Jaargang 30 (2010)
Nummer: 4
Artikel: 280

Samenvatting

In dit artikel wordt geschetst hoe postpsychotische demoralisatie en zelfstigmatisatie bij patiënten met schizofrenie te behandelen. Dit wordt geplaatst in de context van een cognitief model van demoralisatie. Hierbij ligt de nadruk op overdreven negatieve verwachtingen omtrent de eigen capaciteiten en sociale acceptatie. Deze verwachtingen vinden hun basis in de verliezen en cognitieve achteruitgang die patiënten hebben ondergaan, maar zijn desalniettemin vaak onrealistisch en werken vermijding en inactiviteit in de hand. Twee patiënten worden beschreven. Beiden hebben ziektebesef en ziekte-inzicht, maar zitten vast in een toestand van demoralisatie met zelfstigmatiserende ideeën. Bij beide patiënten werd vooruitgang geboekt door creatief cognitief-gedragstherapeutische technieken toe te passen. Het doel was niet herstel tot hun oorspronkelijk niveau van functioneren, maar om ze te helpen bij het doorbreken van isolatie en inactiviteit.

Summary

In this article a treatment is presented for post-psychotic demoralisation and self-stigmatization in patients with schizophrenia. This is placed within the context of a cognitive model of demoralisation. Its focus is on patients’ negative expectations concerning their capabilities and social exclusion. These expectations are based on experiences of loss, shame and cognitive deterioration. Yet, they are often unrealistic and lead to avoidance and inactivity. The treatments of two patients are described. Both have insight into their illness, but are trapped in a state of demoralisation and self-stigmatizing thought patterns. In both patients, progress was achieved by creatively using cognitive behavioural techniques. The goal was not to restore the patients to their old level of functioning, but rather to help them overcome isolation and inactivity.

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