Showing papers on "Antisocial personality disorder published in 1995"
Book•
01 May 1995
TL;DR: In this article, the authors present a scholarly analysis of psychopathic and sociopathic personalities and the conditions that give rise to them and offer a coherent theoretical and developmental analysis of socialization and its vicissitudes, and of the role played in socialization by the crime-relevant genetic traits of the child and the skills and limitations of the primary socializing agents, the parents.
Abstract: This volume presents a scholarly analysis of psychopathic and sociopathic personalities and the conditions that give rise to them. In so doing, it offers a coherent theoretical and developmental analysis of socialization and its vicissitudes, and of the role played in socialization by the crime-relevant genetic traits of the child and the skills and limitations of the primary socializing agents, the parents. This volume also describes how American psychiatry's (DSM-IV) category of "Antisocial Personality Disorder" is heterogeneous and fails to document some of the more interesting and notorious psychopaths of our era. The author also shows why the antinomic formula "Nature vs. Nurture" should be revised to "Nature via Nurture" and reviews the evidence for the heritability of crime-relevant traits. One of these traits -- fearlessness -- seems to be one basis for the primary psychopathy and the author argues that the primary psychopath and the hero may be twigs on the same genetic branch. But crime -- the failure of socialization -- is rare among traditional peoples still living in the extended-family environment in which our common ancestors lived and to which our species is evolutionarily adapted. The author demonstrates that the sharp rise in crime and violence in the United States since the 1960s can be attributed to the coeval increase in divorce and illegitimacy which has left millions of fatherless children to be reared by over-burdened, often immature or sociopathic single mothers. The genus sociopathic personality includes those persons whose failure of socialization can be attributed largely to incompetent or indifferent rearing. Two generalizations supported by modern behavior genetic research are that most psychological traits have strong genetic roots and show little lasting influence of the rearing environment. This book demonstrates that the important trait of socialization is an exception. Although traits that obstruct or facilitate socialization tend to obey these rules, socialization itself is only weakly heritable; this is because modern American society displays such enormous variance in the relevant environmental factors, mainly in parental competence. Moreover, parental incompetence that produces sociopathy in one child is likely to have the same result with any siblings. This book argues that sociopathy contributes far more to crime and violence than psychopathy because sociopaths are much more numerous and because sociopathy is a familial trait for both genetic and environmental reasons. With a provocative thesis and an engaging style, this book will be of principal interest to clinical, personality, forensic, and developmental psychologists and their students, as well as to psychiatrists and criminologists.
1,257 citations
TL;DR: Environmental effects and genetic-environmental interaction account for significant variability in adoptee aggressivity, conduct disorder, and adult antisocial behavior and have important implications for the prevention and intervention of conduct disorder and associated conditions such as substance abuse and aggressivity.
Abstract: Background: The purpose of this study was to determine the effect of an adverse adoptive home environment on adoptee conduct disorder, adult antisocial behavior, and two measures of aggressivity, all of which are behaviors that contribute to adult antisocial personality disorder and that also are associated with increased vulnerability to drug abuse and/or dependence. Methods: The study used an adoption paradigm in which adopted offspring who were separated at birth from biologic parents with documented (by prison and hospital records) antisocial personality disorder and/or alcohol abuse or dependence were followed up as adults. They and their adoptive parents were interviewed in person. These adoptees were compared with controls whose biologic background was negative for documented psychopathologic behavior. Subjects were 95 male and 102 female adoptees and their adoptive parents. Results: Multiple regression analysis was used to measure separately genetic and environmental effects. It showed that (1) a biologic background of antisocial personality disorder predicted increased adolescent aggressivity, conduct disorder, and adult antisocial behaviors, and (2) adverse adoptive home environment (defined as adoptive parents who had marital problems, were divorced, were separated, or had anxiety conditions, depression, substance abuse and/or dependence, or legal problems) independently predicted increased adult antisocial behaviors. Adverse adoptive home environment interacted with biologic background of antisocial personality disorder to result in significantly increased aggressivity and conduct disorder in adoptees in the presence of but not in the absence of a biologic background of antisocial personality disorder. Conclusions: Environmental effects and geneticenvironmental interaction account for significant variability in adoptee aggressivity, conduct disorder, and adult antisocial behavior and have important implications for the prevention and intervention of conduct disorder and associated conditions such as substance abuse and aggressivity.
459 citations
TL;DR: The present investigation carried out in order to test a more specific hypothesis of orbitofrontal and/or frontal ventromedial deficits in psychopathy found that the psychopaths were significantly impulsive on several tests as well as significantly dysosmic [corrected].
339 citations
TL;DR: The model of two independent genetic factors involved in drug abuse/dependence and previous findings that disturbed adoptive parents are associated with adopteedrug abuse/dependency are confirmed.
Abstract: Background: Studies of adoptees have demonstrated that there are two genetic factors leading to alcohol abuse and/or dependence (abuse/dependence). In addition, environmental factors found in the adoptive family also predict alcohol abuse/dependency independently. One study has found evidence that a similar model of two genetic factors and independent adoptive family factors were involved in drug abuse. Our study was designed to test the hypothesis that genetic factors defined by alcohol abuse/dependency and antisocial personality disorder in biologic parents were etiologic in drug abuse/dependency and that psychiatric problems in adoptive parents were an additional factor associated with drug abuse/dependence. Methods: A sample of 95 male adoptees, separated at birth from their biologic parents, were followed up as adults to determine their psychiatric diagnosis and their substance use/abuse in a structured interview administered blind to biologic parent diagnoses. A high-risk, case-control design was used wherein half of the adoptees came from biologic parents known to be alcohol abuser/dependent and/or have antisocial personalities (diagnoses from hospital or prison records). These adoptees were matched for age, sex, and adoption agency to a control group of adoptees whose biologic parents were not found in the hospital and prison record search. Adoptive home environment was assessed by structured interviews, including psychiatric assessment of both adoptive parents. Results: Data were analyzed by log-linear modeling, which showed evidence of two genetic pathways to drug abuse/dependency. One pathway went directly from a biologic parent's alcoholism to drug abuse/dependency. The second pathway was more circuitous, and started with antisocial personality disorder in the biologic parent and proceeded through intervening variables of adoptee aggressivity, conduct disorder, antisocial personality disorder, and, eventually, ended in drug abuse/dependency. Environmental factors defined by psychiatric conditions in adoptive families independently predicted increased antisocial personality disorder in the adoptee. Adoptees born of alcohol-abusing mothers showed evidence of fetal alcohol syndrome, but controlling for this did not diminish the evidence for the direct genetic effect between an alcohol-abusing biologic parent and drug abuse/dependency in offspring. Conclusions: This study confirms the model of two independent genetic factors involved in drug abuse/dependence and previous findings that disturbed adoptive parents are associated with adoptee drug abuse/dependency.
325 citations
TL;DR: Compared DSM-III-R antisocial personality disorder symptoms before vs after the age of 15 years within a sample of twins, characteristics of the shared or family environment that promote antisocial behavior during childhood and early adolescence also promote later antissocial behavior, but to a much lesser extent.
Abstract: Background: Studies of adult antisocial behavior or criminality usually find genetic factors to be more important than the family environment, whereas studies of delinquency find the family environment to be more important. We comparedDSM-III-Rantisocial personality disorder symptoms before vs after the age of 15 years within a sample of twins, rather than comparing across studies. Methods: We administered the Diagnostic Interview Schedule Version III—revised by telephone to 3226 pairs of male twins from the Vietnam Era Twin Registry. Biometrical modeling was applied to each symptom of antisocial personality disorder and summary measures of juvenile and adult symptoms. Results: Five juvenile symptoms were significantly heritable, and five were significantly influenced by the shared environment. Eight adult symptoms were significantly heritable, and one was significantly influenced by the shared environment. The shared environment explained about six times more variance in juvenile antisocial traits than in adult traits. Shared environmental influences on adult antisocial traits overlapped entirely with those on juvenile traits. Additive genetic factors explained about six times more variance in adult vs juvenile traits. The juvenile genetic determinants overlapped completely with genetic influences on adult traits. The unique environment (plus measurement error) explained the largest proportion of variance in both juvenile and adult antisocial traits. Conclusions: Characteristics of the shared or family environment that promote antisocial behavior during childhood and early adolescence also promote later antisocial behavior, but to a much lesser extent. Genetic causal factors are much more prominent for adult than for juvenile antisocial traits.
320 citations
TL;DR: For most boys with CD, the number of symptoms fluctuated above and below the diagnostic threshold from year to year but remained relatively high, but the interaction of parental APD and the boy's verbal intelligence predicted the persistence of CD symptoms over time.
Abstract: A prospective study of conduct disorder (CD) was conducted using 4 annual structured diagnostic interviews of 171 clinic-referred boys, their parents, and their teachers. Only about half of the 65 boys who met criteria for CD in Year 1 met criteria again during the next year, but 88% met criteria for CD again at least once during the next 3 years. For most boys with CD, the number of symptoms fluctuated above and below the diagnostic threshold from year to year but remained relatively high. Lower socioeconomic status, parental antisocial personality disorder (APD), and attention-deficit hyperactivity disorder were significant correlates of CD in Year 1, but the interaction of parental APD and the boy's verbal intelligence predicted the persistence of CD symptoms over time (i.e., only boys without a parent with APD and with above-average verbal intelligence clearly improved). Conduct disorder (CD) is a pattern of maladaptive behavior of children that is characterized by a variety of antisocial behaviors, including physical aggression, deception, and violation of the property rights of others (Lahey, Loeber, Frick, Quay, & Grimm, 1992). It is generally considered to be a serious childhood disorder that is the primary precursor to chronic antisocial behavior during adulthood (Kazdin, 1987a; Robins, Tipp, & Pryzbeck, 1991). Because it is difficult to reduce the frequency of antisocial behavior in children with CD through psychosocial treatment (Kazdin, 1987b), CD is conceptualized as a disorder that is usually chronic (Kazdin, 1987a). Evidence from longitudinal studies is consistent with the view that antisocial behavior in childhood is persistent over time; however, these same data raise a question about the degree of persistence of the disorder. For example, studies of official court records have shown that 50%-70% of youths who are arrested for delinquent acts during childhood or adolescence are arrested in adulthood (Loeber, 1982, 1990, 1991;McCord, 1979;
301 citations
TL;DR: The likelihood of obsessional followers having a nonantisocial axis II personality disorder (related to attachment pathology) distinguishes them from offenders with mental disorders in general, and they are likely to be older, smarter, and better educated, consistent with their resourcefulness and manipulativeness.
Abstract: Obiective: The purpose of this study was to compare certain demographic and clinical variables in a group ofobsessionaL followers andin a group ofoffenders with mentaLdisorders. Method: A static group design comprised of a nonrandom group of convenience and a ran domLy seLected comparison group was used. Twenty obsessionaL followers in custody ,md 30 offenders with mentaL disorders in custody were evaLuated by psychiatrists and psychoLogists for court-ordered reasons during their criminaL proceedings. Both groups were evaLuated dur ing the same period. in the same court diagnostic clinic. and for the same psychoLegaL reasons. The group of obsessionaL followers was measured on demographic, clinicaL, olnd victzm vari ables. InferentiaL comparisons that used nonparametric statistics were done between groups on seLected demographic and clinicaL variabLes. Results: The obsessionaL followers were sig nificantLy oLder, more inteLLigent, wnd better educated than the offenders. There were no sig nificant differences in DS/vf-III-R a.:'Cis I diagnoses. Axis II diagnoses showed significant dif ferences. with the obsessional followers more likely to have a personality disorder other than antisociaL personality disorder .md less likely to have ..mtisociaL personality disorder. CQnc!lI ~ The likelihood of obsessional /olLowers having a nonantisocial axis II personality dis order (related to attachment pathology) distinguishes them from offenders with mental disor ders in general. They are also likely to be older, smarter, olnd better educated. consistent with their resourcefulness ..znd manipulativeness. Idiographic aspects of the obsessional followers
286 citations
209 citations
TL;DR: Addressing unresolved intrapsychic trauma associated with childhood abuse may increase the efficacy of treatment outcomes and reduce relapse rates among alcoholics, highlighting the long-term associations between sexual and physical abuse and adult coexisting mental disorders among alcoholic inpatients.
Abstract: OBJECTIVE: The purpose of this study was to investigate the adult psychiatric correlates of childhood abuse among alcoholic inpatients. METHODS: The 802 patients, who included 321 women, were admitted to one of five New York State alcohol treatment inpatient centers. Each patient was interviewed, and sexual and physical abuse history, DSM-III diagnosis, and other characteristics were recorded. RESULTS: The overall prevalence of reported childhood abuse was 59% for women and 30% for men. Family history of alcoholism was associated with higher levels of physical and sexual abuse. Gender differences in types of childhood abuse (i.e., sexual abuse only, physical abuse only, dual abuse) were evident; 49% of the women and 12% of the men reported sexual abuse (with or without physical abuse), 33% of the women and 24% of the men reported physical abuse (with or without sexual abuse), and 23% of the women and 5% of the men reported dual abuse. Abuse status, and especially dual abuse, was associated with higher rates of antisocial personality disorder and suicide attempts among women and men, with generalized anxiety disorder among women, and with major depression among men. CONCLUSIONS: The findings highlight the long-term associations between sexual and physical abuse and adult coexisting mental disorders among alcoholic inpatients. Addressing unresolved intrapsychic trauma associated with childhood abuse may increase the efficacy of treatment outcomes and reduce relapse rates among alcoholics. Language: en
203 citations
TL;DR: The relationships between various mental disorders and violent behavior have been the subject of much public and professional debate and there is less evidence that schizophrenia or psychotic symptoms increase that risk of violence in samples of persons at high risk for violence.
199 citations
TL;DR: Support was found for the hypothesis that, compared with siblings from nonantisocial families, those from antisocial families would have more psychopathology (ADHD, depression, substance use, and conduct disorders) and the presence of antisocial disorders signals a distinct subtype of ADHD.
Abstract: The authors examined the siblings of 140 attention-deficit hyperactivity disorder (ADHD) and 120 control probands and classified families as antisocial if the proband had conduct disorder or a parent had antisocial personality. Partial support was found for the hypothesis that the ADHD gender effect would be limited to antisocial families. Boys had an increased risk for ADHD compared with girls, but only among siblings from antisocial families. The effect size for predicting ADHD in siblings of probands was greater for maternal compared with paternal ADHD, but only for families exhibiting antisocial disorders. Strong support was found for the hypothesis that, compared with siblings from nonantisocial families, those from antisocial families would have more psychopathology (ADHD, depression, substance use, and conduct disorders). The presence of antisocial disorders signals a distinct subtype of ADHD.
TL;DR: Early-onset dysthymia patients reported significantly more physical and sexual abuse and poorer relationships with both parents than normal controls and patients with dysthythymia reported having received significantly poorer parenting than those with episodic major depression.
Abstract: This study addressed 2 questions: (a) is early-onset dysthymia associated with reports of a disturbed childhood home environment; and (b) can adverse early experiences account, at least in part, for the differing clinical presentations of dysthymia and major depression? Participants included 97 outpatients with early-onset dysthymia, 45 outpatients with episodic major depression, and 45 normal controls. The early home environment was assessed blind to diagnosis using both interview and self-report measures. Early-onset dysthymia patients reported significantly more physical and sexual abuse and poorer relationships with both parents than normal controls. In addition, patients with dysthymia reported having received significantly poorer parenting than those with episodic major depression. The results could not be accounted for by mood state effects, comorbidity with borderline and antisocial personality disorder, or comorbid major depression.
TL;DR: The lifetime prevalence of DSM-III-R alcohol abuse and alcohol dependence and associated patterns of psychiatric comorbidity in the Ontario population aged 15-64 years are estimated from a survey of a representative household sample using the University of Michigan Composite International Diagnostic Interview (UM-CIDI).
TL;DR: It is suggested that the familial aggregation of nonaffective psychiatric disorders depends on the clinical features and comorbid syndromes present in the depressed adolescent proband.
Abstract: Objective To examine whether depression aggregates in the families of depressed adolescents and to determine whether clinical features and/or comorbid syndromes in the depressed adolescents change the risk of psychopathology in relatives. Method Lifetime prevalence rates of psychopathology in the first-degree (n = 228) and second-degree (n = 736) relatives of 76 adolescents with major depressive disorder (MDD) and the first-degree (n = 107) and second-degree (n = 323) relatives of 34 normal control adolescents were assessed by the Family History-Research Diagnostic Criteria (FH-RDC) method using the parent/guardian as the family informant. Results Compared with the first-degree relatives of normal controls, the relatives of depressed adolescents had significantly higher lifetime rates of MDD (25% versus 13%) and “any” of the FH-RDC psychiatric disorders (53% versus 36%). The second-degree relatives of adolescents with MDD had significantly higher lifetime rates of FH-RDC “other” psychiatric disorder (12% versus 7%) and “any” of the FH-RDC psychiatric disorders (22% versus 15%) but not MDD (5% versus 6%) compared with the relatives of normal controls. The first-degree relatives of depressed adolescents who were also suicidal had increased lifetime rates of suicidal behavior which significantly cosegregated with MDD. Comorbid conduct disorder in the depressed adolescent was associated with increased rates of antisocial personality disorder in the first-degree relatives and also tended to cosegregate with MDD. Conclusions The current study provides further evidence for the familial aggregation of depression in adolescent-onset MDD. This study also suggests that the familial aggregation of nonaffective psychiatric disorders depends on the clinical features and comorbid syndromes present in the depressed adolescent proband.
TL;DR: Over 70% of pure alcoholics and over 90% of polysubstance users had comorbid diagnoses, a prevalence higher than in the Epidemiological Catchment Area study in the United States, but similar to clinical studies from North America.
Abstract: In order to elucidate the psychiatric comorbidity of patients in alcohol and other substance use disorder treatment we examined a representative sample of such patients in Iceland (249 men and 102 women). Over 70% of pure alcoholics and over 90% of polysubstance users had comorbid diagnoses, a prevalence higher than in the Epidemiological Catchment Area study in the United States, but similar to clinical studies from North America. The most prevalent disorders were: affective (33%), anxiety (65%), antisocial personality disorder (28%) and psychosexual dysfunction (20%). Pure alcoholics and polysubstance users in studies on psychiatric comorbidity should be separated. Anxiety and affective disorders influence treatment seeking. Findings concerning the impact of psychiatric comorbidity on course should be comparable between North America and Europe.
TL;DR: Findings adjusted for ethnicity revealed that homeless women had higher rates of a concurrent diagnosis of alcohol abuse, drug abuse, and antisocial personality disorder and had less adequate family support.
Abstract: A study of risk factors for homelessness among the severely mentally ill was extended to include women, and a case-control study of 100 indigent women with schizophrenia meeting criteria for literal homelessness and 100 such women with no history of homelessness was conducted. Subjects were recruited from shelters, clinics, and inpatient psychiatric programs in New York City. Clinical interviewers used standardized research instruments to probe three domains of risk factors: severity of mental illness, family background, and prior mental health service use. Findings adjusted for ethnicity revealed that homeless women had higher rates of a concurrent diagnosis of alcohol abuse, drug abuse, and antisocial personality disorder. Homeless women also had less adequate family support.
TL;DR: Mental disorders appear to have a statistical relationship with homicidal behavior in countries with relatively low crime rates and on the basis of the data, there may be special subgroups of women among whom the risk of hom suicidal behavior is very high.
Abstract: Objective: Although violent behavior is one of the most important factors that have a detriniental effect on quality oflife, there are very few quantitative epidemiological studies published on this issue. In particular, female homicidal behavior has remained poorly studied. This study reveals the association between some specific DSM-III-R disorders and female homicidal behavior. Method: The author reviewed forensic psychiatric examinations of 127 f emale homicide offenders in Finland over a I 3-year period. Results: Female homicide offenders had about a 1 0-fold higher odds ratio than the general female population for having schizophrenia or a personality disorder. The disorders with the most substantially higher odds ratios were alcohol abuse/dependence and antisocial personality disorder. Conclusions: Mental disorders appear to have a statistical relationship with homicidal behavior in countries with relatively low crime rates. On the basis ofthe data, there may be special subgroups of women among whom the risk of homicidal behavior is very high. (Amj Psychiatry1995; 152:1216-1218)
TL;DR: It is concluded that for many, ASPD is chronic and is associated with ongoing psychiatric, medical, and social problems.
TL;DR: A personality and behavior pattern called aberrant self-promotion, conceptualized as a subclinical form of psychopathy, has been investigated in this paper and validated using the Revised Psychopathy Checklist (PCL-R) interview and records of antisocial behavior.
Abstract: These studies investigate a personality and behavior pattern called aberrant self-promotion, conceptualized as a subclinical form of psychopathy. Aberrant self-promoters (ASPs) are theoretically defined as individuals characterized by a narcissistic personality configuration in combination with antisocial behavior. The first study verifies the existence of persons who manifest the ASP pattern. The second study validates the pattern, using as criteria the Revised Psychopathy Checklist (PCL-R) interview and records of antisocial behavior. In the first study a 179-item questionnaire, composed of five personality instruments, was administered to two separate samples of normal subjects (N = 214 and 367). ASPs were targeted by three methods: cluster analysis, item factor analysis, and person factor analysis. In Sample 1 the three methods demonstrated a convergence of 92 per cent in identifying the same individuals as ASPs; in Sample 2 the convergence rate was 94 per cent. In the second study 32 ASPs targeted in Study 1 were compared to 30 non-ASPS. The ASPs had significantly higher scores on the PCL-R and had committed significantly more antisocial acts than the non-ASPS. The general discussion focuses on the practical, theoretical, and measurement implications of considering aberrant self-promotion a distinct psychological motif. Language: en
TL;DR: In this article, the authors examined the relationship between basic dimensions of personality and passive-avoidance learning (PAL) deficit in psychopathic and nonpsychopathic criminals, and found that the most consistent personality measure with psychopathy was Impulsive Sensation Seeking (ImpSS), but the relationship was only significant for Whites, and not for Blacks and Hispanics.
01 Jan 1995
TL;DR: If the serum level of total cholesterol is found to be predictive of antisocial personality disorder in longitudinal analyses, this association may have implications for cholesterol-lowering recommendations.
Abstract: Results of several studies suggest that either a reduction in the serum level of total cholesterol level or a persistently low cholesterol level may be associated with an increase in violent deaths. Although there are several possible explanations for these observations, it has been suggested that the cholesterol level could influence various behaviors. We therefore examined the cross-sectional relation of several psychologic characteristics, assessed by the Diagnostic Interview Schedule and the Minnesota Multiphasic Personality Inventory, to levels of total cholesterol, high-density lipoprotein cholesterol, and triglycerides among 3,490 men aged 31-45 years who were examined in 1985-1986. (All men had served in the US Army between 1965 and 1971). Compared with that of other men, the mean total cholesterol level was 5 mg/dl higher among 697 men diagnosed with generalized anxiety disorder (possibly because of increased catecholamine levels) and 7 mg/dl lower among 325 men with antisocial personality disorder (p < 0.01 for each association). These differences could not be attributed to education, relative weight, cigarette smoking, use of various medications, or other potential confounders. In contrast, cholesterol levels were not significantly associated with major depression or hostility; levels of high-density lipoprotein cholesterol and triglycerides were not related to any diagnosis. If the serum level of total cholesterol is found to be predictive of antisocial personality disorder in longitudinal analyses, this association may have implications for cholesterol-lowering recommendations.
TL;DR: Multiple diagnosis of PD is better construed as 'breadth' of psychopathology rather than comorbidity and is a function of sampling frame, which suggests that multiple diagnosis is the norm rather than the exception.
Abstract: BACKGROUND Simultaneous diagnosis of more than one personality disorder (PD) has been termed 'comorbidity' or 'co-occurrence' implying that single diagnoses are the norm and multiple diagnoses interesting exceptions. Surveys of PD subjects in fact show 1.5-5.6 diagnoses per subject. Our study explores the hypothesis that multiple PD diagnosis is common and increases with increasingly personality disordered populations.
METHOD The PDQ-R questionnaire was administered to three UK samples: referrals for specialist PD in-patient treatment (n = 275); high tariff offenders attending a probation centre (n = 57); and undergraduate students (n = 274).
RESULTS Means of 6.0 (95% CI 5.7-6.3), 4.0 (3.1-5.0) and 3.4 (3.0-3.8) PDQ-R diagnoses per subject were found respectively. High rates of PD diagnosis in individual subjects suggest that multiple diagnosis is the norm rather than the exception.
CONCLUSIONS Multiple diagnosis of PD is better construed as 'breadth' of psychopathology rather than comorbidity and is a function of sampling frame. High rates of multiple diagnoses question the interpretation of studies of any single PD. The graded construct of 'breadth' of axis-II pathology may further our understanding of PD.
TL;DR: The findings suggest that an ASPD diagnosis or an adult antisocial lifestyle, at least as measured by DSM-III criteria, does not predict short-term treatment response.
Abstract: We evaluated the relationship of antisociality to 7-month treatment response in 224 alcohol-and/or cocaine-dependent men. Subjects with and without a DSM-III antisocial personality disorder (ASPD) responded similarly and positively to treatment in a number of functional domains, including substance
TL;DR: Results from the psychiatric interview showing a strong association between drug--opiate--dependence and DSM-III mental disorders are further supported by findings of high levels of depressive symptoms on the Center for Epidemiological Studies-Depression (CES-D) scale and increased rates of self-reported suicide attempts and psychiatric hospitalizations.
Journal Article•
TL;DR: The malingerers were significantly more likely to have a history of murder or rape, carry a diagnosis of antisocial personality disorder or sexual sadism, and produce greater PCL-R factor 1, factor 2, and total scores than insanity acquittees who did not malinger.
Abstract: This study compares Psychopathy Checklist-Revised (PCL-R) scores, DSM-III-R diagnoses, and select behavioral indices between hospitalized insanity acquittees (N = 18) and hospitalized insanity acquittees who successfully malingered (N = 18). The malingerers were significantly more likely to have a history of murder or rape, carry a diagnosis of antisocial personality disorder or sexual sadism, and produce greater PCL-R factor 1, factor 2, and total scores than insanity acquittees who did not malinger. The malingerers were also significantly more likely to be verbally or physically assaultive, require specialized treatment plans to control their aggression, have sexual relations with female staff, deal drugs, and be considered an escape risk within the forensic hospital. These findings are discussed within the context of insanity statutes and the relevance of malingering, psychopathy, and treatability to future policy concerning the disposition of insanity acquittees.
TL;DR: One interpretation of the results was that nortriptyline may have reduced impulsive drinking in the antisocial personality disorder subgroup by actions on serotonergic neurotransmission.
Abstract: This double-blind, placebo-controlled, 6-month follow-up treatment study investigated the efficacy of bromocriptine and nortriptyline in attenuating drinking behavior and psychiatric symptoms in 216 male alcoholic patients subtyped by comorbid psychiatric disorder(s). Three well-defined subtypes were examined: alcoholism only, alcoholism + affective/anxiety disorder, and alcoholism + antisocial personality disorder. It was hypothesized that both medications would relieve negative affective symptoms associated with alcohol use and would be particularly effective for the affective/anxiety subgroup. Contrary to our predictions, the only significant effects found were with the antisocial personality disorder patients who were receiving nortriptyline. One interpretation of the results was that nortriptyline may have reduced impulsive drinking in the antisocial personality disorder subgroup by actions on serotonergic neurotransmission.
TL;DR: The fully diagnosed ASPD group (those with CD) was distinguishable from the adult antisocial behavior only group without CD on all childhood behaviors, adult impulsive and aggressive behaviors, and measures of severe drug abuse, including earlier age of onset of drug use and drug treatment utilization.
Abstract: Recent work has shown that a substantial proportion of injecting drug users would have met criteria for antisocial personality disorder (ASPD) if the childhood trajectory of conduct disorder (CD) were ignored. From among 545 St. Louis, Missouri, drug users interviewed in person, we evaluated the clinical homogeneity of the 405 men and women with adult antisocial behaviors who did and did not have conduct disorder. The fully diagnosed ASPD group (those with CD) was distinguishable from the adult antisocial behavior only group without CD on all childhood behaviors, adult impulsive and aggressive behaviors, and measures of severe drug abuse, including earlier age of onset of drug use and drug treatment utilization. Clinical homogeneity of the groups was reflected by the group's similarity on indices such as types of adult antisocial behaviors, consequences of drug use, injection drug use history, and comorbid psychiatric disorders. Implications for a modification in the concept of ASPD are addressed.
TL;DR: The principle finding is that psychiatric status, especially the presence of ASPD, may have to be considered in evaluating the results of HIV risk-reduction interventions.