Psychiatric topic.Useful for all mbbs undergraduates.

1. PRESENTATION BY : TV AKHIL
MODERATOR: DR RICHA

2. CONTENTS
 INTRODUCTION
 EPIDEMIOLOGY
 CAUSES
 RISK FACTORS
 SYMPTOMS
 DIAGNOSIS
 TREATMENT
 COMPLICATIONS
 PREVENTION

3. INTRODUCTION
 Antisocial personality disorder is a condition in which
people show a pervasive disregard for the law and
the rights of others.
 It is a mental health condition in which aperson hasa
long-term pattern of manipulating, exploiting, or violating
the rights of others. Thisbehaviour is oftencriminal.
 People may tend to lie or steal and often fail to fulfil
job or parenting responsibilities. The "sociopath"
and "psychopath" are sometimes used to describe
a person.

4. EPIDEMIOLOGY
 Prevalence rates of 3% for males and 1%
females in general population.
 As noted in DSM-5, there has been some
concern that this disorder may be under
diagnosed in females, given the emphasis on
aggressive items in diagnosing Conduct disorder.
 High frequency is associated with low
socioeconomic status and urban settings.

6. CAUSES
 The exact causes are unknown, but experts
believe that both hereditary factors and
environmental circumstances influence
development of the condition.
 A family history of the disorder — such as having
an antisocial parent — increases the chances of
developing the condition.
 A number of environmental factors within the
childhood home, school and community also may
contribute.

7.  Both adopted and biological children of parents
with ASPD are at a increased risk for this disorder.
 Conduct disorder (before the age of 10 years) and
accompanying ADHD increase the likelihood of
developing ASPD in adult life.
 Conduct disorder is more likely to develop into
Antisocial disorder with erratic parenting, neglect ,
or inconsistent parental discipline.

8.  Abnormal brain function and
serotonin have been linked
with impulsive behaviour.
 Because both the temporal
lobes and prefrontal cortex
help regulate m o o d and
behaviour, it ispossible that
ASP behaviour stems from
functional abnormality in the
serotonin.
 Brain differences reveals
reduced activity in the frontal
lobes.
NORMAL MURDERER

9.  A n unstable or
abuse during
childhood may
contribute to ASPD.
 The lack of
emotional bonding
at a young age can
damage a persons
ability to form
intimate and trusting
relationships in the
future, causing them
to view others solely
as objects or victims.

10. RISK FACTORS
 Having suffered from child abuse
 Having a childhood environment of deprivation or
neglect
 Having an antisocial parent
 Having an alcoholic parent
 Being involved in a group of peers that exhibit
antisocial behaviour
 Having an attention-deficit disorder
 Having a reading disorder

11. SYMPTOMS
 The classic person with an antisocial personality is
indifferent to the needs of others and may manipulate
through deceit or intimidation.
 They are usually loners.
 Aggressive and violent and are likely to have frequent
encounters with the law.
 Some may also possess a considerable amount of
charm and wit.

12.  A persistent agitated or depressed feeling (dysphoria)
 Disregard for the safety of self or others.
 A childhood diagnosis of conduct disorders.
 Lack of remorse for hurting others.
 A sense of extreme entitlement .
 Inability to make or keep friends.

13. CLINICAL CRITERIA
 The hallmarks of ASPD are pervasive disregard for
and violation of rights of others occurring since
the age of 15 years and continuing into
adulthood.
 A person has to be 18 years of age or older, and
there has to be evidence of conduct disorder before
the age of 15 years.

14. DIAGNOSIS
 Diagnostic features includes at least 3 of the
following-
1.) Failure to conform to social norms (resulting in frequent
arrests)
2.) Deceitfulness, including lying and conning others for
personal profit or pleasure.
3.) Impulsivity or failure to plan ahead..
4.) Recklessness, with disregard for safety of self and others.
5.) Lack of remorse, indicated by indifference or rationalising
having hurt, mistreated, or stolen from others.

15.  Some of the associated features include the
following:
 Promiscuity and inability to sustain a monogamous
relationship.
 Lack of empathy, cynicism, contempt for feelings,
rights or suffering of others.
 Inflated and arrogant self-appraisal.
 Abusiveness and irresponsibility towards children.

16. DIFFRENTIAL DIAGNOSIS
 Narcissistic Personality Disorder-rarely manifests
serious criminality, aggression and deficit and is
characterised by excessive need for admiration from
others.
 Histrionic Personality Disorder-includes
seductiveness , attention seeking and rarely
serious criminality and aggressiveness.
 Paranoid Personality disorder- includes
suspiciousness, guarded attitude.

17. TREATMENT
 Typically ineffective.
 Control of behaviour ( Hospitalization/Imprisonment).
 Control of Substance abuse.
 Mood Stabilizers- Lithium, Carbamezepine and Sodium
Valporate can reduce impulsiveness and aggression.
 Anti Depressants- Fluoxetine can help with the mood
and emotional difficulties that they have.
 Unfortunately, many people with antisocial personality
disorder don't take their medications as prescribed.

18.  Cognitive Behavioural Therapy- it identifies the distortions
and engages the patient in efforts to reformulate perceptions
and behaviour.
 Psychotherapy-is often difficult if not impossible.This therapy
can help people to develop appropriate interpersonal skills and
instill a moral code.
 Group Therapy- allows interpersonal psychopathology to
display itself among peer patients where feedback is used by
the therapist to identify and correct maladaptive ideas.

19. COMPLICATIONS
 Dying from a physical trauma, such as an accident.
 Drug and alcohol abuse.
 Low tolerance for boredom.
 Suicide
 Homicide
 Other mental disorders- BPAD ,Anxiety disorders,
Impulse control disorders.
 Committing serious crimes that may result in
imprisonment.

20. PREVENTION
 Because antisocial behaviour has its roots in early
adolescence, early intervention may help diminish the
development of problem behaviours.
 These may include:
- Providing clear rules for conduct and discipline.
-Minimizing academic failures.
-Being consistent in applying consequences for bad
behaviours.
- Teaching respect for others with ethnic, cultural diffrences.
-Teaching critical social and interpersonal skills.
- Teaching respect for others with ethnic, cultural or other
differences.

21. REFERENCES
 KAPLAN AND SADOCK'S COMPREHENSIVE
TEXTBOOK OF PSYCHIATRY-10TH EDITION
 Psychcentral.com
 Medicinet.com
 Webmd.com
 Allpsych.com