Search

Purpose of Review: Antisocial personality disorder (ASPD) is a characterized by lifelong or recurrent behavioral problems that begin in childhood or early adolescence. This communication provides an overview on ASPD including findings from recent reviews and new research. Recent Findings: With regard to DSM-5's Section III Alternative Model of Personality Disorder criteria for ASPD, advocates point to the broader symptom coverage and harmonization with ICD-11; yet critics point to the lack of evidence for improved outcomes. A new report shows that antisocial individuals age faster than non-antisocial peers. ASPD has high heritability and newer molecular studies have found intriguing linkages to genes associated with crucial brain regions. A mentalization-based therapy model has been developed and early work shows promise. Summary: ASPD is common, widespread, and disruptive to individuals, families, and society. Chronic and lifelong, ASPD typically lessens in severity with advancing age. Assessment rests on the individual's history because there are no diagnostic tests. ASPD likely results from an interplay of genetic and environmental factors. Brain imaging studies have linked cortical dysfunction to antisocial behavior in crucial brain regions. Medication is sometimes targeted at the individual's aggression and irritability, but a more rational approach is to target co-occurring disorders. Cognitive-behavioral therapy and mentalization-based therapy models have been developed and are being studied. [ABSTRACT FROM AUTHOR]

Objective: Antisocial behavior and antisocial personality disorder (ASPD) cause serious harm to society and families. Ethnicity may have an impact on an individual’s antisocial behavior and the incidence of ASPD. Therefore, this study aimed to investigate the current status of antisocial behavior and ASPD among youth and its correlation with ethnicity in ethnic minority areas in China. Methods: A total of 2475 Chinese youth (1794 under 18 and 681 greater than or equal to 18) were recruited from December 1 to 30, 2021, in Yunnan, China. All participants completed a General Information Questionnaire and the Personality Diagnostic Questionnaire Fourth Edition Plus (PDQ-4+). Associations between antisocial behavior and ASPD and sociodemographic factors such as ethnicity were examined using binary logistic regression analysis. Results: The positive rate of antisocial behavior screening in youth was 5.4% (95% CI (confidence interval): 4.3-6.4), with a positive rate of ASPD screening of 4.4% (95% CI: 2.9-6.0). Male, single-child and maternal education level at senior high school and above were risk factors for positive antisocial behavior screening, while senior high school grade and medium subjective family economic status were protective factors for positive antisocial behavior screening. Being male and paternal educational background were risk factors for positive ASPD screening. Conclusion: This study found high rates of positive screening for antisocial behavior and ASPD in youth and no significant differences in ethnicity. These results can be used to inform personality development. [ABSTRACT FROM AUTHOR]

Human personality represents a set of psychological traits, permanent, specifically individual, built consciously or unconsciously. The dysfunction of personality structure integrates the inability of coherent representations about the self, the difficulty of interpersonal relationship and the failure of functional adaptation in the social environment. Antisocial personality disorder (TPA) can be confirmed from the age of 15 years old, in the presence of a conduct disorder diagnosis. The discrepancies between socioeconomic levels cause young people from disadvantaged backgrounds to develop frustrations and engage in antisocial behaviors: aggressive, abusive and manipulative. Characteristic of the antisocial is the deficiency of development of the Superego, the hypertrophied Ego and the beliefs of omnipotence, uniqueness and superiority. High levels of dopamine and low levels of serotonin biologically underpin the psycho-behavioral manifestations of extroversion and neuroticism, respectively, with addictive tendencies and marked impulsivity. The antisocial personality caricatures the human condition in terms of self-awareness and self-knowledge, norms of common sense, interpersonal relationships, and genuine moral values, thus distancing them from genuine happiness. [ABSTRACT FROM AUTHOR]

People who are managed by the National Probation Service and convicted of high risk offences will often meet criteria for antisocial personality disorder and have complex psychosocial needs; this group of people present with high risk behavior which may professionals have been reluctant to work with in the past who are associated with higher rates of recidivism. This study investigated the experiences of probation officers in managing people who meet the criteria for Anti Social Personality Disorder. Semi structured interviews were conducted with six participants to capture their experiences of working with this population, the challenges they faced, and coping mechanisms employed, through analysis using Interpretative Phenomenological Analysis (IPA). Three superordinate themes were identified which revealed participants internal feeling, strategies employed, and external challenges. They spoke about internal negative feelings, specifically feeling controlled, having mistrust, a lack of confidence, being overwhelmed with emotion, and experiencing a fear of risk behaviors. Other themes involved external pressures as well as different coping responses. Implications are discussed to help probation officers to understand this population, for the organization to support staff to work with challenging behaviors and prevent burn out, to enable positive outcomes, and for potentially reducing reoffending. [ABSTRACT FROM AUTHOR]

Background: Those with cooccurring antisocial personality disorder (ASPD) and borderline personality disorder (BPD) are reported to be highly psychopathic and to represent a severe challenge to treatment efforts. In a sample of such individuals, the effects of two treatments, mentalization‐based therapy (MBT) and the unified protocol (UP), were investigated on three outcomes: (i) the psychopathy trait domains of meanness, boldness and disinhibition proposed by the triarchic psychopathy model (TPM); (ii) antisocial and borderline symptom severity; and (iii) the severity of their common features including impulsivity, anger expression and self‐harm. Methods: Of 163 individuals with BPD + ASPD screened for eligibility, 55 were randomized to MBT treatment and 53 to UP treatment. Outcomes of treatment were assessed at 6‐month intervals to 36 months. Results: Short‐term reductions were seen following both treatments in traits of psychopathy, antisocial and borderline personality symptom severity, anger dysregulation, impulsivity and self‐harm, but both treatment groups showed almost complete relapse of symptoms at the 36‐month follow‐up. UP had more durable effects than MBT. Conclusions: Despite being a considerably shorter treatment, UP was at least as effective as MBT and in some respects superior. Remission of symptoms was not achieved by either treatment in the long term. Psychopathy and borderline/antisocial comorbidity with which it is associated are to some extent remediable through psychotherapy, but only in the short term. Clinical Implications: Patients with high levels of impulsivity and disinhibition are likely to relapse following psychotherapy and should be closely monitored after treatment. [ABSTRACT FROM AUTHOR]

Recent studies have consistently demonstrated that antisocial behaviors occur in online environments. Although online antisocial behavior has a long history, it appears to have become more widespread in recent years due to the widespread use of online social networks. Although there are established criteria and instruments assessing antisocial behavior there are few examining such behavior online. Therefore, the present study aimed to develop the Online Antisocial Personality Scale (OAPS). The OAPS was developed using the diagnostic criteria for antisocial personality disorder in DSM-5. The OAPS assesses antisocial behavior in online environments. The present study comprised 447 adolescents (219 girls and 228 boys) from four different samples. The measures used included the Online Antisocial Personality Scale (OAPS), E-Bullyıng Scale (E-BS), and Personality Belief Questionnaire-Short Form (PBQ-STF). The structural validity of OAPS was investigated with exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and criterion validity. When validity and reliability analysis of the OAPS are considered as a whole, it is concluded that the OAPS is a valid and reliable scale that assesses online antisocial personality among adolescents. [ABSTRACT FROM AUTHOR]

Abstract Background Visual impairment (VI) with comorbid mental disorders (MDs) are expected to have a major impact on people’s daily functioning, for which tailored support is needed. However, this has been barely investigated. Therefore, this study aimed to (1) determine the impact of VI and comorbid MDs on functioning in essential life domains, (2) gain insight into best-practices that are currently used to support this target group, and (3) determine strategies to optimize care in the future. Methods A four-step qualitative Delphi method was used to obtain input from 31 Dutch professionals who work with this target group (84% female, mean age 46 years, on average 11 years of experience in working with the target group). The Self-Sufficiency Matrices were used to determine the impact on various aspects of daily living, for people with VI and (1) autism spectrum disorder, (2) psychotic disorders, (3) obsessive-compulsive disorder, (4) antisocial personality disorder, (5) borderline personality disorder, (6) dependent personality disorder. Results Experts describe a frail and vulnerable population, in which the VI and MD often have a cumulative negative impact on people’s physical and mental health. People frequently experience anxiety, depression, fatigue and sleep disturbances. Also, many tend to neglect self-care and substance abuse is common. They often experience difficulty in trusting others while at the same time being dependent on them. Social interaction and relationships are complicated because of communication restrictions (e.g. no facial recognition) and social incompetence or withdrawal. Experts advise taking transdiagnostic factors into account, using evidence-based psychological treatment options based on an intermittent approach, and offering multidisciplinary care. They stress the importance of building trust, showing patience and empathy, stimulating empowerment, involving the informal network and building on positive experiences. Conclusion VI and comorbid MD have a major impact on people’s daily functioning on a mental, physical, social and environmental level. This study provides insight into best-practices to support this target group. According to experts, more research is needed which could be aimed at investigating tailored diagnostic approaches and treatment options and include clients’ perspectives.

Should offenders with psychopathy or those exhibiting extreme forms of antisocial behaviour be considered criminally responsible? The current debate seems to have reached a stalemate. Several scholars have argued that neuropsychological data on individuals with psychopathy might be relevant for determining their criminal responsibility. However, relying on such data has not produced a consensus among legal scholars and philosophers on whether individuals with psychopathy should be excused from responsibility. We offer a diagnosis about why this debate has reached a standoff. We argue that part of the problem is that psychopathy, being a syndrome-based category, is too heterogeneous and thus offers low prospects for being integrated with neuropsychological data that might support significant conclusions about the criminal responsibility of individuals with psychopathy. Moreover, the construct of psychopathy was not originally devised to discriminate criminally accountable from unaccountable antisocial individuals. To overcome these difficulties and advance the debate, we extend a currently less discussed theoretical framework for bridging biopsychology and the law that focuses on neuropsychological constructs, domains, and processes that directly measure capacities of offenders that are relevant for criminal responsibility, without necessarily relying on mediating syndrome-based constructs. The novelty of our contribution is that the biopsychological bases of exculpation can be further developed and used for determining more fine-grained categorisations of antisocial personality types. We show how this framework provides guidelines for interdisciplinary research that can significantly advance our understanding of the preconditions for criminal responsibility and help the legal practice of ascribing or withholding it. [ABSTRACT FROM AUTHOR]

Background Visual impairment (VI) with comorbid mental disorders (MDs) are expected to have a major impact on people’s daily functioning, for which tailored support is needed. However, this has been barely investigated. Therefore, this study aimed to (1) determine the impact of VI and comorbid MDs on functioning in essential life domains, (2) gain insight into best-practices that are currently used to support this target group, and (3) determine strategies to optimize care in the future. Methods A four-step qualitative Delphi method was used to obtain input from 31 Dutch professionals who work with this target group (84% female, mean age 46 years, on average 11 years of experience in working with the target group). The Self-Sufficiency Matrices were used to determine the impact on various aspects of daily living, for people with VI and (1) autism spectrum disorder, (2) psychotic disorders, (3) obsessive-compulsive disorder, (4) antisocial personality disorder, (5) borderline personality disorder, (6) dependent personality disorder. Results Experts describe a frail and vulnerable population, in which the VI and MD often have a cumulative negative impact on people’s physical and mental health. People frequently experience anxiety, depression, fatigue and sleep disturbances. Also, many tend to neglect self-care and substance abuse is common. They often experience difficulty in trusting others while at the same time being dependent on them. Social interaction and relationships are complicated because of communication restrictions (e.g. no facial recognition) and social incompetence or withdrawal. Experts advise taking transdiagnostic factors into account, using evidence-based psychological treatment options based on an intermittent approach, and offering multidisciplinary care. They stress the importance of building trust, showing patience and empathy, stimulating empowerment, involving the informal network and building on positive experiences. Conclusion VI and comorbid MD have a major impact on people’s daily functioning on a mental, physical, social and environmental level. This study provides insight into best-practices to support this target group. According to experts, more research is needed which could be aimed at investigating tailored diagnostic approaches and treatment options and include clients’ perspectives. [ABSTRACT FROM AUTHOR]

Antisocial personality disorder (ASPD) is associated with therapeutic pessimism among health professionals. Several variables are associated with obstacles in therapist's willingness to treat ASPD. Variables that are relevant are (i) confusion associated with the term ASPD, (ii) characteristics of the disorder, (iii) attitudes, experiences, and knowledge clinicians possess, and (iv) insufficient management of countertransference. We assume that therapeutic pessimism is related to the lack of evidence-based, effective treatment for individuals with ASPD. This is problematic because ASPD is associated with large socio-economic costs and considerable suffering for the individual and the society. Mentalization-based treatment (MBT) was developed in treating borderline personality disorder (BPD) and is now considered an effective treatment for this group. Mentalization is defined as the process by which individuals make sense of themselves and others in terms of subjective states and mental processes. This ability affects an individual's psychological functioning, mental health, self-organization, and interpersonal relationships. The overall goal of MBT is to strengthen the individual's mentalizing abilities and facilitate more adaptive handling of problematic, internal states. Recently, a version of MBT tailored for individuals with ASPD (MBT-ASPD) has been developed. The purpose of this review is to investigate how MBT-ASPD relates to the major obstacles that contribute to the therapeutic pessimism toward this group. Despite a limited evidence base, preliminary studies indicate promising results for MBT-ASPD. More research is still required, this review suggests MBT-ASPD can contribute to increased therapeutic optimism and demonstrate specific characteristics of MBT-ASPD that contribute to management of therapeutic pessimism. [ABSTRACT FROM AUTHOR]

Introduction: Dual diagnosis in individuals with cocaine use disorders (CUDs) presents a mental health challenge marked by an increased susceptibility to disabling morbidities and premature mortality. Despite extensive research on depression and anxiety, other prevalent comorbidities, such as psychotic and personality disorders, have received less attention. This study explores inflammation-related mediators as potential biomarkers for CUD and dual diagnosis with schizophrenia (SCZ) or antisocial personality disorder (APD). Methods: This exploratory study included 95 participants, comprising 40 healthy subjects and 55 abstinent patients with CUD. Lifetime CUD was diagnosed either as single diagnosis (CUD group, N = 25) or as a dual diagnosis (DD group. N = 30) with SCZ (CUD+SCZ subgroup) or APD (CUD+APD subgroup). Participants were clinically assessed, and the plasma concentrations of growth factors (i.e., G-CSF, BDNF, and VEGF-A) and chemokines (i.e., CCL11/eotaxin-1, CCL2/MCP-1, and CXCL12/SDF-1) were determined and log(10)-transformed for analysis. Results: Growth factors and chemokines were dysregulated by CUD and psychiatric diagnoses. Specifically, patients in the CUD group exhibited significantly lower concentrations of G-CSF and CCL11/eotaxin-1 than the control group. In contrast, the DD group showed significantly higher concentrations of all analytes than both the CUD and control groups. Additionally, no differences in these analytes were observed between the CUD+SCZ and CUD+APD subgroups within the DD group. Regarding cocaine-related variables, significant associations were identified in the CUD group: an inverse correlation between the age at first cocaine use and the concentrations of BDNF and CCL2/MCP-1; and a positive correlation between the duration of the cocaine abstinence and the concentrations of BDNF and CCL11/eotaxin-1. Lastly, a logistic regression model incorporating all these analytes demonstrated high discriminatory power in distinguishing patients with CUD alone from those with dual diagnosis. Conclusions: Individuals with dual diagnosis of CUD exhibit elevated concentrations of growth factors and chemokines, distinguishing them from those with CUD alone. It is unclear whether the differences in these inflammatory mediators are specific to the presence of SCZ and APD. The study highlights potential biomarkers and associations, providing valuable insights into the intricate interplay of CUD and psychiatric disorders to enhance clinical diagnosis and therapeutics. [ABSTRACT FROM AUTHOR]

This article covers a case of premeditated murder that occurred in a Hungarian city fifteen years ago. The perpetrators were juveniles, and investigations were conducted by the police, prosecutors, psychologists, forensic psychiatrists, and the court to determine the motive for the crime. However, no root cause was found that could be understood by human reason. The defendants only cited their annoyance with their third companion’s friendship. The article also discusses emotional intelligence disabilities and antisocial personality disorder. It covers the criminal verdicts and the reasons for the second-degree civil verdict in the non-pecuniary compensation case of the murdered 17-year-old boy’s parents. The civil judgment highlights the importance of parents teaching their children values such as mercy, grace, compassion, and pity as part of moral education. The article also covers the possibilities of prevention through teaching children skills such as managing their emotions for better frustration tolerance and anger management.

AimsTo describe the clinical course and symptom profile of DSM-IV Antisocial Personality Disorder (ASPD) and the syndrome of Adult Antisocial Behavior Syndrome (AABS) and determine if they differ based on sex and race.MethodsUsing questions from a validated semi-structured interview, data were gathered from 2 independent family studies in: 1) American Indians (AI), and 2) European Americans (EA), African Americans (AA) (total n = 7171) who reported antisocial symptoms.ResultsWithin these two samples 1148 (16%) individuals met ASPD criteria, 1932 (27%) met adult ASPD but not childhood conduct disorder (CD) (i.e., AABS). The clinical course of the antisocial behaviors studied did not differ based on race or sex; however, individual symptom counts, and age of onsets of those symptoms, were significantly different across the groups. Women reported fewer symptoms and at an older age (less fights, school suspensions/expulsions, arrests or jail time), than men but were more likely to run away from home. Those with ASPD vs. AABS had more symptoms overall including not experiencing remorse. AA and AI participants and those with ASPD, had more symptoms, and were more likely to be suspended/expelled from school and arrested at a younger age than EA.ConclusionIn these select samples, the order and sequence of antisocial behaviors did not differ by race, AASB vs. ASPD, or sex; however individual symptom endorsement did, with men (vs. women), those with ASPD (vs. AABS), AI and AA (vs. EA) reporting more suspensions/expulsions from school and arrests. This suggests further study of the possible role of race and sex in the consequences associated with antisocial syndromes is warranted.

There is sufficient evidence that the index-finger-to-ring-finger-ratio (2D:4D-ratio) is associated with testosterone and estrogen exposure during the fetal stage. More specifically, a lower 2D:4D-ratio (that is; a shorter index finger, compared to a longer ring finger) was associated with a prenatally higher testosterone and lower estrogen exposure during the first trimester of the fetal stage. At a behavioral level, among adults, a lower 2D:4D-ratio was associated with a higher competitive performance among both female and male professional athletes, and with personality traits such as higher scores for mental toughness, dark triad traits, and aggressive behavior, and internet use disorder. Here, we tested, if 2D:4D-ratios differed among three clinical samples of individuals with amphetamine use disorder (AUD), antisocial personality disorder (ASPD), or both AUD and ASPD (AUD + ASPD), and when compared to healthy controls. The sample consisted of 44 individuals (mean age: 32.95 years; 22.7% females) diagnosed either with AUD (n = 25), ASPD (n = 10) or both AUD + ASPD (n = 9), and of 36 healthy controls (mean age: 23.28; 25% females). After a thorough clinical assessment, participants provided the scans of their right-hand palm to measure the lengths of their index finger and ring finger. Further, participants with AUD, ASPD and both AUD + ASPD completed a series of self-rating questionnaires on Dark Triad traits, narcissism sensitivity, and intolerance of uncertainty. Compared to healthy controls, participants with AUD, ASPD, or AUD + ASPD showed statistically significantly lower 2D:4D-ratios. Participants with AUD + ASPD showed statistically significantly lowest 2D:4D-ratios, compared to participants with AUD and compared to healthy controls. For the clinical sample, a lower 2D:4D-ratio was associated with higher Dark Triad traits. 2D:4D-ratios were unrelated to narcissism sensitivity or intolerance of uncertainty. Higher scores for Dark Triad traits were associated with higher scores for narcissism sensitivity and intolerance of uncertainty. Compared to healthy controls, individuals with amphetamine use disorder and concomitant antisocial personality disorder (AUD + ASPD) appeared to have been exposed to particularly high prenatal testosterone and particularly low estrogen concentrations, which, at a behavioral level, might have led to a fast life history for immediate resource acquisition. [ABSTRACT FROM AUTHOR]

The genetic correlates of extreme impulsive violence are poorly understood, and there have been few studies that have characterized a large group of affected individuals both clinically and genetically. We performed whole exome sequencing (WES) in 290 males with the life‐course‐persistent, extremely impulsively violent form of antisocial personality disorder (APD) and analyzed the spectrum of rare protein‐truncating variants (rPTVs). Comparisons were made with 314 male controls and publicly available genotype data. Functional annotation tools were used for biological interpretation. Participants were significantly more likely to harbor rPTVs in genes that are intolerant to loss‐of‐function variants (odds ratio [OR] 2.06; p < 0.001), specifically expressed in brain (OR 2.80; p = 0.036) and enriched for those involved in neurotransmitter transport and synaptic processes. In 60 individuals (20%), we identified rPTVs that we classified as clinically relevant based on their clinical associations, biological function and gene expression patterns. Of these, 37 individuals harbored rPTVs in 23 genes that are associated with a monogenic neurological disorder, and 23 individuals harbored rPTVs in 20 genes reportedly intolerant to loss‐of‐function variants. The analysis presents evidence in support of a model where presence of either one or several private, functionally relevant mutations contribute significantly to individual risk of life‐course‐persistent APD and reveals multiple individuals who could be affected by clinically unrecognized neuropsychiatric Mendelian disease. Thus, Mendelian diseases and increased rPTV burden may represent important factors for the development of extremely impulsive violent life‐course‐persistent forms of APD irrespective of their clinical presentation. [ABSTRACT FROM AUTHOR]

Cocaine use could be modulated by drug expectancies based on previously experienced subjective effects. Some patients perceive a paradoxical calming effect after cocaine use. This study was performed to explore cocaine effect expectancies in patients diagnosed with cocaine use disorder, with and without co-occurring adult attention deficit hyperactivity disorder (ADHD). Secondly, we sought to empirically determine the presence of this paradoxical calming effect after cocaine use in patients with co-occurring adult ADHD to identify the individuals most at risk of cocaine use and relapse. Cross-sectional study using a consecutive sampling method of patients diagnosed with cocaine use disorder (n = 221) treated at public therapeutic communities in Andalusia (Spain). Participants completed a battery of instruments to assess the following variables: cocaine effect expectancies, paradoxical calming effect, adult ADHD, and other co-occurring psychiatric disorders. A multivariate binary logistic regression analysis showed that two variables, the paradoxical calming effect and antisocial personality disorder (ASPD), were independently associated with the probability of being diagnosed with adult ADHD (OR = 3.43, 95% CI = 1.88–6.26 and OR = 3.42, 95% CI = 1.30–8.95, respectively). The presence of a paradoxical calming reaction to cocaine and/or a diagnosis of ASPD in patients with cocaine use disorder increases the diagnostic suspicion of co-occurring adult ADHD. [ABSTRACT FROM AUTHOR]

Background: Cluster B personality disorders (PDs) are considered some of the most severe mental health conditions. Scarce evidence exists about the realworld utilization of psychotropics for cluster B PD individuals. Objective: We aimed to uncover trends and patterns of psychotropic medication use among individuals diagnosed with cluster B PD in the year before and after their diagnosis and to identify factors associated with medication use in a large cohort of individuals newly diagnosed with cluster B PDs. Methods: We conducted a population-based observational study using Quebec's health services register. We identified Quebec residents aged =14 years and insured with the provincial drug plan with a first diagnosis of cluster B PD recorded between April 1, 2002, and March 31, 2019. Cluster B PD was defined with ICD-9/10 diagnostic codes. We retrieved all claims for the main psychotropic medication classes: antipsychotics, antidepressants, anxiolytics, mood stabilizers, and attention-deficit/hyperactivity disorder (ADHD) medications. We calculated the proportion of individuals exposed to these medication classes and analyzed trends over the years using robust Poisson regression models, adjusting for potential confounders. We used robust Poisson regression to identify factors associated with medication class use. Results: We identified 87,778 new cases of cluster B PD, with a mean age of 44.5 years; 57.5% were women. Most frequent psychiatric comorbidities in the five years before cluster B PD diagnosis were depression (50.9%), anxiety (49.7%), and psychotic disorders (37.5%). Most individuals (71.0%) received at least one psychotropic during the year before cluster B PD diagnosis, and 78.5% received at least one of these medications in the subsequent year. The proportion of users increased after the diagnosis for antidepressants (51.6-54.7%), antipsychotics (35.9-45.2%), mood stabilizers (14.8-17.0%), and ADHD medications (5.1-5.9%), and remained relatively stable for anxiolytics (41.4-41.7%). Trends over time showed statistically significant increased use of antipsychotics and ADHD medications, decreased use of anxiolytics and mood stabilizers, and a stable use of antidepressants. Conclusion: Psychotropic medication use is highly prevalent among cluster B PD individuals. We observed an increase in medication use in the months following the diagnosis, particularly for antipsychotics, antidepressants, and mood stabilizers. [ABSTRACT FROM AUTHOR]

Antisocial Personality Disorder (APD) is a condition largely represented in detention centers where can reach a prevalence of 60% in male prisoners. The objective of this study is to identify the clinical and demographic factors that differentiate subjects with APD and hosted in penitentiary with respect to those are treated in outpatient psychiatric clinics. We recruited 65 male patients affected by APD, whose 26 were followed up in community mental health services and 39 were serving their sentence in a detention center located in Monza. Socio-demographic and clinical data were obtained through a review of the clinical charts, and interviews with patients or their relatives (if available). We performed descriptive analyses on the total sample, then we compared the two groups identified by the type of setting (outpatient clinic vs. penitentiary) by independent sample t tests (quantitative variables) or χ2 tests (qualitative ones). For qualitative variables odds ratios (OR s) were also calculated. Outpatients with APD (with respect to those hosted in the detention center) resulted: to be older (p =.02), to be less likely married (p =.01), to have more pre-onset psychiatric comorbidity (p =.05), to have more pre-onset substance poly-misuse (p =.01), to have more previous psychiatric hospitalizations (p <.01), and to be less likely to have received lifetime psychotherapy (p <.01). Globally, the results of this study show how the presence of psychiatric comorbidity or substance abuse (with the probable access to psychiatric services) before the onset of APD prevents imprisonment. This aspect is even more surprising when we consider that the two groups of patients show no differences in the frequency of crimes. Future research will have to confirm if early mental health care can really limit the access to penitentiary of subjects affected by APD. [ABSTRACT FROM AUTHOR]

The discussion about whether the ideas and/or actions of the so-called liberators of Hispanic America have been correct is a debate that continues in the academic field. In this sense, it is clarifying to include the psychological component in this discussion. The information about these self-proclaimed liberators helps to understand History in a holistic manner and to join the facts that are isolated in the official narrative. Motivation, as a basic psychological process, is essential to know the true motives of the acts carried out by these personalities. History is made by men and these men do not escape from the laws of the human psyche. In this sense, the present work points to a tentative diagnosis, not exempt from errors, on the personality of José de San Martín in order to be able to analyze in depth the events that occurred during the independence of the Hispano-American republics. [ABSTRACT FROM AUTHOR]

Objective: Developing good interpersonal relationships is one of the main impediments for people with an antisocial personality disorder (ASPD). However, in treatment of psychiatric disorders, establishing a strong therapeutic alliance (TA) is important for effective treatment. Nevertheless, there is little knowledge on how to establish this TA with this challenging patient group. This study investigates which factors are important in TA development. Method: For this study, a qualitative research methodology is applied. In‐depth interviews with therapists experienced in treating ASPD were conducted and analysed through thematic analysis. Results: The analysis revealed six themes important in alliance formation: the patient's needs, regulating interpersonal dynamics, connective attitude, connective skills, treatment process and treatment goals. Each theme is defined including aspects of the recommended therapeutic attitude and required skills for therapists working with patients with ASPD. Conclusions: This study determined that, for therapists working with patients with ASPD, several key factors are essential in establishing a strong TA. These factors include the ability to be firm, authentic, non‐judgmental and genuinely involved. An attentive presence is crucial, in which the therapist takes initiative in establishing contact and makes the patient feel that he is truly seen as an autonomous and equal person. In doing so, the therapist needs to provide clarity and structure while remaining perceptive to boundary violations. The therapist must be able to set limits using a clear yet kind tone of voice. Furthermore, it was notable that an intensive appeal is made to the therapist's reflective capacity in these treatments. [ABSTRACT FROM AUTHOR]

Antisocial personality is generally used to describe people who treat other people with callous disregard and disrespect. Although animal cruelty is diagnostic of conduct disorder, a precursor of antisocial personality in children, it is unclear whether the term antisocial also encompasses disregard and disrespect toward nonhuman animals among adults. In this study, we examined associations between three antianimal attitudes and behaviors-speciesism, hunting/fishing, and lack of sympathy for animal rights-and traits that underlie adult antisocial behavior. We found consistent links between antisocial personality traits and antianimal attitudes and behaviors in 2 samples. These effects were generally specific to traits linked to antisociality (although we also found associations with low openness), and these traits were stronger as predictors of variation among meat eaters than as predictors of differences between vegetarians and meat eaters. These results suggest that the term antisocial applies to negative attitudes and behaviors toward both humans and nonhuman animals and imply the potential value of considering antianimal attitudes and behaviors in the clinical assessment of antisocial personality. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Abstract Background Antisocial personality disorder (ASPD) is characterized by a lack of empathy, a sense of guiltlessness and shamelessness, as well as impulsiveness. ASPD is a relatively common psychiatric condition in the general population, whereas individuals with ASPD often have substantial social impairments and a lower quality of life, especially for those who have mental comorbidities. This review gives an overview of the etiological and clinical aspects of ASPD and critically examines ASPD from the structural, functional and biochemical perspectives. Results Twin and family studies showed genetic predisposition in ASPD. Some candidate genes associated with ASPD include SLC6A4, COMT, 5-HTR2A, TPH1, DRD2, OXTR, CACNG8, COL25A1 and several serotonergic genes. Environmental factors like adverse childhood experience (ACE) and active empathy deficits in toddlerhood play a role in the etiology of ASPD, whereas low intelligence or attainment, a large family size, a convicted parent, a disrupted family, and a young mother are predictors of antisocial personality. Structural abnormalities involving the corpus callosum, amygdala, putamen, anterior cingulate cortex, as well as orbitofrontal- and dorsolateral frontal cortices have been identified in ASPD. Other observed structural changes include a decrease in grey matter volume, whole-brain volume, and white matter volume and thickness. In addition, functional abnormalities involving autonomic activity, prefrontal functions, as well as brain functional networks like sensorimotor networks, cognitive networks and cortico-striatal connectivity have been reported. Biochemical factors associated with ASPD include fatty acid amide hydrolase (FAAH) reduction in the amygdala, as well as changes in plasma levels of inflammatory biomarkers and neurotropic factors [namely, tumor necrosis factor (TNF)-α, interleukin 10 (IL-10), transforming growth factor (TGF)-β1 and brain-derived neurotrophic factor (BNDF). Increased plasma levels of testosterone, ghrelin and cortisol and decreased levels of leptin have also been implicated in ASPD. Conclusions To date, there is no Food and Drug Administration (FDA) approved drugs for ASPD. Understanding the disease from different perspectives is important, as this provides insights into the underlying mechanisms of ASPD, whereas the associated biochemical markers can be used as potential diagnostic and treatment targets for ASPD.

This study aims to develop an up-to-date scale that can be used in the assessment of antisocial personality traits and to conduct validity and reliability studies. The Antisocial Personality Characterisitics Scale (APCS) items were developed by benefiting DSM-5 diagnostic criteria and various clinical descriptions. In the pilot application, the number of items was reduced to 22 as a result of the analysis applied to a data set of 171 individuals. In the main application, data were collected from a total of 794 university students and a community sample consisting of 555 females (69.9%) and 239 males (30.1%) aged 18-73 (27.72±9.61). Exploratory Factor Analysis (EFA) was conducted with the data of 387 participants, and Confirmatory Factor Analysis (CFA) was conducted with the data of 407 participants. According to the EFA conducted for construct validity, it was seen that the 17-item APCS, which had a 4-dimensional factor structure and explained 56.26% of the variance, had acceptable fit indices with only one modification in the CFA. Test-retest correlations were found between .72 and .89 and item-total correlations between .40 and .58. Cronbach's alpha values of the scale were between .67 and .76. In addition, as a result of the analyses conducted for convergent validity, the APCS had significant correlations with other scales. In conclusion, it was determined that the APCS, a scale developed in Turkish culture, is a valid and reliable scale with strong psychometric properties that can be used to assess antisocial personality traits and susceptibility to antisocial personality disorder.

Antisocial personality disorder (ASPD) is associated with therapeutic pessimism among health professionals. Several variables are associated with obstacles in therapist’s willingness to treat ASPD. Variables that are relevant are (i) confusion associated with the term ASPD, (ii) characteristics of the disorder, (iii) attitudes, experiences, and knowledge clinicians possess, and (iv) insufficient management of countertransference. We assume that therapeutic pessimism is related to the lack of evidence-based, effective treatment for individuals with ASPD. This is problematic because ASPD is associated with large socio-economic costs and considerable suffering for the individual and the society. Mentalization-based treatment (MBT) was developed in treating borderline personality disorder (BPD) and is now considered an effective treatment for this group. Mentalization is defined as the process by which individuals make sense of themselves and others in terms of subjective states and mental processes. This ability affects an individual’s psychological functioning, mental health, self-organization, and interpersonal relationships. The overall goal of MBT is to strengthen the individual’s mentalizing abilities and facilitate more adaptive handling of problematic, internal states. Recently, a version of MBT tailored for individuals with ASPD (MBT-ASPD) has been developed. The purpose of this review is to investigate how MBT-ASPD relates to the major obstacles that contribute to the therapeutic pessimism toward this group. Despite a limited evidence base, preliminary studies indicate promising results for MBT-ASPD. More research is still required, this review suggests MBT-ASPD can contribute to increased therapeutic optimism and demonstrate specific characteristics of MBT-ASPD that contribute to management of therapeutic pessimism.

Aims: Antisocial personality disorder (ASPD) and conduct disorder (CD) are characterized by a persistent pattern of violations of societal norms and others' rights. Ample evidence shows that the pathophysiology of these disorders is contributed by orbitofrontal cortex (OFC) alterations, yet the underlying molecular mechanisms remain elusive. To address this knowledge gap, we performed the first‐ever RNA sequencing study of postmortem OFC samples from subjects with a lifetime diagnosis of ASPD and/or CD. Methods: The transcriptomic profiles of OFC samples from subjects with ASPD and/or CD were compared to those of unaffected age‐matched controls (n = 9/group). Results: The OFC of ASPD/CD‐affected subjects displayed significant differences in the expression of 328 genes. Further gene‐ontology analyses revealed an extensive downregulation of excitatory neuron transcripts and upregulation of astrocyte transcripts. These alterations were paralleled by significant modifications in synaptic regulation and glutamatergic neurotransmission pathways. Conclusion: These preliminary findings suggest that ASPD and CD feature a complex array of functional deficits in the pyramidal neurons and astrocytes of the OFC. In turn, these aberrances may contribute to the reduced OFC connectivity observed in antisocial subjects. Future analyses on larger cohorts are needed to validate these results. [ABSTRACT FROM AUTHOR]

Purpose of Review: Despite significant negative outcomes, the co-occurrence of personality disorders (PDs) and substance use disorders (SUDs) continues to be underrecognized, and the mechanisms contributing to this co-occurrence remain unclear. This review summarizes recent work on PD-SUD co-occurrence, with a focus on borderline and antisocial PDs, general substance use patterns among those with PDs, and the association of personality traits with SUDs. Recent Findings: The prevalence of co-occurring PD-SUD is generally high, with estimates ranging depending on the type of PD and SUD, the population assessed, and the sampling methods and measures used. Current theoretical explanations for co-occurrence include shared etiology and predisposition models, with research highlighting the importance of transactional processes. Potential underlying mechanisms include personality traits and transdiagnostic characteristics. Summary: Recent research has increased focus on substances besides alcohol, dimensional models of personality pathology, and transactional explanations of co-occurrence, but more research is needed to disentangle the nuanced PD-SUD relationship. [ABSTRACT FROM AUTHOR]

Secure mental health services aim to assess and treat mentally disordered offenders, where a patients care pathway involves their movement from service to service on an individual journey towards recovery. Research has attempted to understand the relationship between psychosis and violence for mentally disordered offenders. From this empirical evidence base a tripartite typology has emerged. Three subgroups have been categorised as (i) schizophrenia preceded by conduct disorder (SZ+CD), (ii) offenders with schizophrenia who begin offending at illness onset (SZ+AS), and (iii) offenders with schizophrenia (SZ). This study aimed to examine differences in care pathways between subgroups. The sample consisted of 77 male patients admitted to low- and medium-secure care. The subgroup of patients was determined from data collected from health records. The analysis examined the differences in patient care pathways. The results demonstrated differences in subgroup pathways to, within and from secure services. The SZ+CD subgroup had a higher number of placements used, were more likely to transition between the same level of security, and had an increased use of the private sector. The SZ+AS subgroup was significantly more likely to use intensive care and less likely to use high secure services. Examining care pathways of mentally disordered offenders will ensure a more evidence-based approach to the configuration and operationalisation of services, help guide policymakers and hopefully improve patient care. [ABSTRACT FROM AUTHOR]

Section III of the fifth iteration of the Diagnostic and Statistical Manual of Mental Disorders (DSM -5) includes an alternative model of personality disorder diagnosis that conceptualizes antisocial personality disorder as an interpersonal, rather than behavioral, construct. However, the diagnostic specifier for psychopathy has been met with recent controversy due to its conceptual and empirical overlap with triarchic boldness, which has been debated as a necessary and sufficient domain of psychopathy. This study examined the concurrent, convergent, and discriminant validity of the specifier using canonical correlation analysis in samples of undergraduate students (N = 224) and community adults with prior criminal involvement (N = 306). Findings highlight the specifier as a multidimensional construct with divergent associations across its three facets. There was limited validity evidence for two of the three facets, raising concerns regarding the clinical utility of the psychopathy specifier. [ABSTRACT FROM AUTHOR]

Copyright of Turk Psikiyatri Dergisi is the property of Turk Psikiyatri Dergisi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)