Substance Use Disorders and Antisocial Personality Disorder among a Sample of Incarcerated Individuals with Inadequate Health Care: Implications for Correctional Mental-Behavioural Health and Addiction Services.

Epidemiological estimates of substance use disorders (SUD) are critical for the planning of evidence-informed intervention and services. In this study, 250 incarcerated individuals in Nigeria were interviewed with the Mini International Neuropsychiatric Inventory (MINI) to diagnose SUD and antisocial personality disorder (ASPD). Most of the participants were males (97.6%), and the mean age was 35.4 (SD=13.5) years. Substance use disorder and ASPD were prevalent in 57.6% and 11.2% of the participants, respectively. Of those diagnosed with SUD, 35.2% and 22.4% had poly-SUD and mono-SUD respectively. Psychotic and dependence syndromes involving cannabis misuse were the most prevalent poly-SUD, and mono-SUD was characterized by alcohol, nicotine, and opioid dependence syndromes. Substance use disorder was more likely in participants charged with robbery and convicted, while ASPD was associated with prior and long-term imprisonment. There is a need for effective integration of treatment for ASPD/SUD into correctional mental health services in settings with inadequate health care using an appropriate model and a viable strategy.

[Psychosocial Characteristics of Adolescents Treated for Alcohol Intoxication in Emergency Departments]. / Psychosoziale Merkmale von Jugendlichen, die wegen einer Alkoholintoxikation im Krankenhaus behandelt wurden.

Psychosocial Characteristics of Adolescents Treated for Alcohol Intoxication in Emergency Departments In Germany, every year a substantial number of adolescents is treated in emergency departments for acute alcohol intoxication. Until now, only few studies have been published investigating psychosocial aspects in this group of adolescents. In the present study 316 adolescents were surveyed in the emergency department regarding their problematic use of alcohol and illicit drugs, their patterns of alcohol consumption, their alcohol-related and mental problems. We reported results for the whole sample. Additionally, the sample was divided in two groups based on the result in an established screening instrument for problematic alcohol use (CRAFFT-d). To compare the two groups we conducted unpaired t tests, chi-square tests and logistic regression analyses. Compared to the other group the adolescents exceeding the cut-off value of the CRAFFT-d reported a statistically significant higher past 30-day binge drinking frequency and number of standard-drinks consumed on a typical drinking occasion, more alcohol-related problems, more frequently a problematic use of illicit drugs and more mental problems (regarding antisocial behavior, anger control problems and self-esteem). Antisocial behavior was the most important factor for the affiliation to one of the two groups. The application of the screening instrument for problematic alcohol use (CRAFFT-d) in the emergency department seems to be a promising approach to identify adolescents with a general higher psychosocial burden.

[Non-medical applications for brain MRI: Ethical considerations]. / Applications non médicales de l'IRM cérébrale : considérations éthiques.

INTRODUCTION: The recent neuroimaging techniques offer the possibility to better understand complex cognitive processes that are involved in mental disorders and thus have become cornerstone tools for research in psychiatry. The performances of functional magnetic resonance imaging are not limited to medical research and are used in non-medical fields. These recent applications represent new challenges for bioethics. OBJECTIVE: In this article we aim at discussing the new ethical issues raised by the applications of the latest neuroimaging technologies to non-medical fields. METHODS: We included a selection of peer-reviewed English medical articles after a search on NCBI Pubmed database and Google scholar from 2000 to 2013. We screened bibliographical tables for supplementary references. Websites of governmental French institutions implicated in ethical questions were also screened for governmental reports. RESULTS: Findings of brain areas supporting emotional responses and regulation have been used for marketing research, also called neuromarketing. The discovery of different brain activation patterns in antisocial disorder has led to changes in forensic psychiatry with the use of imaging techniques with unproven validity. Automated classification algorithms and multivariate statistical analyses of brain images have been applied to brain-reading techniques, aiming at predicting unconscious neural processes in humans. We finally report the current position of the French legislation recently revised and discuss the technical limits of such techniques. DISCUSSION: In the near future, brain imaging could find clinical applications in psychiatry as diagnostic or predictive tools. However, the latest advances in brain imaging are also used in non-scientific fields raising key ethical questions. Involvement of neuroscientists, psychiatrists, physicians but also of citizens in neuroethics discussions is crucial to challenge the risk of unregulated uses of brain imaging.

Psychopathic traits in adolescence: a review / Traços psicopáticos na adolescência: uma revisão

Currently, and throughout the history of mental healthcare, the literature highlights that there is no agreement on the use of the terms "antisocial personality disorder" and "psychopathic personality". This paper aims to promote a debate over these concepts and their evaluation for both adults and adolescents. With this aim, a systematic review was conducted in the MedLine data base between 1968 and March 2011 using the terms "adolescent", "antisocial personality disorder", and "personality assessment". From the 59 identified articles 29 were selected to further analysis. The discussion of these terms was confirmed, as well as the importance of assessing psychopathic traits during adolescence. An initial tendency to disregard the term psychopathy and its affective implications was evidenced. However, the latest psychological instruments return to the discussion regarding the use of this diagnosis and its implications...

Atualmente e durante a história da saúde mental, encontram-se, na literatura, diferentes posicionamentos a respeito dos termos "transtorno de personalidade antissocial" e "personalidade psicopática". Este artigo tem como objetivo debater esses conceitos em relação a sua avaliação tanto na vida adulta como na adolescência. Para tal, foi realizada uma revisão sistemática na base de dados MedLine, de 1968 a março de 2011, cruzando os descritores "adolescente", "transtorno antissocial da personalidade" e "avaliação da personalidade". A partir dos 59 artigos identificados, foram selecionados 29 para serem analisados. A discussão dos termos é encontrada no material revisado, bem como a importância de identificação de traços de psicopatia na adolescência. Evidencia-se uma tendência inicial ao abandono do termo psicopatia e as alterações afetivas relacionadas a ela. No entanto, os instrumentos de avaliação psicológica mais recentes retomam a discussão desse diagnóstico e suas implicações...

Oxitocina-vasopresina: el futuro en tratamientos / Oxytocin-Vasopressin: the Future of Treatments

Las acciones de la oxitocina contemplan aspectos que incluyen la modulación de conductas destinadas al cuidado y crecimiento saludable de la descendencia. la oxitocina está relacionada con patrones sexuales y conducta maternal, actúa como neurotransmisor en el cerebro ejerciendo un papel esencial regulando el comportamiento social y afectivo. Investigaciones recientes demostraron que la oxitocina aumenta la empatía, facilita la conducta social, la confieanza hacia otros, y modifica la forma de procesamiento de las señales sociales, su codificación e interpretación, para así lograr una adecuada relación con pares. Estudios que apoyan el posible uso terapéutico de estas neurohormonas revelan datos alentadores al demostrar que mejoran la ansiedad social, que la oxitocina reduciría los síntomas psicóticos y disminuye déficit de la cognición social que no mejoran con tratamientos actuales. Por razones farmacocinéticas la vía de administración terpéutica es intranasal, lo cual aporta comodidad en su aplicación. Los trastornos psiquiátricos que se están investigando para evaluar el potencial beneficio del uso de estos neuropéptidos son esquizofrenia, trastornos del espectro autista, trastornos de ansiedad y estrés, y trastorno bordeline de la personalidad. El objetivo de esta revisión es actualizar avances en la investigación que sustentan la tuilización de estos neuropéptidos como propuesta terapéutica en psiquiatría

Oxytocin effects encompass aspects which include the modulation of behaviors intended for the care and healthy gowth of the offspring. Oxytocin is related to sexual patterns and maternal behavior and acts as a neurotransmitter in the brain, playing a key role in social and affective behavior. Recent studies have demonstrated that oxytocin increases empathy, facilitates social behavior, trust towards others, and also changes the way in which social signals are processed, as well as their coding and interpretation, thus leading to a suitable relationship with peers. Studies supporting the potential therapeutic use of these neurohormones reveal encouraging data by demonstrating that these imporve social anxiety, that oxyctocin might reduce psychotic symptoms and social cognitive deficit that do not imporve with the treatments aviable. For pharmacokinetics reasons, the route of administration of oxytocin is intranasal, which makes its application more comfortable. The psychiatric disorders which disorders that are currently being investigated to assess the potential benefit of oxytocin are schizophrenia, autistic spectrum disorders, anxiety disorders and stress, and bordeline personality disorder. The purpose of this review is to provide an updante on the investigations that justify the use of these neuropeptide as therapeutic treatment

Consideraciones sobre el fenómeno de la psicopatía en el contexto de las personalidades narcisistas / Considerations on the phenomenon of psychopathy in the context of narcissistic personalities

El presente trabajo tiene el objetivo de buscar explicaciones sobre el fenómeno de la psicopatía. Se revisan distintas definiciones de psicopatía y se discute la diferencia entre psicopatía y conducta antisocial. Se postula que a la base del fenómeno psicopático encontramos un narcisismo patológico particularmente agresivo. Se vincula esta psicopatología con el concepto de narcisismo destructivo de Rosenfeld. Los individuos psicopáticos tienden al acting out, se sienten en peligro por tener que vivir en relación a otro al cual no pueden controlar. En estas personalidades la omnipotencia infantil y las partes destructivas se encuentran idealizadas, y se construyen relaciones basadas en la explotación, el sadismo y la crueldad. Finalmente, se expone el tema de psicopatía y contratransferencia

This work aims to find explanations for psychopathic phenomenon. Several definitions of psychopathy are reviewed and the difference between psychopathy and antisocial behavior is discussed. I propose that a particularly aggressive and pathological narcissism is on the basis of the psychopathic phenomenon. This psychopathology is linked to Rosenfeld’s destructive narcissism concept. Psychopathic individuals have acting out tendency; they feel threatened by having to live in relation to another which they cannot control. In this type of personalities, infantile omnipotence and destructive parts of the self are idealized; they construct relationships based upon exploitation, sadism and cruelty. Finally, the theme of psychopathy and countertransference is exposed

Malignant Narcissism: from fairy tales to harsh reality.

INTRODUCTION: Malignant Narcissism has been recognized as a serious condition but it has been largely ignored in psychiatric literature and research. In order to bring this subject to the attention of mental health professionals, this paper presents a contemporary synthesis of the biopsychosocial dynamics and recommendations for treatment of Malignant Narcissism. METHODS: We reviewed the literature on Malignant Narcissism which was sparse. It was first described in psychiatry by Otto Kernberg in 1984. There have been few contributions to the literature since that time. We discovered that the syndrome of Malignant Narcissism was expressed in fairy tales as a part of the collective unconscious long before it was recognized by psychiatry. We searched for prominent malignant narcissists in recent history. We reviewed the literature on treatment and developed categories for family assessment. RESULTS: Malignant Narcissism is described as a core Narcissistic personality disorder, antisocial behavior, ego-syntonic sadism, and a paranoid orientation. There is no structured interview or self-report measure that identifies Malignant Narcissism and this interferes with research, clinical diagnosis and treatment. This paper presents a synthesis of current knowledge about Malignant Narcissism and proposes a foundation for treatment. CONCLUSIONS: Malignant Narcissism is a severe personality disorder that has devastating consequences for the family and society. It requires attention within the discipline of psychiatry and the social science community. We recommend treatment in a therapeutic community and a program of prevention that is focused on psychoeducation, not only in mental health professionals, but in the wider social community.

Psicopatía infanto-juvenil: avances en conceptualización, evaluación e intervención: [revisión] / Child and juvenile psychopathy: advances in conceptualization, assessment and intervention: [review]

Considerando las necesidades actuales presentes en el trabajo psicológico con adolescentes con problemas de adaptación social, este artículo realiza una revisión teórica actualizada sobre el constructo de psicopatía infanto-juvenil. Se abordan aspectos relacionados con la definición y extensión del constructo, los instrumentos de evaluación disponibles, los factores de riesgo y las perspectivas de tratamiento y prevención. En la discusión se ponderan las diferentes aproximaciones conceptuales, se plantea la conveniencia de desarrollar tanto instrumentos comprehensivos como de evaluación específica, ajustados a nuestro contexto sociocultural, y se destaca la necesidad de iniciar estudios sobre intervención que consideren las características de personalidad que están involucradas en el constructo.

Considering the current needs present in the psychological approach to adolescents with social adjustment problems, this article presents an actualized theoretical review about the construct of child and juvenile psychopathy. The topics included in the revision are the construct definition and extension, the tools for assessment that are available, the risk factors and different approaches to intervention. The discussion weights the different approaches to conceptualization, it points the convenience for studying general and specific assessments tools adjusted to our socio-cultural context, and it remarks the need for studying interventions that include the personality characteristics involved in the psychopathy construct.

Comorbidade com transtorno de personalidade antissocial: implicações para o tratamento da dependência química / Comorbid antisocial personality disorder: implications for treatment of chemical dependency

Introdução: O transtorno de personalidade antissocial (TPAS) e seu precursor no desenvolvimento, o transtorno de conduta (TC), são fortemente associados com transtornos por uso de substância. Estimativas da prevalência de TPAS em amostras clínicas de pacientes em tratamento para transtorno de uso de substância variam de 7 a 53%. Um diagnóstico de TPAS tem um impacto negativo no prognóstico dos transtornos por uso de substância. Objetivo: Explorar diferenças clínicas no padrão de uso e na gravidade de dependência química entre portadores de TPAS e não portadores que fazem tratamento em um Centro de Atenção Psicossocial para Álcool e Drogas (CAPS AD) e avaliar o impacto do TPAS na adesão ao tratamento após 12 semanas e 1 ano de tratamento. Métodos: Foram revisados prontuários do período de 1 ano (julho de 2008 a junho de 2009) e incluídos 213 pacientes com 18 anos ou mais que haviam respondido aos questionários ASI, ASSIST e MINI. Resultados: 20,2% dos pacientes (n=43) apresentaram o diagnóstico de TPAS e estes eram mais jovens, moraram na rua com mais frequência, faziam uso mais freqüente de maconha, cocaína e crack, apresentavam mais problemas legais, mais depressão maior, mais risco de suicídio e uma adesão menor ao tratamento após um ano. Não houve diferenças significativas quanto ao sexo, raça, estado civil, nível de escolaridade, comportamentos de risco, abusos ou agressões sofridos e uso de álcool. Conclusão: Intervenções terapêuticas que levem em consideração tais particularidades possivelmente aumentarão a adesão e o sucesso do tratamento. O tratamento para transtornos relacionados ao uso de substância pode ser visto como uma oportunidade para intervenções que visem à diminuição da ocorrência de atos antissociais.

NICE guidelines, clinical practice and antisocial personality disorder: the ethical implications of ontological uncertainty.

The British National Institute for Health and Clinical Excellence (NICE) has recently (28 January 2009) released new guidelines for the diagnosis, treatment and prevention of the psychiatric category antisocial personality disorder (ASPD). Evident in these recommendations is a broader ambiguity regarding the ontology of ASPD. Although, perhaps, a mundane feature of much of medicine, in this case, ontological uncertainty has significant ethical implications as a product of the profound consequences for an individual categorised with this disorder. This paper argues that in refraining from emphasising uncertainty, NICE risks reifying a controversial category. This is particularly problematical given that the guidelines recommend the identification of individuals "at risk" of raising antisocial children. Although this paper does not argue that NICE is "wrong" in any of its recommendations, more emphasis should have been placed on discussions of the ethical implications of diagnosis and treatment, especially given the multiple uncertainties associated with ASPD. It is proposed that these important issues be examined in more detail in revisions of existing NICE recommendations, and be included in upcoming guidance. This paper thus raises key questions regarding the place and role of ethics within the current and future remit of NICE.

No skin off my back: retribution deficits in psychopathic motives for punishment.

When deciding a criminal's punishment, people typically exhibit both retributive and consequentialist motives in their decision making, though retribution's role may be stronger. This study aimed to discern possible functions of retribution by examining a population predicted to be deficient in retributive drive. Participants who rated either high or low in psychopathic traits read stories about a homicide. These stories were designed to evoke both retribution and the consequentialist motive of behavior control by varying, respectively, criminal intent and likelihood of recidivism. The participants then recommended a length of confinement for the offender. Individuals high in psychopathic traits were uniquely insensitive to retributive cues, and they were particularly consequentialist in their punishment of criminal offenders. These results clarify aspects of psychopathic aggression and corroborate the hypothesis that retribution may stabilize cooperative behavior.

Transtornos de personalidade, psicopatia e serial killers / Personality disorders, psychopathy, and serial killers

OBJETIVO: Apresentar as características básicas dos diversos transtornos específicos de personalidade, mas centrando-se no transtorno de personalidade anti-social, fazendo sua diferenciação com psicopatia. O estudo ainda se propõe a abordar a figura do serial killer, apontando a presença de aspectos psicopáticos no homicídio seriado. MÉTODO: Uma revisão bibliográfica foi feita no sentido de se abordar convergências e divergências entre diversos autores sobre um assunto tão polêmico, sobretudo quanto à viabilidade de tratamento dessa clientela forense. RESULTADOS: Enquanto o transtorno de personalidade anti-social é um diagnóstico médico, pode-se entender o termo "psicopatia", pertencente à esfera psiquiátrico-forense, como um "diagnóstico legal". Não se pode falar ainda de tratamento eficaz para os chamados "serial killers". CONCLUSÃO: Os transtornos de personalidade, especialmente o tipo anti-social, representam ainda hoje um verdadeiro desafio para a psiquiatria forense. O local mais adequado e justo para seus portadores, bem como recomendação homogênea e padronizada de tratamento são questões ainda não respondidas

OBJECTIVE: To illustrate the basic characteristics of several specific personality disorders, focusing mainly in antisocial personality disorder. The differences between antisocial personality disorder and psychopathy are highlighted. Serial killers and its psychopathic aspects are also discussed.METHOD: A bibliographic review was completed in order to outline convergences and divergences among different authors about this controversial issue, especially those concerning the possibility of treatment.RESULTS: While anti-social personality disorder is a medical diagnosis, the term "psychopathy" (which belongs to the sphere of forensic psychiatry) may be understood as a "legal diagnosis". It is not still possible to identify an effective treatment for serial killers.CONCLUSION: Personality disorders, especially of the antisocial type, still represent a formidable challenge to forensic psychiatry today. Questions as yet unanswered include the best and most humane place for patients with this condition and the nature of a standardised treatment recommendation

Fire interest, fire setting and psychopathology in Australian children: a normative study.

OBJECTIVE: Child and adolescent fire setting is associated with a broad pattern of antisocial behaviour and is associated with huge costs to the Australian community. Assessment and treatment options have principally been tested in clinically referred or incarcerated children and adolescents. Little information is available about fire setting in normal populations and thus opportunities for screening and early intervention are not well developed. METHOD: In this study, a large sample of 4- to 9-year-old children were assessed using a seven-item fire interest history screen with other measures of antisocial behaviour, children's mental health, parenting style and quality and parenting stress. These were followed-up with parent and teacher report measures and a diagnostic interview at 12 months. RESULTS: The fire history screening tool demonstrated utility in screening for early signs of fire setting. Prevalences of fire interest, and match- and fire-play were low overall but consistently higher for boys than for girls across ages. As expected, fire setting was associated with parental stress and a range of antisocial behaviours including conduct problems, hyperactivity, cruelty to animals and thrill-seeking temperament. In girls, it was also associated with anxiety/depression problems. CONCLUSIONS: Fire behaviours in children are related to broader psychopathology and family stress, and can be effectively identified in young children using a brief screening measure.

Borderline personality disorder, antisocial personality disorder and risk-taking among heroin users: findings from the Australian Treatment Outcome Study (ATOS).

AIM: To determine the relationship between borderline personality disorder (BPD), antisocial personality disorder (ASPD) and harm among current heroin users. DESIGN: Cross-sectional survey. SETTING: Sydney, Australia. PARTICIPANTS: 615 current heroin users. FINDINGS: Forty-six percent met criteria for BPD, 71% for ASPD, and 38% met criteria for both diagnoses. ASPD was related to attempted suicide, lifetime overdose, polydrug use, depression and overall psychological distress. BPD was also related to each of these risk domains, and to needle risk and recent suicide as well. When analysed separately, both BPD and ASPD thus appeared to predict harm. For the purposes of further analysis, the relationships between BPD, ASPD and harm, the sample was divided into four independent diagnostic groups: no diagnosis (ND, 21%), ASPD only (ASPD, 33%), BPD only (BPD, 7%), ASPD plus BPD (DUAL, 38%). The division of the sample into four distinct diagnostic groups produced substantially different results. There were strong relationships between BPD and attempted suicide, needle sharing and psychopathology. In none of these domains did the ASPD group significantly differ from the ND group. Also, the levels of harm among the DUAL group were identical to BPD, suggesting no additive risk from ASPD. Thus, while initial analyses suggested an increased risk for ASPD patients for suicide and psychopathology, these relationships disappeared after BPD was taken into account. The only domain in which there appeared to be an additive risk for ASPD and BPD was heroin overdose. CONCLUSIONS: The extensive comorbidity between BPD and ASPD means that, unless BPD is controlled for, artefactual relationships may emerge between ASPD and harm.

Personalidad antisocial y trastorno de deficit de atención con hiperactividad en la infancia / Antisocial personality disorder and attention deficit hiperactivity disorder in chilhood

Se presenta un caso con diagnóstico de personalidad antisocial de acuerdo a los criterios del DSM III-R y antecedente de Déficit de Atención e hiperactividad en la infancia. Se revisa la literatura con referencia al tema y se plantean algunas interrogantes en torno a la identidad psicopatológica y etiopatogénica, y al tratamiento de este cuadro.

The authors present a patient with a diagnosis of Antisocial Personality Disorder according to DSM III-R criteria and a history of Attention Deficit Hiperactivity Disorder in childhood. They review the literature and pose some question regarding the psychopathological and etiopathogenic entity as well as comments about the treatment of this disorder.

Milieu therapy with the adolescent sociopath.

This paper defines sociopathy, presents current research experimentation being conducted and findings as to its causes and treatment. Also presented is a description of a milieu therapy program for the adolescent sociopath. Both preventive and active treatment methods in this program are discussed. The value of the milieu therapy approach is shown in its attempt to keep the adolescent sociopath engaged in constructive activities and relationships in order to overcome antisocial behavior patterns. With the failure of individual therapy alone to reinforce normal living patterns and overcome lack of socialization functions in the adolescent sociopath, a more comprehensive and effective approach is required. Such an approach is described in which the following are stressed: 1) prevention of incarceration, 2) prevention of rejection by parents, peers and teachers, 3) active treatment of hyperkinesis and specific learning disabilities, 4) utilization of "sponsors," and 5) multiple therapist (family, group, individual) programs.