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Victimization in psychosis

van der Stouwe, Elise

DOI:

10.33612/diss.98151981

IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from

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Publication date:

2019

Link to publication in University of Groningen/UMCG research database

Citation for published version (APA):

van der Stouwe, E. (2019). Victimization in psychosis: a body-oriented and social cognitive approach.

https://doi.org/10.33612/diss.98151981

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“Marja Krijnen was begin 20 toen ze geleidelijk wegdreef van de realiteit.

Onder druk van studie en familieproblemen begon ze stemmen te horen, zag

ze mensen die er niet waren en raakte ze in de ban van bizarre details, zoals

van teksten op auto’s als ‘Reparatiebedrijf Jansen & Jansen’. Ze werd eenzamer,

ongelukkiger en leefde meer en meer in een eigen wereld.

‘Ik voelde me heel kwetsbaar’, zegt Krijnen, nu in de 40. ‘Je schat situaties

verkeerd in en komt nauwelijks voor jezelf op. En dat straalt op één of andere

manier van je af, je bent vleugellam voor iedereen die kwaad in de zin heeft.

Om de stemmen te ontvluchten, nam ik soms lukraak een trein, zonder de

praktische consequenties te overzien. Eén keer strandde ik ’s nachts op het

station in Brussel, een vreselijke sfeer, ik ben daar aangerand. Een andere keer,

in Parijs, liep ik in een winkelstraat, toen een man me bij m’n arm greep en me

een hotel in sleurde. Ik bevroor en liet het allemaal gebeuren. Ik heb daarna

geen aangifte gedaan van seksueel misbruik. De grens tussen normaal en

abnormaal was ik uit het oog verloren.’

Niet lang daarna vond ze op een ochtend een baksteen in de woonkamer, de

ruit compleet aan diggelen. ‘Ik weet niet zeker of die steen voor mij persoonlijk

was bedoeld, maar een normaal mens zou de politie hebben gebeld en daarna

een glaszetter. Maar dat lukte mij allemaal niet. Het eerste wat ik dacht was:

wegwezen hier, ik trok de voordeur achter me dicht en ging naar mijn moeder.’

Over al deze incidenten sprak ze met niemand. ‘Uit schaamte, denk ik, en om de

schone schijn op te houden. Niemand mocht in de gaten krijgen dat het slecht

met me ging, want dan moest ik zelf ook erkennen dat mijn leven in puin lag.“

Bron: Timmermans, M. (2018, 8 juni). ‘Schizofreniepatiënten krijgen kickboksles om minder kwetsbaar te worden’. Volkskrant. https://www.volkskrant.nl/wetenschap/ schizofreniepatient-en-krijgen-kickboksles-om-minder-kwetsbaar-te-worden~bb143d35/

In films, in de krant en in andere media wordt vaak een link gelegd tussen psychose

en agressie of geweld. Maar in tegenstelling tot wat films als Shutter Island (waarin

de hoofdpersoon tijdens een psychose zijn vrouw vermoord) en nieuws over Bart

van U. doen vermoeden, zijn mensen met een diagnose in het psychose spectrum

veel vaker slachtoffer dan dader van een misdrijf (Bengtsson-Tops & Ehliasson,

2012; Dean et al., 2007). Hoewel dit een grote impact kan hebben op het leven van

deze mensen, is er op dit moment geen bewezen effectieve interventie voorhanden

om victimisatie te voorkomen. Daarom hebben we een psychomotorische

weerbaarheidstherapie ontwikkeld, gestoeld op in de literatuur beschreven mogelijke

risicofactoren voor victimisatie. In dit proefschrift hebben we met behulp van een

pilot studie gekeken naar de haalbaarheid van de therapie en vervolgens hebben

we door middel van een grootschalig gerandomiseerd onderzoek effecten op

gedragsniveau (geweldsincidenten, risicofactoren en generieke maten) onderzocht.

Daarnaast hebben we een fMRI studie uitgevoerd om meer zicht te krijgen op welke

hersengebieden of hersennetwerken geassocieerd zijn met victimisatie van mensen

met psychose, en wat het effect van de psychomotore therapie is op hersenniveau.

Omdat er in de therapie veel bewogen wordt hebben we eerdere onderzoeken naar

SamEnVaTTing

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het effect van fysieke activatie interventies op het brein van mensen met psychose en

gezonde mensen samengevoegd in een review.

BrEDErE ConTExT: hET nWo onDErzoEkSProgramma

Mensen met psychiatrische problematiek in het algemeen lopen een verhoogde

kans om slachtoffer te worden van geweld (Teplin et al., 2005). In een grootschalig

Nederlands epidemiologisch onderzoek rapporteerde bijvoorbeeld bijna de helft van

de deelnemers met chronische (> 2 jaar) psychose, bipolaire stoornis of depressieve

stoornis dat zij slachtoffer waren geweest in het voorgaande jaar (Kamperman et

al., 2014b). Bovendien liet een recente longitudinale studie zien dat psychiatrische

symptomen voorspellend waren voor het rapporteren van fysieke victimisatie (Bhavsar

et al., 2018). Omdat steeds meer onderzoek aantoont dat mensen met een psychische

diagnose vaak het slachtoffer zijn van geweld, zette de Nederlandse organisatie voor

Wetenschappelijk Onderzoek (NWO) in 2013 het onderzoeksprogramma ‘Geweld

tegen psychiatrische patiënten’ op. Het doel van dit programma is meer inzicht krijgen

in de aard van victimisatie, het in kaart brengen van de mogelijke risicofactoren en het

ontwikkelen en onderzoeken van interventies om victimisatie te voorkomen. Er zijn

vijf onderzoeksprojecten gehonoreerd, elk gefocust op een andere patiëntengroep:

de SOS studie voor mensen met een dubbele diagnose (de Waal et al., 2015), het

VICTORIA project voor mensen met ernstige psychiatrische aandoeningen (Albers et

al., 2018), de VRAPT studie voor mensen in de forensische psychiatrie (Klein Tuente

et al., 2018), het ALERT onderzoek bij mensen met een depressie (Christ et al., 2018b)

en de BEATVIC studie voor mensen met een diagnose in het psychose spectrum (E.C.D.

van der Stouwe et al., 2016). Dit proefschrift betreft de BEATVIC studie, gericht op

mensen met een psychotische kwetsbaarheid.

PSyChoSE

Volgens het handboek voor de classificatie van psychische stoornissen (DSM 5, APA)

worden diagnoses in het schizofrenie spectrum (zie tekstvak 1) gekenmerkt door

wanen en hallucinaties, negatieve symptomen en cognitieve problemen (van Os &

Kapur, 2009). Hallucinaties worden gedefinieerd als zintuigelijke waarnemingen in

de afwezigheid van een externe stimulus (b.v. zoals het horen van stemmen terwijl er

niemand praat). Wanen betreffen uiterst stellige overtuigingen die meestal berusten

op een misinterpretatie van waarnemingen of ervaringen (zoals het gevoel hebben

dat je achtervolgd wordt of dat boodschappen op televisie speciaal voor jou zijn

bedoeld), die niet kunnen worden begrepen op basis van iemands sociale of culturele

achtergrond. Meer dan de helft van de patiënten met een psychotische aandoening

heeft last van zogenaamde negatieve symptomen: verschijnselen, gedragingen of

gevoelens die minder (of helemaal niet meer) aanwezig zijn (Patel, Jayatilleke, Jackson,

Stewart, & Mcguire, 2014; Tsapakis, Dimopoulou, & Tarazi, 2015). Voorbeelden hiervan

zijn: geen plezier meer beleven aan dingen die je vroeger wel leuk vond (anhedonie),

geen initiatief meer kunnen nemen en geen motivatie meer hebben om betekenisvolle

doelen na te streven (avolitie) en verminderde spraak (alogie). Daarnaast krijgen

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