink diagnostiek; rigide koppeling diagnostiek met behandeling DBC).

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11 Een jaar geleden

12 Clinical Case Formulation The case formulation for any given patient must involve a careful clinical history and concise summary of the social, psychological, and biological factors that may have contributed to developing a given mental disorder. Hence, it is not sufficient to simply check off the symptoms in the diagnostic criteria to make a mental disorder diagnosis. /../ The symptoms in our diagnostic criteria are part of the relatively limited repertoire of human emotional responses to internal and external stresses that are generally maintained in a homeostatic balance without a disruption in normal functioning. It requires clinical training to recognize when the combination of predisposing, precipitating, perpetuating, and protective factors has resulted in a psychopathological condition in which physical signs and symptoms exceed normal ranges. The ultimate goal of a clinical case formulation is to use the available contextual and diagnostic information in developing a comprehensive treatment plan that is informed by the individual s cultural and social context.

13 Clinical Case Formulation The case formulation for any given patient must involve a careful clinical history and concise summary of the social, psychological, and biological factors that may have contributed to developing a given mental disorder. Hence, it is not sufficient to simply check off the symptoms in the diagnostic criteria to make a mental disorder diagnosis. /../ The symptoms in our diagnostic criteria are part of the relatively limited repertoire of human emotional responses to internal and external stresses that are generally maintained in a homeostatic balance without a disruption in normal functioning. It requires clinical training to recognize when the combination of predisposing, precipitating, perpetuating, and protective factors has resulted in a psychopathological condition in which physical signs and symptoms exceed normal ranges. The ultimate goal of a clinical case formulation is to use the available contextual and diagnostic information in developing a comprehensive treatment plan that is informed by the individual s cultural and social context.

14 Need for treatment The diagnosis of a mental disorder should have clinical utility: it should help clinicians to determine prognosis, treatment plans, and potential treatment outcomes for their patients. However, the diagnosis of a mental disorder is not equivalent to a need for treatment. Need for treatment is a complex clinical decision that takes into consideration symptom severity, symptom salience (e.g., the presence of suicidal ideation), the patient s distress (mental pain) associated with the symptom(s), disability related to the patient s symptoms, risks and benefits of available treatments, and other factors (e.g., psychiatric symptoms complicating other illness). Clinicians may thus encounter individuals whose symptoms do not meet full criteria for a mental disorder but who demonstrate a clear need for treatment or care. The fact that some individuals do not show all symptoms indicative of a diagnosis should not be used to justify limiting their access to appropriate care.

15 Need for treatment The diagnosis of a mental disorder should have clinical utility: it should help clinicians to determine prognosis, treatment plans, and potential treatment outcomes for their patients. However, the diagnosis of a mental disorder is not equivalent to a need for treatment. Need for treatment is a complex clinical decision that takes into consideration symptom severity, symptom salience (e.g., the presence of suicidal ideation), the patient s distress (mental pain) associated with the symptom(s), disability related to the patient s symptoms, risks and benefits of available treatments, and other factors (e.g., psychiatric symptoms complicating other illness). Clinicians may thus encounter individuals whose symptoms do not meet full criteria for a mental disorder but who demonstrate a clear need for treatment or care. The fact that some individuals do not show all symptoms indicative of a diagnosis should not be used to justify limiting their access to appropriate care.

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