Antisocial personality disorder is a mental condition in which a person consistently shows no regard for right and wrong and ignores the rights and feelings of others.
Antisocial personality disorder is a mental condition in which a person consistently shows no regard for right and wrong and ignores the rights and feelings of others.
Suicide, risk factors, assessment and methodological problemsDr. Amit Chougule
Seminar on Suicide from a psychiatric point of view
definition, global and indian epidemiology of suicide, risk assessment of suicide and methodological issues associated with risk assessment and suicide research are covered.
Impulse-control disorders (ICDs) are psychological disorders characterized by the repeated inability to refrain from performing a particular action that is harmful either to oneself or others.
The individual fails to resist performing a potentially harmful act and it is usually accompanied by a sense of tension or arousal before committing the act and a sense of relief or pleasure when it is committed.
The hallmark in describing any of the ICDs is a tendency to gratify an immediate desire or impulse regardless of the consequences to one's self or to others.
special thanks and acknowledgement goes out to the contributors of the slide:
meroshana, haziman fauzi, griselda pearl, widad ulya, atiqah shakira, halim latiffi, farith che man and marwan omar.
Hopefully this is able to help medical students to understand about the psychiatry topic, suicide.
This is made by students so if there are any mistakes, please do correct us. We are open to constructive criticism. thank you :)
Insight is one of the crucial components of a mental status examination in Psychiatry. Scarce data is available in the standard textbooks on this concept.
The following presentation was made after going through the myriad of articles and case studies i found online.
DISORDER CONTENTOF THOUGHT -DELUSION
BY DR.WASIM
UNDER GUIDANCE OF
DR.SANJAY.JAIN
Definition of delusion:
Delusions are categorized into four different groups
THERE ARE 2 TYPES OF DISORDERS OF THOUGHT CONTENT
1.DELUSION
2.OVERVALUED IDEAS
DISTINGUISED
DELUSION
OTHER MEMBERS OF THE CULTURE DONOT SHARE THE BELIEF.
NEED NOT BE ASSOCIATED WITH AFFECT.
FIRMLY SUSTAINED BELIEF.
CONVINCED THAT DELUSION IS REAL.
RECOGNIZED AS ABSURED.
CANNOT BE ACCEPTED.
OCCUR IN MENTALLY ILL PATIENTS.
OVERVALUED IDEAS
OTHER MEMBERS OF THE CULTURE SHARE THE BELIEF.
ASSOCIATED WITH VERY STRONG AFFECT.
NOT HELD FIRMLY.
ATLEAST SOME LEVEL OF DOUBT AS TO ITS TRUTHFULNESS.
NOT RECOGNIZED AS ABSURED.
ACCEPTABLE.
CAN OCCUR IN BOTH HEALTHY AND MENTALLY ILL PATIENTS.
KENDLER’S VECTORS FOR DELUSION:
five stages in the development of delusion(FISH & CONRAD)
FACTORS CONCERNED WITH GENERATION OF DELUSIONS
PATHPOPHYSIOLOGY OF DELUSIONS
PRIMARY DELUSIONS
SECONDARY DELUSIONS
SYSTEMATIZATION
DELUSIONS ON THE BASIS OF CONTENT OF DELUSIONS
THANK YOU
Suicide, risk factors, assessment and methodological problemsDr. Amit Chougule
Seminar on Suicide from a psychiatric point of view
definition, global and indian epidemiology of suicide, risk assessment of suicide and methodological issues associated with risk assessment and suicide research are covered.
Impulse-control disorders (ICDs) are psychological disorders characterized by the repeated inability to refrain from performing a particular action that is harmful either to oneself or others.
The individual fails to resist performing a potentially harmful act and it is usually accompanied by a sense of tension or arousal before committing the act and a sense of relief or pleasure when it is committed.
The hallmark in describing any of the ICDs is a tendency to gratify an immediate desire or impulse regardless of the consequences to one's self or to others.
special thanks and acknowledgement goes out to the contributors of the slide:
meroshana, haziman fauzi, griselda pearl, widad ulya, atiqah shakira, halim latiffi, farith che man and marwan omar.
Hopefully this is able to help medical students to understand about the psychiatry topic, suicide.
This is made by students so if there are any mistakes, please do correct us. We are open to constructive criticism. thank you :)
Insight is one of the crucial components of a mental status examination in Psychiatry. Scarce data is available in the standard textbooks on this concept.
The following presentation was made after going through the myriad of articles and case studies i found online.
DISORDER CONTENTOF THOUGHT -DELUSION
BY DR.WASIM
UNDER GUIDANCE OF
DR.SANJAY.JAIN
Definition of delusion:
Delusions are categorized into four different groups
THERE ARE 2 TYPES OF DISORDERS OF THOUGHT CONTENT
1.DELUSION
2.OVERVALUED IDEAS
DISTINGUISED
DELUSION
OTHER MEMBERS OF THE CULTURE DONOT SHARE THE BELIEF.
NEED NOT BE ASSOCIATED WITH AFFECT.
FIRMLY SUSTAINED BELIEF.
CONVINCED THAT DELUSION IS REAL.
RECOGNIZED AS ABSURED.
CANNOT BE ACCEPTED.
OCCUR IN MENTALLY ILL PATIENTS.
OVERVALUED IDEAS
OTHER MEMBERS OF THE CULTURE SHARE THE BELIEF.
ASSOCIATED WITH VERY STRONG AFFECT.
NOT HELD FIRMLY.
ATLEAST SOME LEVEL OF DOUBT AS TO ITS TRUTHFULNESS.
NOT RECOGNIZED AS ABSURED.
ACCEPTABLE.
CAN OCCUR IN BOTH HEALTHY AND MENTALLY ILL PATIENTS.
KENDLER’S VECTORS FOR DELUSION:
five stages in the development of delusion(FISH & CONRAD)
FACTORS CONCERNED WITH GENERATION OF DELUSIONS
PATHPOPHYSIOLOGY OF DELUSIONS
PRIMARY DELUSIONS
SECONDARY DELUSIONS
SYSTEMATIZATION
DELUSIONS ON THE BASIS OF CONTENT OF DELUSIONS
THANK YOU
Red Flags to Narcissistic Personality Disorder compiled by Jeni MawterJeni Mawter
Narcissistic Personality Disorder is insidious and toxic. It destroys relationships with partners, family, friends, work colleagues and members of the community.
This slide show identifies some of the red flags that signal a relationship with someone with a Narcissistic Personality Disorder.
It is an attempt to explain aberrant relationship behaviours that may be observed at home, with partners, at work, or in community groups.
Borderline Personality Disorder is a Personality Disorder
BPD is one of several personality disorders recognized by the American Psychiatric Association.
Personality disorders are psychological conditions that begin in adolescence or early adulthood, continue over many years, and cause a great deal of distress.
Personality disorders can also often interfere with a person's ability to enjoy life or achieve fulfillment in relationships, work, or school.
Configuring and Managing Results Sources in SharePoint 2013SurfRay
In this live webcast Josh Noble, author of "Pro SharePoint Search 2010", will show attendees how to replicate the functionality of Search Scopes (not available in 2013) in SharePoint 2013 with Result Sources. He will also share a few insider tips to keep in mind whenever working with Result Sources in SP 2013.
A seminar presentation I'd made for as part of my post-grad psych curriculum. Technically Jung and Alder being here is a problem for some, but it was what the faculty wanted added.
Personality disorder are a group of mental health conditions that are characterized by inflexible and atypical patterns of thinking, feeling, and behaving.
Learn to identify, understand and deal with narcissistic personalities. Presented by Dr. Claudia Diez, PhD, ABPP, Jewish Community Center, New York, October 2010.
Notes: video clips cannot be viewed in this mode
Psychoanalytic Social Theory is built on the assumption that social and cultural conditions, especially childhood experiences, are largely responsible for shaping personality.
SOCIAL PSYCHOLOGICAL THEORY
Karen Horney (Theory of Neurosis)
* Background
* Comparison of her theory to Sigmund Freud
* Basic Anxiety
* Neurotic Needs
* The three solutions
* Alienation
Harry Stack Sullivan (Interpersonal Psychoanalytic Theory)
* Background
* Dynamism
* Dynamism of the Self-System
* Personification
* Cognitive Processes
* Tension and its Types
* Energy Transformation
* Stages of Development
* Determiners of Development
* Research on Schizophrenia
Classification in Psychiatry
The concept, reliability, validity, advantages and disadvantages of different classification systems, controversies in psychiatry classification
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
2. OVERVIEW
Introduction
Historical Aspects And Evolution Of The Concept
Epidemiology
Different Perspectives
Comorbidity
Course And Prognosis
Assessment
Management
Ethical Issues
3. A MODEL OF PSYCHIATRIC DISORDERS
1. Disorders of brain chemistry/brain functioning:
Schizophrenia Bipolar disorders
Anxiety disorders Major depressions
2. Disorders of self in relation to others:
Personality disorders
Addictions
Disorders related to trauma
3. Disorders of self in relation to community and society:
Dissocial personality disorders
Conduct disorder
4. INTRODUCTION
Dissocial personality disorder:
Personality disorder usually coming to attention because
of a gross disparity between behaviour and the prevailing
social norms
Anti-social Personality Disorder:
A pervasive pattern of disregard for and violation of the
rights of others
5. PSYCHOPATH SOCIOPATH
1% of general population 4% of general population
Highly heritable
Minnesota twin study showed 60%
heritability
They are simply “ That way”
Origin lies in environment and
upbringing
Defective parenting style
Highly educated and have good
career
Uneducated and unable to have a
steady job
Controlled behaviour Erratic
Manipulative Impulsive
Unable to form an personal
attachment
Can form an attachment to a
particular group
Take calculated risks, minimize
evidence
Spontaneous crimes, tend to leave
evidence
6. PSYCHOPATHY VS SOCIOPATHY VS
ASPD
The terms “sociopath” and “antisocial personality” refer to
behavior and its consequences
“Psychopath” to inner experience
Most sociologists, criminologists believe that ASPD is caused
by social conflicts and thus prefer the term Sociopathy
Those who believe that a combination of psychological,
biological, genetic and environmental factors all contribute to
the ASPD are more likely to use the term psychopathy
7. 1.Gross disparity between behaviour and the prevailing
social norms
2.Flagrantly and pervasively violate the rights of others
Dissocial
personality
disorder
Psychopathy/
Sociopathy
Antisocial
personality
disorder
9. STYLE VS DISORDER
PERSONALITY STYLE PERSONALITY DISORDER
Own value system above that of the
group
Consistently violates social norms
through illegal activities
Spin objective events to its advantage
without engaging in outright deception
Deceive to achieve its own ends
Style is naturally spontaneous and self-
indulgent
Too impulsive to consider the
consequences of its actions
Assertive in creating a felt physical
presence
Irritable and aggressive to the
point of repeated fights or
assaults
Remain free of external constraints
spend on the joys of the present rather
than save prudently for the future
Consistently irresponsible as to
work and financial obligations
Aggressively or impulsively self-serving,
but within moral, social, and legal
boundaries
Lacks a conscience and
rationalizes exploitation of others
10.
11. HISTORICAL ASPECTS AND EVOLUTION
OF CONCEPT
Psychopathy was described by Theophrastus a student of
Aristotle
1800:Philosophical debate between free will and
determinism
Philippe Pinel (1801,1806):
1. Form of madness known as “la folie raisonnante”
2. manie sans delire (insanity without delirium)
3. Unimpaired intelligence and full awareness of actions
4. Intended to be descriptive, not value-laden
12. HISTORICAL ASPECTS AND EVOLUTION OF
CONCEPT
Prichard (1835): Moral Insanity
Despite understanding the choices before them, their
conduct was swayed by overwhelming compulsions
“Can these individuals understand the consequences or
individuals are defective in character and therefore, worthy
of moral condemnation”
13. HISTORICAL ASPECTS AND EVOLUTION OF
CONCEPT
Specific cerebral center controlled morality (Maudsley,1874)
Koch (1891): Psychopathic inferiority
Syndrome as an “congenital or acquired inferiority of brain
constitution”
Kraepelin (1905) classified ‘Personality disorder’
Schneider(1923):
Individuals with ‘psychopathic personalities’ as those who ‘suffer
through their abnormalities or through whom society suffers’
14. HISTORICAL ASPECTS AND EVOLUTION OF
CONCEPT
Psychopathy:
Literally meaning “Psychological Pathology”
First three decades of the twentieth century
Hervey Cleckley’s The Mask of Sanity (1941)
Hare developed the Psychopathy Checklist Revised (PCL-R)
which was influenced by the previous work of Cleckley
15. HISTORICAL ASPECTS AND EVOLUTION
OF CONCEPT
DSM-I in 1952 included the diagnosis of Sociopathic Personality
Disturbance
1. Antisocial sociopaths referred to common offenders
2. Dissocial sociopaths included white collar criminals
The diagnosis evolved to reflect the changing attitudes of the era
Criminality was due to environmental factors in particular a lack
of socialization
In 1980 with the publication of the DSMIII only the term ASPD
was used
17. EPIDEMIOLOGY
Condition is much more prevalent among men
The lifetime prevalence in two North American studies was
4.5% among men and 0.8% among women
(Robins et al.,1991)
Two European studies found a prevalence of:
1. 1.3% in men and 0% in women (Torgensen et al., 2001)
2. 1% in men and 0.2% in women (Coid et al., 2006)
Women have:
1. Greater severity of problems
2. More complex comorbidities for both Axis I and Axis II
disorders
3. Poor outcomes
18. PRISON SETTING
Worldwide- Prevalence of 47% for
men and 21% for women
In the UK- Prevalence is:
1. 63% for male remand prisoners
2. 49% male sentenced prisoners
3. 31% female prisoners
The prevalence of Psychopathy in
UK prisoners is:
1. 4.5% using a PCL-R score of 30
2. 13% using a score of 25
(Fazel & Danesh, 2002, Hare et al., 2000,Singleton et al., 1998)
19. BIOLOGICAL PERSPECTIVES
Inborn temperaments-Aggression, Fearless, Impulsive
Cleckley (1950):
1. Semantic aphasia
2. Inborn inability to understand and express the meaning of
emotional experience
3. Struggle to learn the emotional mechanics of interpersonal
communication
Siever, klar, and coccaro (1985) suggest that:
1. Less cortically aroused but more motorically
disinhibited
2. Tend to act before they can take time to reflect
Low serotonin and high cortisol and testosterone
20. PSYCHODYNAMIC FACTORS
The ego develops, but the superego does not
Total personality remains dominated by the infantile id and its
pleasure principle (friedlander,1945)
Characteristics of “id”
Completely centered on its own immediate needs
Dominated by sex and aggression
Demands immediate gratification
No tolerance for frustration
Lack of conscience is the most important characteristic
21. INTERPERSONAL PERSPECTIVE
According to Kiesler (1996), the antisocial personality
represents almost pure interpersonal hostility
People with ASPD are oppositional, irritable, and rude
They are quick to argue, ignore the feelings of others, resist
cooperation, and readily provoke disputes
Defiant and ruthlessly attack, torment, and abuse others who
thwart their intentions
Antisocials also seek to control others, while vigorously
resisting any and all attempts by others to control them
22. How does the antisocial personality develop
from the interpersonal perspective?
Children exposed to neglect, indifference, hostility, and
physical abuse are likely to learn that the world is a cold,
unforgiving place
Such infants lack normal models of empathic tenderness
Future people with ASPD never learn to control aggression
adequately
They learn that physical intimidation and violence can be
used instrumentally with peers and siblings to coerce their
behavior
23. What shifts the child down a specifically
antisocial pathway?
Neglect and abuse are rather
nonspecific factors, implicated in the
early childhood of many personality
disorders
Benjamin- “context of parenting”
Parents of future people with ASPD
are neglectful and stern
disciplinarians
24. COGNITIVE PERSPECTIVE
Beck et al. (1990) hold that the core beliefs of antisocials are
organized around a need to see themselves as strong and
independent
World is seen as an intrinsically hostile place
Survival demands survival-oriented core beliefs
“I must look out for myself”
“If I am not the aggressor, then I will be the victim”
“It’s okay to take advantage of someone who allows it”
25. CONTRAST WITH OTHER PERSONALITIES
Antisocial Borderline Histrionic
Manipulative Need to dominate,
seize power
Attempt to evoke
support and
nurture
Attempt to occupy and
hold the center of
attention
Impulsivity shortsighted
fixation on
immediate
gratification
impulsive in
reaction to anxious
feelings of
emptiness or
depersonalization
Impulsivity is part of
emotional
dramatization
Acting out intense verbal
threat or violence
acting-out often
takes the form of
suicidal gestures
26. ASPD VS NPD
Share a tendency to be tough-minded, glib, superficial,
exploitative and lack empathy
Narcissistic personality disorder(NPD) does not include
characteristics of impulsivity, aggression, and deceit
Individuals with ASPD are not needy of the admiration and
envy of others
Persons with NPD usually lack the history of conduct
disorder in childhood or criminal behavior in adulthood
27. ASPD AND COMORBIDITY
Swanson and colleagues (1994) community study showed:
Increased prevalence of nearly every other psychiatric
disorder:
1. 90.4% having at least one other psychiatric disorder
2. Substance misuse is the most important Comorbidity
Epidemiological Catchment Area (ECA) study:
1. Five times more likely to misuse alcohol and illicit drugs
2. Half have co-occurring anxiety disorders
3. Quarter have a depressive disorder
28. COURSE AND PROGNOSIS
Antisocial behaviours have their onset before age 8 years
Nearly 80% of people with ASPD developed their first
symptom by age 11 years
Boys develop symptoms earlier than girls
Robins observed that a child who makes it to age 15 without
exhibiting antisocial behaviours are less likely to develop
ASPD
An estimated 25% of girls and 40% of boys with CD will later
meet criteria for ASPD
Subset of antisocial adults have no history of childhood CD
29. COURSE AND PROGNOSIS
ASPD is more common in men and more likely to persist when compared
with women
Guze (1976) found that male felons were still antisocial by interview at
follow-up (87% at 3 years, 72% at 9 years)
Martin and colleagues (1982) found that among women:
1. 33% were engaging in criminal behaviour at 3 years
2. 18% at 6 years
Black and colleagues (1995) longitudinal follow up study in Men showed
that”:
1. Reduced impulsive behaviour and criminality with time
2. Continued to have significant interpersonal problems throughout their
lives
30. PREVENTIVE MEASURES
Secondary prevention with principles of primary prevention
Applied to people who are markedly at risk or who show its very early
signs
Interventions tend to focus on the reduction of risk and strengthening of
resilience
Risk factors:
Poverty, unemployment, inadequate transportation, sub-standard
housing, parental mental health problems and marital conflict
Elmira Project:
Early intensive nurse home visitation intervention worked well to
prevent child maltreatment in the early years and delinquency at 15
years’ follow-up
31. PRESENTATION IN HEALTHCARE
Rarely present in healthcare settings requiring help to deal
directly with problems arising from their personality disorder
‘Treatment rejecting’ rather than ‘treatment seeking’
People antisocial personality disorder present for treatment:
1. Comorbid condition and/or they have been coerced into
treatment
2. By a relative or some external authority in a crisis
32. RISK ASSESSMENT
Psychopathy Checklist Revised (PCL-R; Hare, 1991)
1. It is a measure of psychopathy
2. Shown to correlate highly with violence risk
3. Widely used in violence risk assessment
4. Measure of severity for antisocial personality disorder
Screening version (PCL-SV) - 12 items providing a score
from 0 to 24 (Hart et al., 1999)
Violence Risk Assessment Guide (VRAG)
Offender Group Reconviction Scale (OGRS)
33. TREATMENT AND MANAGEMENT
Pharmacological treatments
The research evidence justifying the use of these interventions
is limited
DSM diagnosis has limited uses for treatment planning
(Livesley, 2007), Soloff (1998) recommended a symptom-
orientated approach:
1. Impulse–behavioural
2. Affective
3. Cognitive-perceptual
SSRIs and antimanic drugs for impulsive dyscontrol
SSRIs and other antidepressants for emotional dysregulation
Low dose antipsychotics for cognitive-perceptual abnormalities
34. THERAPEUTIC TRAPS
For Antisocials therapy is just another annoying encounter with
the constraining forces of society
Antisocials are basically interested in shrugging off external
constraints
Therapy goals are:
1. To develop a sense of conscience
2. Express guilt
3. Express a sincere desire to reform and make amends
They should change slowly and mostly in response to the
searching and confrontive questions of the therapist
35. THERAPEUTIC TRAPS
Duping of therapist by Antisocials by:
1. Seemingly sincere expressions of regret
2. Guilt about the destruction of life and property
3. Existential despair about the wasting own life
Naive therapists get trapped:
1. Those who “need” to cure their subjects
2. Those who might compete against fellow therapists by
displaying their psychopath as one who grew a
conscience
36. THERAPEUTIC TRAPS
Therapists often:
1. Exhibit a variety of intense countertransference
reactions
2. Become suspicious, angry, and resentful
3. They may miss opportunities to catalyze real change
with a genuine therapeutic alliance
37. DEALING WITH THERAPEUTIC TRAP
Beck et al. (1990) suggest:
1. Self-assurance
2. Reliable but not infallible objectivity
3. Relaxed and non-defensive interpersonal style
4. Clear sense of personal limits
5. Strong sense of humor
Frances (1985) suggests that the therapist openly
acknowledge the vulnerability of the therapy setting to the
possibility of manipulation, as many subjects appreciate such
frank disclosure
38. STRATEGIES AND TECHNIQUES
The ultimate goal of therapy is developing a sense of nurturing
attachment (Benjamin, 1996)
The primary objectives of therapy are:
1. To find some way of bonding with the antisocial person
2. To develop a therapeutic alliance
Address the underlying sense of hostility as they are coerced into
therapy
39. INTERPERSONAL THERAPY
Interpersonally Benjamin (1996) suggests that antisocial
subjects lack constructive socializing experiences
Strategies that can be used to help antisocials internalize
values:
1. Sports figures to model warm and benevolent attitudes
2. Put antisocial in a potentially nurturing position
3. Giving a pet or allowed to instruct children in some
supervised context such as a skill or a sport
40. COGNITIVE THERAPY
Beck et al. (1990) and D. Davis describes the use of
cognitive therapy
Move the subject from a primitive to a more abstract level of
moral reasoning
Make subjects recognize that their actions affect others and
have reciprocal consequences for themselves
Delay of gratification and teaching skills necessary to make
enlightened self-interest
41. PSYCHOSOCIAL INTERVENTIONS
Therapeutic community
The therapeutic community movement had a significant
impact on mental healthcare in the mid to late 20th century
(Lees et al., 2003)
Prison service (Grendon Underwood; Snell, 1962) and drug
service
High costs
Absence of convincing evidence for efficacy
42. ETHICAL CONSIDERATIONS IN ANTISOCIAL
PERSONALITY DISORDER
Whether ASPD/Psychopathy/Sociopathy is a disorder at all?
For Philosophers:
Psychopathy is a medical entity to explore issues of moral
reasoning and responsibility
For Psychologists and Psychiatrists:
Whether people with antisocial personality disorder are subject of
medical discourse at all
Implications for criminal responsibility
Much of the current research is used to address this debate
If biological basis- then it is a disorder which needs treatment or at
least intervention
43. ETHICAL CONSIDERATIONS
Conceptual slippage:
‘Antisocial behaviour’ is not the same as criminality or
violence or antisocial personality disorder or psychopathy
Brain research cannot explain why people in general choose
to behave antisocially
All human behaviours are complex
It seems very probable that genetic vulnerability interacts
with environment to produce a neural matrix that contributes
causally to socially significant rule breaking
Only a contribution and not a total explanation
44. ETHICAL CONSIDERATIONS
Researchers and healthcare policy makers need to understand
that:
Problems posed by these people are social ones
There has to be a social/political dimension to the work that is
undertaken
This seems alien to many healthcare professionals and
scientists who see biosciences as politically and morally neutral
Biological model for anti social behaviour is unlikely to change
public attitudes
45. ETHICAL ISSUES- TREATABILITY
The notion of ‘treatment’ raises a number of ethical issues
The assumption that it is a disorder that is amenable to
intervention
A key issue is test of therapeutic outcome
Most ethical arguments about healthcare resources are utilitarian
in nature:
“What will bring about the most good for the greatest
number?”
46. ETHICAL ISSUES OF COERCION IN
RELATION TO ASPD
The only people with capacity who cannot refuse treatment, and
can have treatment forced upon them, are those with mental
disorders who pose a risk to themselves or others
Most libertarian philosophical arguments (Saks, 2003):
Forced medical treatment is only justified to improve a person’s
own health and safety
Insult to dignity is outweighed by the prevention of serious
harm
What is the extent to which societies should coerce people into
treatment that is not of benefit to them directly?
47. ETHICAL ISSUES OF COERCION IN
RELATION TO ASPD
Mental health professionals often argue that they are not
being unethical in two ways:
1. Patients are benefiting even if indirectly
At least they are benefiting from not being allowed to
harm others
Discriminatory—generally competent citizens are
allowed to choose whether they do harm or not, and take
the consequences
2. People who are a risk to others have lost some of their
claims to full exercise of autonomy
48. ETHICAL ISSUES OF COERCION IN RELATION
TO ASPD
Need for distinction to be made between legal coercion and
therapeutic persuasion
Unlikely that all antisocial patients can be coerced into pro-
social thinking or behaviour
Balance between:
The rights of individuals to have liberty
VS
Rights of a community to be protected from potential harm
49. THE ETHICS OF PUBLIC PROTECTION
The extent to which a range of healthcare professionals should be
involved in public protection
Act on knowledge to assist in public protection from a small
number of risky individuals with mental disorders
VS
Make the care of the patient their first concern
A possible ethical and legal solution to the tension is:
Informed consent for both risk assessments and medico-legal
interviews
Clearly advise patients/defendants of the purpose of the interview
The use to which the material will be put
Who will be informed of the outcome
50. ETHICAL ISSUES AND CHILDREN
The prevention of antisocial personality disorder
Justified in terms of beneficial consequences in the future:
1. No (or reduced) antisocial personality disorder
2. Prevention of harm to others and costs to society
Outcomes look very attractive
The question is:
At what cost to human dignity and justice will these benefits
come?
Will the ends justify the harms done in the process?
Most importantly in ethical decision making: who gets to
decide?
51. REFERENCES
1. Book. Theodore. M. Personality disorders in modern life.
Second edition. Florida. Coral gables.
2. Book. Antisocial personality disorder: treatment,
management and prevention. National collaborating centre
for mental health. National institute for health & clinical
excellence. The british psychological society and the royal
college of psychiatrists. 2010
3. Book. Tasman. A. Psychiatry. Fourth edition. John wiley &
sons, ltd.2015
52. They are angry
They make you angry
They need help
You can help them
“ Will you ?”
Thank you
Editor's Notes
First personality disorder to be recognized in psychiatry
Semantic refers to meaning, and aphasia is broadly considered a class of disorders related to the understanding or production of language
Therapist may wish to suggest that because external forces have mandated a course of therapy, the time might as well be used constructively, even though the therapist has no personal investment in the outcome
and involve higher level thinking about motives, beliefs, attributions
It is a general principle of bioethics that respect for the autonomy of patients is paramount and a general principle of law that everyone has control over his/her own body and any treatment interventions that are offered. Under the new Mental Capacity Act
(HMSO, 2005), any person with capacity can refuse treatment, even if this is to
his/her own detriment