Symptoms and Main Differences Between a Psychopath and a Sociopath.

ABSTRACT: The research relevance is predefined by the fact that, in modern psychology and psychiatry, the concepts of psychopathy and sociopathy are combined and interchanged. These are two concepts that describe different etiologies of the same mental health condition. The research aims to describe in detail the main manifestations and characteristics of personality disorders (psychopathy and sociopathy) in psychiatry and psychology. The research analyzes the main features and manifestations of sociopathy and psychopathy. It examines the work of psychologists, psychiatrists, neurologists, and neurosurgeons in helping sociopaths and psychopaths. The study also explores the challenges of treating antisocial personality disorders and identifies internal and external factors that influence the development of these conditions. In addition, the article emphasizes the behavioral differences between sociopaths and psychopaths, proposes various methods for integrated therapy, diagnoses the main aspects of these disorders, and highlights the importance of psychiatric care and psychotherapeutic interventions. The research is of theoretical and practical value for psychologists, psychoanalysts, and physicians who can help people with these pathologies of personal development.

Effects of two treatments on interpersonal, affective, and lifestyle features of psychopathy and emotion dysregulation.

This study investigated the relative efficacy of Mentalization-based therapy (MBT) and United Protocol (UP) in reducing symptoms of psychopathy and emotion dysregulation in a sample of Iranian community residents with concurrent diagnoses of antisocial and borderline personality disorders (PDs). Interpersonal, affective, and lifestyle features of psychopathy were measured post-treatment and at 6-, 12-, 18-, 24-, and 36-months follow-up using the 13-item version of the Psychopathy Revised-Checklist (PCL-R), which excluded, by design, criminal history features. Emotion dysregulation was measured using the Deficits in Emotion Regulation Scale (DERS) developed by Gratz and Roemer (2004). After treatment, both UP- and MBT-treated individuals showed significantly fewer features of psychopathy and significantly less emotion dysregulation. Compared with those treated with MBT, UP-treated individuals showed significantly less emotion dysregulation in all DERS subscales and a greater reduction in psychopathy features, particularly affective features. It is suggested that this likely reflected the particular emphasis placed by UP on improving emotional self-regulation and facilitating the therapeutic alliance. These results suggest that, despite the traditional pessimism that surrounds psychopathic individuals' treatability, they can be successfully treated.

The Spanish Short Dark Tetrad (SD4): Association With Personality and Psychological Problems / El Cuestionario Corto de la Tétrada Oscura (SD4) en Español: Asociación con la Personalidad y los Problemas Psicológicos

Background: The Short Dark Tetrad (SD4) is a recently developed instrument for assessing the “dark” personality traits of psychopathy, narcissism, Machiavellianism, and sadism. We aimed to examine the SD4’s psychometric properties, adapting it into Spanish and exploring its structure, gender invariance, reliability, concurrent validity, and nomological network. Method: A sample of 668 adults (Mage = 26.36, SD = 10.64, 69.2% females) completed the SD4 and other self-report questionnaires. Results: The results demonstrated sound indices of reliability and concurrent validity, an adequate four-factor structure, and support for gender invariance. Furthermore, most of the findings about the nomological network were in line with prior hypotheses: All four SD4 scales were associated with low levels of agreeableness and antagonism; psychopathy was also related to low conscientiousness, disinhibition and impulse-control problems; narcissism was positively associated with extraversion and negatively associated with internalizing symptoms; Machiavellianism was uncorrelated with impulsivity- related problems, which made it distinct from the psychopathy profile; finally, sadism showed a similar pattern of associations to psychopathy, albeit less strongly linked to impulsivity problems and externalizing behavior. Conclusions: Overall, the SD4 presents sound psychometric properties, although the overlap between psychopathy and sadism warrants some caution.(AU)

Antecedentes: El Short Dark Tetrad (SD4) es un instrumento recientemente desarrollado para evaluar los rasgos “oscuros” de personalidad de psicopatía, narcisismo, maquiavelismo y sadismo. Nuestro objetivo fue profundizar en las propiedades psicométricas del SD4 adaptando el instrumento al español, y examinar su estructura, invariancia de género, fiabilidad, validez concurrente y red nomológica. Método: Una muestra de 668 adultos (Medad = 26,36, SD = 10,64, 69,2% mujeres) completaron el SD4 y otros cuestionarios. Resultados: Encontramos índices apropiados de fiabilidad y validez concurrente, una estructura de cuatro factores, y apoyo a la invariancia de género. Además, los hallazgos sobre la red nomológica estuvieron mayoritariamente en línea con las hipótesis prerregistradas: las cuatro escalas SD4 se asociaron con baja amabilidad y antagonismo; la psicopatía se relacionó con baja responsabilidad, desinhibición y problemas de impulsividad; el narcisismo se asoció con extraversión y negativamente con síntomas de interiorización; el maquiavelismo no correlacionó con problemas de impulsividad, por lo que mostró un perfil diferenciado al de psicopatía; el sadismo mostró un patrón de asociaciones similar a psicopatía, aunque menos vinculado a problemas de impulsividad y comportamientos externalizantes. Conclusiones: En general, el SD4 presenta buenas propiedades psicométricas, aunque el solapamiento entre psicopatía y sadismo justifica cierta precaución.(AU)

National Comprehensive Cancer Network Guideline Recommendations of Cancer Drugs With Accelerated Approval.

Importance: Many cancer drugs are approved under the US Food and Drug Administration (FDA) accelerated approval pathway based on preliminary evidence. It is unclear how this limited evidence is integrated into the National Comprehensive Cancer Network (NCCN) guidelines, which are common references for clinicians and are used by public and private payers to determine reimbursement for oncology treatments. Objective: To analyze the NCCN guidelines' assessments for cancer drug indications that received FDA accelerated approval compared with cancer drug indications that received FDA regular approval. Design, Setting, and Participants: This cross-sectional study analyzes FDA-approved indications for cancer drugs that were granted accelerated approval from program inception in 1992 to June 30, 2022. For each drug, the FDA-approved labeling was reviewed to identify all indications. All analyses were performed at the drug-indication level. Exposure: The exposure was FDA regulatory status as of October 2022, including regular approval, accelerated approval, accelerated approval converted to regular approval, and withdrawn accelerated approval. Main Outcomes and Measures: The level of evidence and consensus (category 1, 2A, 2B, and 3) and treatment preference (preferred, alternative preferred, other recommended, and useful in certain circumstances) ratings assigned by NCCN committees as of February 2023. Results: A total of 315 oncology indications for 100 drugs were analyzed. These indications included 156 (50%) with regular approval, 60 (38%) with accelerated approval, 78 (49%) with accelerated approval that was converted to regular approval, and 21 (13%) with withdrawn accelerated approvals. Among all indications, 105 (33%) were rated by the NCCN as having category 1 evidence, 185 (59%) with category 2A, 6 (2%) with category 2B, and 2 (1%) with category 3 evidence. Compared with indications with regular approval, those with accelerated approval were less frequently assigned category 1 evidence (47% vs 3%; P < .001) and were less often listed as preferred treatment options (58% vs 40%; P = .008). Among the 21 withdrawn accelerated approval indications, 8 (38%) remained in the NCCN guidelines, with most having level 2A evidence ratings. Conclusions and Relevance: This study found that cancer drug indications with accelerated approval were less likely to be assigned high-level evidence ratings and preferred status in the NCCN guidelines compared with indications with regular approval; most accelerated and regular approval drugs had low-quality evidence ratings but high levels of consensus among oncologists on NCCN committees. Greater clarity on the thresholds and definitions of evidence levels would make the NCCN guidelines more useful to clinicians, patients, and payers.

Association of Perceived Benefit or Burden of Research Participation With Participants' Withdrawal From Cancer Clinical Trials.

Importance: Attrition in cancer clinical trials (CCTs) can lead to systematic bias, underpowered analyses, and a loss of scientific knowledge to improve treatments. Little attention has focused on retention, especially the role of perceived benefits and burdens, after participants have experienced the trial. Objectives: To examine the association between patients' perceived benefits and burdens of research participation and CCT retention. Design, Setting, and Participants: This survey study was conducted at a National Cancer Institute-designated comprehensive cancer center in the Northeast region of the US. The sample included adult patients with a cancer diagnosis participating in cancer therapeutic trials. Data were collected from September 2015 to June 2019. Analysis of study data was ongoing since November 2019 through October 2022. Exposures: Self-reported validated survey instrument with a list of 22 benefits and 23 burdens of research participation that can be rated by patients with a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Main Outcomes and Measures: A primary outcome was actual withdrawal from the CCT, and a composite outcome was composite withdrawal that included both actual withdrawal and thoughts of withdrawing. Bivariate and multivariable logistic regressions were used. Results: Among the 334 participants in the sample, the mean (SD) age was 61.9 (11.5) years and 174 women (52.1%) were included. Top-cited benefits included both aspirational and action-oriented goals, including helping others (94.2%), contributing to society (90.3%), being treated respectfully (86.2%), and hoping for a cure (86.0%). Worry over receiving a placebo (61.3%), rearranging one's life (41.9%), and experiencing bothersome adverse effects (41.6%) were notable burdens. An increased burden score was associated with a higher probability of actual withdrawal (adjusted odds ratio [OR], 1.86; 95% CI, 1.1-3.17; P = .02) or composite withdrawal (adjusted OR, 3.44; 95% CI, 2.09-5.67; P < .001). An increased benefit score was associated with lower composite withdrawal (adjusted OR, 0.40; 95% CI, 0.24-0.66; P < .001). For participants who reported the benefits as being equal to or greater than the burdens, 13.4% withdrew. For those who perceived the benefits as being less than the burdens, 33.3% withdrew (adjusted OR, 3.38; 95% CI, 1.13-10.14; P = .03). The risk of withdrawal was even higher for the composite outcome (adjusted OR, 7.70; 95% CI, 2.76-21.48; P < .001). Conclusions and Relevance: This survey study found that patients perceived important benefits from CCT participation, and this perception was associated with trial retention, even among those who also perceived substantial burdens. A broader dialogue among stakeholders can inform an ethical and patient-centric focus on benefits throughout the course of a CCT to increase retention.

Arts and Cultural Engagement, Reportedly Antisocial or Criminalized Behaviors, and Potential Mediators in Two Longitudinal Cohorts of Adolescents.

Arts and cultural engagement is a potential strategy for reducing or preventing reportedly antisocial or criminalized behaviors (those previously and problematically termed as "delinquent") in adolescence. However, most research to date has focused on arts-based interventions and has not tested arts and cultural engagement in large population-based longitudinal studies. This study investigated whether arts and cultural engagement reduced reportedly antisocial or criminalized behaviors in two large nationally representative cohorts, the National Longitudinal Study of Adolescent to Adult Health (n = 10,610; 50% female, 72% White, age range = 11-21 mean = 15.07) and the National Education Longitudinal Study of 1988 (n = 15,214; 50% female, 73% White, age range = 13-16 mean = 14.38). Structural equation modelling also allowed exploration of two potential mechanisms that might link arts and cultural engagement to reportedly antisocial or criminalized behaviors (self-control and attitudes towards these behaviors). More arts and cultural engagement was associated with fewer reportedly antisocial or criminalized behaviors, better self-control scores, and fewer positive perceptions of reportedly antisocial or criminalized behaviors concurrently and one to two years later. Arts and cultural engagement may provide opportunities for adolescents to realize positive developmental outcomes, reducing their risk of reportedly antisocial or criminalized behaviors.

Does mindfulness reduce trolling? The relationship between trait mindfulness and online trolling: The mediating role of anger rumination and the moderating role of online disinhibition.

BACKGROUND: Online trolling is a highly prevalent online antisocial behaviour that has recently received increasing attention because of its potentially destructive consequences. The current study aimed to examine whether trait mindfulness was negatively related to online trolling and whether anger rumination mediated this relationship. We further examined whether online disinhibition moderated the direct and indirect relation between trait mindfulness and online trolling. METHODS: A total of 1303 Chinese college students completed the measurements of trait mindfulness, anger rumination, online disinhibition, and online trolling. Moderated mediation analysis was performed to examine the relationships between these variables. RESULTS: After controlling for sex, the results showed that trait mindfulness was negatively related to online trolling and that this relationship was partially mediated by anger rumination. Moreover, the effect of anger rumination on online trolling was strengthened when online disinhibition was high. LIMITATIONS: This study is a cross-sectional study, and causal inferences cannot be drawn. CONCLUSIONS: Individuals with trait mindfulness are less likely to ruminate anger and further express less online trolling. Online disinhibition serves as a risk factor for online trolling. Interventions targeting trait mindfulness, anger rumination, and online disinhibition might aid prevention strategies.

Mentalizing and Group Psychotherapy: A Novel Treatment for Antisocial Personality Disorder.

Antisocial personality disorder (ASPD) is a common condition associated with interpersonal and social violence, and current treatments are unsatisfactory. Mentalizing, which has developmental roots in attachment processes, offers a framework to reconsider treatment for ASPD, in which dysfunction of the attachment system temporarily inhibits affect regulation and reduces mentalizing abilities, resulting in impulsivity and relational reactivity. Mentalization-based treatment for ASPD (MBT-ASPD), which focuses on the mental and relational processes central to personality disorder rather than on anger management and violent behavior, is a promising intervention. Implemented as a group psychotherapy, MBT-ASPD targets the mentalizing vulnerabilities and attachment patterns of patients by using a semi-structured group process focused on personal formulation and by establishing group values to promote learning from other members and generating "we-ness." The treatment then emphasizes mentalizing in relationships. This article discusses the mentalizing model of ASPD and outlines strategies for MBT-ASPD from a therapy group conducted in Great Britain.

A case study on a severe paranoid personality disorder client treated with metacognitive interpersonal therapy.

Paranoid personality disorder (PPD) is a severe condition, lacking specialized and empirically supported treatment. To provide the clinician with insights into how to treat this condition, we present a case study of a 61-year-old man with severe PPD who presented with ideas of persecution, emotionally charged hostility, and comorbid antisocial personality disorder. The client was treated with 6 months of Metacognitive Interpersonal Therapy, which included: creating a shared formulation of his paranoid attitudes; trying to change his inner self-image of self-as-inadequate and his interpersonal schemas where he saw the others as threatening. Guided imagery and rescripting techniques, coupled with behavioral experiments, were used to promote a change. At the end of the therapy the client reported a reliable change in general symptomatology and, specifically, in interpersonal sensitivity, hostility, and paranoid ideation; he could no longer be diagnosed as PPD and only some paranoid and antisocial characteristics remained.

Review of Neuropsychological and Electrophysiological Correlates of Callous-unemotional Traits in Children: Implications for EEG Neurofeedback Intervention.

Conduct disorder is a significant psychiatric disorder of childhood and adolescence. The Diagnostic and Statistical Manual of Mental Disorders, fifth version (DSM-5), added the limited prosocial specifier to identify those individuals who exhibit a more severe pattern of behavior characterized by a callous and unemotional (CU) interpersonal style across multiple settings and relationships. This review has attempted to summarize the relevant research focusing on the significance of CU interpersonal style in the development of psychopathy. The primary focus was on the electrophysiological and neuropsychological correlates of CU traits and their implication on the treatment protocol using neurofeedback training for children with such traits. The source of the literature search was PubMed, which majorly uses the MEDLINE database. The keywords used included CU traits, conduct disorder, child psychopathy, empathy, electrophysiology, criminal behavior, neuropsychology, neurofeedback training, and so on. Studies from the last 15 years were considered for the review. This review revealed that children with conduct disorder and high-CU traits with a combination of reactive and proactive aggression are more likely to develop psychopathy. Evidence suggests that these children have distinct forms of electrophysiological and neuropsychological correlates. However, research in this area is still not conclusive as they yield variation in findings. Studies on the efficacy of neurofeedback training on reducing symptoms such as impulsivity, hostility, and psychopathy indicate that neurofeedback training can be a promising treatment alternative for children with severe conduct disorder.

Psychopathology Symptoms are Associated with Prenatal Health Practices in Pregnant Women with Heavy Smoking Levels.

PURPOSE: Smoking during pregnancy may be linked to other problematic prenatal health behaviors in women. We examined interrelationships among prenatal smoking, prenatal health behaviors and mental health. The objective of this study was to examine factors that may contribute to variations in prenatal health practices among women who smoke during pregnancy. METHODS: Birth mothers from an adoption study (N = 912) were interviewed about prenatal smoking, health behaviors, and mental health symptoms at 5 months postpartum. RESULTS: One-quarter of participants (N = 222) reported smoking 6 or more cigarettes daily for at least 1 trimester. For mothers who smoked more than 6 cigarettes daily, higher levels of antisocial behaviors (ß = - .14, p = .03) and depressive symptoms (ß = - .17, p = .03) were associated with less frequent prenatal folate use; antisocial behaviors and depressive symptoms were not associated for prenatal folate use among women who did not smoke more than 6 cigarettes daily. For mothers who did not smoke more than 6 cigarettes daily, more depressive symptoms were associated with fewer prenatal care visits (ß = .12, p = .01). Antisocial behaviors and anxiety symptoms were not associated with prenatal care visits in either group of mothers. CONCLUSIONS FOR PRACTICE: Maternal antisocial behaviors and depressive symptoms during pregnancy may be markers for poorer adherence to recommendations for folate supplementation among women who smoke 6 or more cigarettes daily during pregnancy, independent of adequacy of prenatal care.

Balancing the brain of offenders with psychopathy? Resting state EEG and electrodermal activity after a pilot study of brain self-regulation training.

Although investigation of the brains of criminals began quite early in the history of psychophysiological research, little is known about brain plasticity of offenders with psychopathy. Building on our preliminary study reporting successful brain self-regulation using slow cortical potential (SCP) neurofeedback in offenders with psychopathy, we investigated the central nervous and autonomic peripheral changes occurring after brain self-regulation in a group of severe male offenders with psychopathy. Regarding the central nervous system, an overall suppression of the psychopathic overrepresentation of slow frequency bands was found, such as delta and theta band activity, after EEG neurofeedback. In addition, an increase in alpha band activity could be observed after the SCP self-regulation training. Electrodermal activity adaptively changed according to the regulation task, and this flexibility improved over training time. The results of this study point towards a constructive learning process and plasticity in neural and peripheral measures of offenders with psychopathy.

Omega-3 supplementation, child antisocial behavior, and psychopathic personality: a randomized, double-blind, placebo-controlled, stratified, parallel group trial.

While some RCTs have observed efficacy for omega-3 supplementation in reducing antisocial behavior, the role of psychopathic personality and gender in moderating treatment outcome has not been examined. This study examines whether omega-3 supplementation reduces antisocial behavior, and whether any treatment effects are a function of gender and psychopathy. Three hundred and twenty-four schoolchildren with a mean age of 11.9 years were randomized into 3 groups: omega-3 (N = 108), placebo (N = 110), and no-treatment controls (N = 106). Parent and child reports of child antisocial and aggressive behavior and psychopathic-like personality were collected at 0 months (baseline), 6 months (end of treatment), and 12 months (6 months post-treatment). A group × time × gender interaction (p = .016) indicated that only females in the omega-3 group showed a significant reduction in antisocial behavior 6 months post-treatment compared to baseline (d = .35), whereas the females in the two control groups showed no change over time. A group x time x psychopathy interaction (p < .006) was also observed, with psychopathic personality levels moderating treatment outcome. Children in the omega-3 group with high (but not low) psychopathic-like personality showed significant improvements in child-reported antisocial behavior at the end of treatment (d = .19) Results suggest that omega-3 supplementation may be helpful in reducing childhood antisocial and aggressive behavior in females, and those with psychopathic-like personalities.

Mentalization for Offending Adult Males (MOAM): study protocol for a randomized controlled trial to evaluate mentalization-based treatment for antisocial personality disorder in male offenders on community probation.

BACKGROUND: Antisocial personality disorder (ASPD), although associated with very significant health and social burden, is an under-researched mental disorder for which clinically effective and cost-effective treatment methods are urgently needed. No intervention has been established for prevention or as the treatment of choice for this disorder. Mentalization-based treatment (MBT) is a psychotherapeutic treatment that has shown some promising preliminary results for reducing personality disorder symptomatology by specifically targeting the ability to recognize and understand the mental states of oneself and others, an ability that is compromised in people with ASPD. This paper describes the protocol of a multi-site RCT designed to test the effectiveness and cost-effectiveness of MBT for reducing aggression and alleviating the wider symptoms of ASPD in male offenders subject to probation supervision who fulfil diagnostic criteria for ASPD. METHODS: Three hundred and two participants recruited from a pool of offenders subject to statutory supervision by the National Probation Service at 13 sites across the UK will be randomized on a 1:1 basis to 12 months of probation plus MBT or standard probation as usual, with follow-up to 24 months post-randomization. The primary outcome is frequency of aggressive antisocial behaviour as assessed by the Overt Aggression Scale - Modified. Secondary outcomes include violence, offending rates, alcohol use, drug use, mental health status, quality of life, and total service use costs. Data will be gathered from police and criminal justice databases, NHS record linkage, and interviews and self-report measures administered to participants. Primary analysis will be on an intent-to-treat basis; per-protocol analysis will be undertaken as secondary analysis. The primary outcome will be analysed using hierarchical mixed-effects linear regression. Secondary outcomes will be analysed using mixed-effects linear regression, mixed-effects logistic regression, and mixed-effects Poisson models for secondary outcomes depending on whether the outcome is continuous, binary, or count data. A cost-effectiveness and cost-utility analysis will be undertaken. DISCUSSION: This definitive, national, multi-site trial is of sufficient size to evaluate MBT to inform policymakers, service commissioners, clinicians, and service users about its potential to treat offenders with ASPD and the likely impact on the population at risk. TRIAL REGISTRATION: ISRCTN 32309003 . Registered on 8 April 2016.

Psychopathy as an Emergent Interpersonal Syndrome: Further Reflections and Future Directions.

In our article (Lilienfeld et al., 2019), we hypothesized that psychopathy and some other personality disorders are emergent interpersonal syndromes (EISs): interpersonally malignant configurations of distinct personality subdimensions. We respond to three commentaries by distinguished scholars who raise provocative challenges to our arguments and intriguing suggestions for future research. We clarify the role of folk concepts in our understanding of psychopathy, offer further suggestions for testing our interactional hypotheses, consider the role of boldness in motivational accounts of psychopathy, and discuss future directions for incorporating developmental considerations and the role of victims in our EIS account. We are optimistic that this account will prove to be of heuristic value, and should encourage researchers and theoreticians to explore alternative models of psychopathy and other personality disorders.

Personality Disorders as Emergent Interpersonal Syndromes: Psychopathic Personality as a Case Example.

Personality disorders have long been bedeviled by a host of conceptual and methodological quandaries. Starting from the assumption that personality disorders are inherently interpersonal conditions that reflect folk concepts of social impairment, the authors contend that a subset of personality disorders, rather than traditional syndromes, are emergent interpersonal syndromes (EISs): interpersonally malignant configurations (statistical interactions) of distinct personality dimensions that may be only modestly, weakly, or even negatively correlated. Preliminary support for this perspective derives from a surprising source, namely, largely forgotten research on the intercorrelations among the subscales of select MMPI/MMPI-2 clinical scales. Using psychopathic personality as a case example, the authors offer provisional evidence for the EIS hypothesis from four lines of research and delineate its implications for personality disorder theory, research, and classification. Conceptualizing some personality disorders as EISs elucidates long-standing quandaries and controversies in the psychopathology literature and affords fruitful avenues for future investigation.

To Better Understand the Link between Psychopathy and Antisocial Behavior: Moderation by Dispositional Mindfulness.

BACKGROUND: Dispositional mindfulness deficits and psychopathic personality traits have been shown to be closely associated and independent predictors of antisocial behaviors (AB) in young adults. However, the interaction effects of these 2 factors have not yet been explored. The aim of this study was to examine the contribution of dispositional mindfulness and psychopathic traits to ABs in a college student sample. METHODS: Participants were 1,572 students from different French universities who completed self-report questionnaires. Regression analyses were conducted in order to test a moderation model between psychopathic traits and AB. RESULTS: Moderation analyses revealed that dispositional mindfulness interacted with psychopathic personality traits in predicting AB. In males with high levels of dispositional mindfulness, as psychopathic traits increased, AB increased less than in males with low levels of dispositional mindfulness. CONCLUSIONS: The present study suggests possible implications for prevention and treatment of AB among non-clinical young adults with relatively high psychopathic traits.

Psychodynamic art psychotherapy for the treatment of aggression in an individual with antisocial personality disorder in a secure forensic hospital: A single-case design study.

The aim of this single-case study was to investigate the responses to psychodynamic art psychotherapy from a man who had a diagnosis of antisocial personality disorder and ongoing aggressive behavior in a secure care setting. The intervention was 19 sessions of psychodynamic art psychotherapy lasting up to 1 hr per week. This study uses a single-case design with pretreatment, treatment, and posttreatment follow-up assessment of symptoms using multiple methods reported by the therapist, other staff members, and the patient. Treatment progress was assessed by (a) repeated self-report symptom measurements, (b) continuous assessment of observed aggressive behavior and risk incident reports in the hospital, (c) pre-post treatment assessment of relationship patterns and interpersonal schemas, and (d) interviews with the patient and his nurse at 9-month follow-up, retrospectively assessing the change. The patient showed a clinically significant reduction pre-post and pre-follow-up in symptoms. Behavioral observations indicated a reduction of overt aggression and risk-related incidents. Comparison of the Core Conflictual Relationship Theme pre-post treatment indicated positive changes in interpersonal schemas. This illustrative systematic single-case study highlights the potential for investigation of a novel psychotherapeutic approach that has in turn led to further developments in clinical research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Single-Photon Emission Computed Tomography and Positron Emission Tomography Studies of Antisocial Personality Disorder and Aggression: a Targeted Review.

PURPOSE OF REVIEW: This paper aims to provide a comprehensive discussion of single-photon emission computed tomography (SPECT) and positron emission tomography (PET) studies of antisocial personality disorder (ASPD) and aggression. RECENT FINDINGS: Among ASPD males with high impulsivity, the density of brainstem serotonin (5-HT) transporters shows a relationship with impulsivity, aggression, and ratings of childhood trauma. 5-HT1B receptor (R) binding in the striatum, anterior cingulate cortex, and orbitofrontal cortex (OFC) correlated with anger, aggression, and psychopathic traits in another study of violent offenders, most of whom were diagnosed with ASPD. Finally, the density of monoamine oxidase-A (MAO-A), a mitochondrial enzyme that degrades 5-HT, norepinephrine, and dopamine (DA), was reported as lower in the OFC and ventral striatum of ASPD. Among non-clinical populations, 5-HT4R binding, as an index of low cerebral 5-HT levels, has been associated with high trait aggression, but only in males. Furthermore, evidence suggests that individuals with high-activity MAO-A genetic variants compared with low-activity MAO-A allelic variants release more DA in the ventral caudate and putamen when exposed to violent imagery. There are very few PET or SPECT studies that exclusively sample individuals with ASPD. However, among ASPD samples, there is evidence of regional serotonergic abnormalities in the brain and alteration of neural MAO-A levels. Future studies should consider employing additional molecular probes that could target alternative neurotransmitter systems to investigate ASPD. Furthermore, examining different typologies of aggression in clinical and non-clinical populations using SPECT/PET is another important area to pursue and could shed light on the neurochemical origins of these traits in ASPD.

Omega-3 Supplementation as a Dietary Intervention to Reduce Aggressive and Antisocial Behavior.

PURPOSE OF REVIEW: Although there is an increasing body of literature on the relationship between omega-3 fatty acids and aggressive/antisocial behavior, evidence to date suggests that there are mixed findings on the efficacy of omega-3 supplementation as a dietary intervention to reduce such behaviors. This article describes the current state of the research regarding omega-3 supplementation and aggressive/antisocial behavior from intervention studies, with an emphasis on randomized controlled trials. RECENT FINDINGS: The current evidence base indicates a small effect size (approximately d = .20) for the efficacy of increased omega-3 intake in reducing aggressive and antisocial behavior in children and adults. How precisely omega-3 supplementation results in such behavioral improvement is an open question, although upregulation of dysfunctional prefrontal regions is one candidate mediator. Directions for further research include understanding the more basic mechanisms that may underlie any intervention effects, delineating dose-response relationships, ascertaining optimal treatment duration and composition, conducting follow-ups post-treatment, and testing the provisional hypothesis that more impulsive, reactive forms of aggression may be particularly amenable to omega-3 supplementation.