antisocial personality disorder
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| Three Clusters of Personality Disorders | 1. Cluster A (odd-eccentric), 2. Cluster B (dramatic-emotional), 3. Cluster C (anxious-fearful)
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| 3 Cluster A Personality Disorders | paranoid, schizoid, schizotypal
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| 4 Cluster B Personality Disorders | borderline, antisocial, histrionic, narcissistic
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| 3 Cluster C Personality Disorders | avoidant, dependent, ocpd
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| various names aspd previously known as | moral insanity, psychopathic, psychopath
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| is “psychopath” used in DSM-IV-TR? | no
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| 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
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| 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
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| Difference between DSM-IV-TR and Cleckley/Hare criteria | DSM=observable behavior; CH=personality traits
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| Typical ASPD characteristics | more likely to have low levels of education, 80% are substance abusers, increased risk for suicide/violent death
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| 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.
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| 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)
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| role of testosterone | probably important pre-natally in organizing the fetal brain, but not so important on behavior in adolescence/adulthood
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| serotonin | a monamine neurotransmitter involved in regulation of mood, emotions, and impulsions
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| 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
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| parts of brain assoc. w/ASPD | deficits in frontal and temporal lobes
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| role of arousability in ASPD | low levels of arousability lead to fearlessness in dangerous situations and/or stimulation-seeking
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| homes of ASPD children | physical abuse, inconsistent parenting alternating between neglect and hostility/violence
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| 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
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| 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.
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| Focus of psychotherapy for ASPD | 1. Controlling anger and impulsive behavior. 2. Try to increase the person’s empathy for their effects on others.
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| Drugs for ASPD | lithium & atypical antipsychotics. Effectiveness of SSRIs is being researched.
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| Characteristics of Personality Disorders | MEDIC: maladaptive, enduring, deviates from cultural norms, inflexible, causes soc/occupational functioning
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| Treatment of Personality Disorders | psychotherapy is the mainstay, pharmacotherapy reserved for cases w/ comorbid mood, anxiety, or psychotic disorders
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| Cluster A description | ”weird” or odd-eccentric
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| Cluster B description | ”wild” or dramatic-emotional
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| Cluster C description | ”worried and wimpy” or anxious-fearful
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| 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)
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| 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
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