Samenvatting

ALCOHOL, COGNITION, AND ILLNESS-INSIGHT: ASSESSMENT AND TREATMENT
S.J.W. WALVOORT, P.T. VAN DER HEIJDEN, R.P.C. KESSELS, J.I.M. EGGER
Chronic alcohol use as well as acute alcohol withdrawal may bias self-evaluation and the outcome of self-report questionnaires in two ways. First, withdrawal effects of alcohol during abstinence may cause psychological and somatic discomfort which are difficult to distinguish from other forms of (comorbid) psychopathology. Second, chronic alcohol use may lead to cognitive dysfunction and impaired illness insight affecting the quality of self-evaluations with questionnaires. The effects of alcohol withdrawal and alcohol abstinence, the effects of underlying cognitive dysfunction and impaired illness-insight, and clinical implications on the clinical picture will be discussed in this paper.


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Serge Walvoort en collega’s besteden aandacht aan de neurocognitieve stoornissen die voorkomen bij patiënten die in behandeling zijn voor stoornissen in het gebruik van alcohol (Alcohol Use Disorders; AUD). Ze gaan in op de gevolgen van alcoholonttrekking en de invloed hiervan op het diagnostisch proces en bespreken de implicaties voor de indicatiestelling en behandeling. ‘Cognitieve stoornissen en een verminderd ziekte-inzicht maken dat patiënten zelfrapportagevragenlijsten vaak als ‘probleemloos’ invullen.’

Neurocognitieve stoornissen bij patiénten met AUD

Jarenlang overmatig alcoholgebruik met daarbij een slecht en onregelmatig eetpatroon kan leiden tot stoornissen in het cognitief functioneren (Crews et al., 2005; Harper, 2009; Kalivas & Volkow, 2005; McCrady & Smith, 1986; Oscar- Berman & Marinkovic, 2007)16253152. Een alcoholinname van meer dan 21 glazen per week blijkt een risicofactor te zijn voor het ontwikkelen van neurocognitieve stoornissen door alcohol (Jue & Schilt, 2009)24. Geschat wordt dat er bij ongeveer de helft van de patiënten met Alcohol Use Disorders (AUD), sprake is van neurocognitieve stoornissen ten gevolge van het alcoholgebruik (Bruijnen et al., 2016)12. Deze neurocognitieve stoornissen kunnen optreden ruim voordat neurologische verschijnselen, zoals loopstoornissen, oogbewegingsstoornissen en verwardheid, zichtbaar zijn. Bij ongeveer tien procent van de patiënten met AUD is sprake van ernstige neurocognitieve stoornissen, bijvoorbeeld het syndroom van Korsakov (Rourke & Grant, 2009; Dry et al., 2012)1940. Bij patiënten met een dergelijke

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