Antisocial Personality Disorder

Psychiatric topic.Useful for all mbbs undergraduates.

1. ANTI-SOCIAL PERSONALITY DISORDER PRESENTATION BY : TV AKHIL MODERATOR: DR RICHA

2. CONTENTS INTRODUCTION EPIDEMIOLOGY CAUSES RISK FACTORS SYMPTOMS DIAGNOSIS TREATMENT COMPLICATIONS PREVENTION

3. INTRODUCTION Antisocial personality disorder is a condition in which people show a pervasive disregard for the law and the rights of others. It is a mental health condition in which a person has a long-term pattern of manipulating, exploiting, or violating the rights of others. This behaviour is often criminal. People may tend to lie or steal and often fail to fulfil job or parenting responsibilities. The "sociopath" and "psychopath" are sometimes used to describe a person.

4. EPIDEMIOLOGY Prevalence rates of 3% for males and 1% females in general population. As noted in DSM-5, there has been some concern that this disorder may be under diagnosed in females, given the emphasis on aggressive items in diagnosing Conduct disorder. High frequency is associated with low socioeconomic status and urban settings.

5. CAUSES The exact causes are unknown, but experts believe that both hereditary factors and environmental circumstances influence development of the condition. A family history of the disorder — such as having an antisocial parent — increases the chances of developing the condition. A number of environmental factors within the childhood home, school and community also may contribute.

6. Both adopted and biological children of parents with ASPD are at a increased risk for this disorder. Conduct disorder (before the age of 10 years) and accompanying ADHD increase the likelihood of developing ASPD in adult life. Conduct disorder is more likely to develop into Antisocial disorder with erratic parenting, neglect , or inconsistent parental discipline.

7. Abnormal brain function and serotonin have been linked with impulsive behaviour. Because both the temporal lobes and prefrontal cortex help regulate mood and behaviour, it is possible that ASP behaviour stems from functional abnormality in the serotonin. Brain differences reveals reduced activity in the frontal lobes. NORMAL MURDERER

8. An unstable or abuse during childhood may contribute to ASPD. The lack of emotional bonding at a young age can damage a persons ability to form intimate and trusting relationships in the future, causing them to view others solely as objects or victims.

9. RISK FACTORS Having suffered from child abuse Having a childhood environment of deprivation or neglect Having an antisocial parent Having an alcoholic parent Being involved in a group of peers that exhibit antisocial behaviour Having an attention-deficit disorder Having a reading disorder

10. SYMPTOMS The classic person with an antisocial personality is indifferent to the needs of others and may manipulate through deceit or intimidation. They are usually loners. Aggressive and violent and are likely to have frequent encounters with the law. Some may also possess a considerable amount of charm and wit.

11. A persistent agitated or depressed feeling ( dysphoria ) Disregard for the safety of self or others. A childhood diagnosis of conduct disorders. Lack of remorse for hurting others. A sense of extreme entitlement . Inability to make or keep friends.

12. CLINICAL CRITERIA The hallmarks of ASPD are pervasive disregard for and violation of rights of others occurring since the age of 15 years and continuing into adulthood . A person has to be 18 years of age or older , and there has to be evidence of conduct disorder before the age of 15 years.

13. DIAGNOSIS Diagnostic features includes at least 3 of the following- 1.) Failure to conform to social norms (resulting in frequent arrests) 2.) Deceitfulness, including lying and conning others for personal profit or pleasure. 3.) Impulsivity or failure to plan ahead.. 4.) Recklessness, with disregard for safety of self and others. 5.) Lack of remorse, indicated by indifference or rationalising having hurt, mistreated, or stolen from others.

14. Some of the associated features include the following : Promiscuity and inability to sustain a monogamous relationship. Lack of empathy, cynicism, contempt for feelings, rights or suffering of others. Inflated and arrogant self-appraisal. Abusiveness and irresponsibility towards children.

15. DIFFRENTIAL DIAGNOSIS Narcissistic Personality Disorder- rarely manifests serious criminality, aggression and deficit and is characterised by excessive need for admiration from others. Histrionic Personality Disorder- includes seductiveness , attention seeking and rarely serious criminality and aggressiveness. Paranoid Personality disorder- includes suspiciousness, guarded attitude.

16. TREATMENT Typically ineffective. Control of behaviour ( Hospitalization/Imprisonment ). Control of Substance abuse. Mood Stabilizers- Lithium, Carbamezepine and Sodium V alporate can reduce impulsiveness and aggression. Anti Depressants- Fluoxetine can help with the mood and emotional difficulties that they have. Unfortunately, many people with antisocial personality disorder don't take their medications as prescribed.

17. Cognitive Behavioural Therapy- it identifies the distortions and engages the patient in efforts to reformulate perceptions and behaviour. Psychotherapy- is often difficult if not impossible. This therapy can help people to develop appropriate interpersonal skills and instill a moral code. Group Therapy- allows interpersonal psychopathology to display itself among peer patients where feedback is used by the therapist to identify and correct maladaptive ideas.

18. COMPLICATIONS Dying from a physical trauma, such as an accident. Drug and alcohol abuse. Low tolerance for boredom. Suicide Homicide Other mental disorders- BPAD ,Anxiety disorders, Impulse control disorders. Committing serious crimes that may result in imprisonment.

19. PREVENTION Because antisocial behaviour has its roots in early adolescence, early intervention may help diminish the development of problem behaviours. These may include: - Providing clear rules for conduct and discipline. - Minimizing academic failures. -Being consistent in applying consequences for bad behaviours. - Teaching respect for others with ethnic, cultural diffrences . -Teaching critical social and interpersonal skills. - Teaching respect for others with ethnic, cultural or other differences.

20. REFERENCES KAPLAN AND SADOCK'S COMPREHENSIVE TEXTBOOK OF PSYCHIATRY-10TH EDITION Psychcentral.com Medicinet.com Webmd.com Allpsych.com