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antisocial pd

antisocial personality disorder

Three Clusters of Personality Disorders 1. Cluster A (odd-eccentric), 2. Cluster B (dramatic-emotional), 3. Cluster C (anxious-fearful)
3 Cluster A Personality Disorders paranoid, schizoid, schizotypal
4 Cluster B Personality Disorders borderline, antisocial, histrionic, narcissistic
3 Cluster C Personality Disorders avoidant, dependent, ocpd
various names aspd previously known as moral insanity, psychopathic, psychopath
is “psychopath” used in DSM-IV-TR? no
key features of ASPD per DSM-IV-TR problems forming positive relations with others, violates social norms/values, deceitful, violent crimes with no remorse, impulsive, low tolerance for frustration, no concern for consequences of behavior, seek thrills, easily bored/restless
Cleckley/Hare criteria for dx of ASPD superficial charm, grandiosity, tendency towards boredom, need stimulation, pathological lying, ability to be manipulative, lack of remorse, cold/callous, pleasure from humiliating others, insist on being seen as faultless, dogmatic in opinions
Difference between DSM-IV-TR and Cleckley/Hare criteria DSM=observable behavior; CH=personality traits
Typical ASPD characteristics more likely to have low levels of education, 80% are substance abusers, increased risk for suicide/violent death
Most stable personality characteristic tendency to engage in antisocial behaviors. Many show this behavior in childhood (conduct disorder). Antisocial tendencies tend to diminish with age if only started in teens.
7 contributors to ASPD genetics, pre-natal testosterone, low serotonin, ADHD, deficits in executive functions of the brain, low arousability, social-cognitive (inconsistent parenting, assume others are aggressive towards them)
role of testosterone probably important pre-natally in organizing the fetal brain, but not so important on behavior in adolescence/adulthood
serotonin a monamine neurotransmitter involved in regulation of mood, emotions, and impulsions
executive functions of the brain ability to concentrate, abstract reasoning and concept formation, ability to anticipate/plan, self-monitor, ability to shift from maladaptive to adaptive patterns of behavior
parts of brain assoc. w/ASPD deficits in frontal and temporal lobes
role of arousability in ASPD low levels of arousability lead to fearlessness in dangerous situations and/or stimulation-seeking
homes of ASPD children physical abuse, inconsistent parenting alternating between neglect and hostility/violence
integrative model of ASPD development born w/ bio dispositions or into sociocltrl contexts that put at risk for AS beh> early aggrssn leads to dscpln, coldness, & conflict w/ othrs>academic/soc prblms> dvant peer grps, see wrld as hstl, dfends aggressively>>dvlp hx of neg intractions w/ othrs
Do ASPDers think they need treatment? No, they are prone to blaming others for their situations. Do not accept responsibility for their actions. As such, many clinicians don’t think psychotherapy will be effective.
Focus of psychotherapy for ASPD 1. Controlling anger and impulsive behavior. 2. Try to increase the person’s empathy for their effects on others.
Drugs for ASPD lithium & atypical antipsychotics. Effectiveness of SSRIs is being researched.
Characteristics of Personality Disorders MEDIC: maladaptive, enduring, deviates from cultural norms, inflexible, causes soc/occupational functioning
Treatment of Personality Disorders psychotherapy is the mainstay, pharmacotherapy reserved for cases w/ comorbid mood, anxiety, or psychotic disorders
Cluster A description ”weird” or odd-eccentric
Cluster B description ”wild” or dramatic-emotional
Cluster C description ”worried and wimpy” or anxious-fearful
Atypical antipsychotics first-line tx for schizophrenia, side fx: wt gain, type 2 dm, sedation, agranulocytois (clozapine), examples: clozapine, risperidone (Risperdal), quetiapine (Seroquel), olanzapine, ziprasidone (Geodon), aripiprazole (Abilify)
Lithium mood stabilizer, used for acute mania, prophylaxis in bipoloar, and augments depression tx; side fx: thirst, polyuria, tremor, nausea, seizures; toxicity: ataxia, dysarthira, delirium; therapeutic range: 0.5-1.5mEq/L
Created by: jondoh
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