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Frontiers in Psychology 2019The emergence of enduring antisocial personality changes in previously normal individuals, or "acquired sociopathy," has consistently been reported in patients with...
The emergence of enduring antisocial personality changes in previously normal individuals, or "acquired sociopathy," has consistently been reported in patients with bilateral injuries of the ventromedial prefrontal cortex. Over the past three decades, cases of acquired sociopathy with (a) bilateral or (b) unilateral sparing of the ventromedial prefrontal cortex have been reported. These cases indicate that at least in a few individuals (a') neural structures beyond the ventromedial prefrontal cortex are also critical for normal social behavior, and (b') the neural underpinnings of social cognition may be lateralized to one cerebral hemisphere. Moreover, researchers have presented evidence that lesion laterality and gender may interact in the production of acquired sociopathy. In the present review, we carried out a comprehensive literature survey seeking possible interactions between gender and hemispheric asymmetry in acquired sociopathy. We found 85 cases of acquired sociopathy due to bilateral ( = 48) and unilateral ( = 37) hemispheric injuries. A significant association between acquired sociopathy and right hemisphere damage was found in men, whereas lesions were bilateral in most women with acquired sociopathy. The present survey shows that: (i) the number of well-documented single-cases of acquired sociopathy is surprisingly small given the length of the historical record; (ii) acquired sociopathy was significantly more frequent in men after an injury of the right or of both cerebral hemispheres; and (iii) in most women who developed acquired sociopathy the injuries affected both cerebral hemispheres. These findings may be especially valuable to neuroscientists and to functional neurosurgeons in particular for the planning of tumor resections as well as for the choice of the best targets for therapeutic neuromodulation.
PubMed: 30941065
DOI: 10.3389/fpsyg.2019.00346 -
Journal of Substance Abuse Treatment May 2019Contingency Management is an evidence-based treatment for substance use disorders with strong potential for measurement-based customization. Previous work has examined...
Contingency Management is an evidence-based treatment for substance use disorders with strong potential for measurement-based customization. Previous work has examined individual difference factors in Contingency Management treatment response of potential relevance to treatment targeting and adaptive implementation; however, a systematic review of such factors has not yet been conducted. Here, we summarize and evaluate the existing literature on patient-level predictors, mediators, and moderators of Contingency Management treatment response in stimulant and/or opioid using outpatients - clinical populations most frequently targeted in Contingency Management research and clinical practice. Our search strategy identified 648 unique, peer-reviewed publications, of which 39 met full inclusion criteria for the current review. These publications considered a variety of individual difference factors, including (1) motivation to change and substance use before and during treatment (8/39 publications), (2) substance use comorbidity and chronicity (8/39 publications), (3) psychiatric comorbidity and severity (8/39 publications), (4) medical, legal, and sociodemographic considerations (15/39 publications), and (5) cognitive-behavioral variables (1/39 publications). Contingency Management was generally associated with improved treatment outcomes (e.g., longer periods of continuous abstinence, better retention), regardless of individual difference factors; however, specific patient-level characteristics were associated with either an enhanced (e.g., more previous treatment attempts, history of sexual abuse, diagnosis of antisocial personality disorder) or diminished (e.g., complex post-traumatic stress symptoms, pretreatment benzodiazepine use) response to Contingency Management. Overall, the current literature is limited but existing evidence generally supports greater benefits of Contingency Management in patients who would otherwise have a poorer prognosis in standard outpatient care. It was also identified that the majority of previous work represents a posteriori analysis of pre-existing clinical samples and has therefore rarely considered pre-specified, hypothesis-driven individual difference factors. We therefore additionally highlight patient-level factors that are currently understudied, as well as promising future directions for measurement-based treatment adaptations that may directly respond to patient traits and states to improve Contingency Management effectiveness across individuals and over time.
Topics: Behavior Therapy; Evidence-Based Practice; Humans; Individuality; Motivation; Outcome Assessment, Health Care; Reward; Substance-Related Disorders
PubMed: 30898330
DOI: 10.1016/j.jsat.2019.03.001 -
Frontiers in Psychiatry 2019Antisocial personality disorder is an enduring mental disorder associated with significant disease burden and treatment difficulties. This is apparent within forensic...
Antisocial personality disorder is an enduring mental disorder associated with significant disease burden and treatment difficulties. This is apparent within forensic populations. There is growing evidence to suggest that treatment with oxytocin could have some benefit in treating a range of psychiatric disorders. There are no reviews studying the use of oxytocin for patients with ASPD. We aim to present the first literature review on the use of oxytocin in patients with ASPD. We searched relevant databases for original research on effect of oxytocin upon persons with a diagnosis of ASPD or healthy participants with symptoms seen in ASPD. Studies were included if they included healthy participants that evaluated the effect of oxytocin on symptoms relevant to ASPD, including empathy, inhibitory control, compliance, conformity, aggression, violence, and moral responsibility. Thirty-six studies were included. There were a range of study designs, including randomized controlled trials, double blinded, single blinded, and unblinded controlled trials. The sample sizes in studies ranged from 20 to 259 participants. Studies looked at participants with a diagnosis of ASPD and participants with symptoms relevant to ASPD, including empathy, inhibitory control, compliance, conformity, aggression, violence, and moral responsibility. Oxytocin was found to demonstrate diversified effects, in most cases being associated with socially positive or non-criminogenic behaviors. However, some studies found opposite, and non-desirable, effects, e.g., an increase in violent inclinations to partners. The two studies looking at participants with ASPD had a number of limitations and had conflicting results on the impact that OT has on aggression in ASPD. This is the first systematic literature review exploring the potential use of oxytocin in managing ASPD and the symptoms of ASPD. It is apparent that there is a body of evidence addressing related symptoms in healthy individuals. There were diversified effects with oxytocin showing some benefits in promoting positive effects on symptoms of ASPD, but there were also studies showing non-desirable effects. It is difficult to draw any direct inferences from healthy control studies. Further high quality large sample studies are required to explore the effects of oxytocin in those with ASPD.
PubMed: 30873049
DOI: 10.3389/fpsyt.2019.00076 -
Neuroscience and Biobehavioral Reviews Jan 2019According to the dual-hormone hypothesis, the relationship between testosterone and status-relevant behavior is moderated by cortisol, suggesting this relationship only... (Meta-Analysis)
Meta-Analysis
A meta-analytical evaluation of the dual-hormone hypothesis: Does cortisol moderate the relationship between testosterone and status, dominance, risk taking, aggression, and psychopathy?
According to the dual-hormone hypothesis, the relationship between testosterone and status-relevant behavior is moderated by cortisol, suggesting this relationship only exists when cortisol is low. In the current study, a meta-analysis (including 30 papers with 33 studies, 49 effect sizes, n = 8538) on the interaction effect of testosterone and cortisol on status-relevant behavior (i.e. status, dominance, risk taking, aggression, and psychopathy) was performed. There was only marginal support for the dual-hormone hypothesis: The effect size of the interaction between testosterone and cortisol on status-relevant behavior was significant but very small (r = -.061, p = .026), which was corroborated by follow-up meta-analyses on simple slopes on low and high cortisol. Effect sizes were largest for direct status measures, although not significantly different from other outcome measures. Similarly, effect sizes seemed larger for men than for women. However, robustness analyses indicated signs of publication bias, enhanced significance due to potential flexibility in data-analysis, and a lack of power of individual studies, emphasizing the need for a large, pre-registered study.
Topics: Aggression; Animals; Antisocial Personality Disorder; Humans; Hydrocortisone; Models, Biological; Risk-Taking; Social Dominance; Testosterone
PubMed: 30529754
DOI: 10.1016/j.neubiorev.2018.12.004 -
Personality Disorders Nov 2018Antisocial Behavior (AB) has a tremendous societal cost, motivating investigation of the mechanisms that cause individuals to engage and persist in AB. Recent theories...
Antisocial Behavior (AB) has a tremendous societal cost, motivating investigation of the mechanisms that cause individuals to engage and persist in AB. Recent theories of AB emphasize the role of reward-related neural processes in the etiology of severe and chronic forms of AB, including antisocial personality disorder and psychopathy. However, no systematic reviews have evaluated the hypothesis that reward-related neural dysfunction is an etiologic factor in AB in adult samples. Moreover, it is unclear whether AB is linked to a hyper- or hyposensitive reward system and whether AB is related to neural sensitivity to losses. Thus, the current systematic review examined whether AB (including antisocial personality disorder) and psychopathic traits are related to neural reactivity during reward processing, loss processing, or both. Our review identified seven task-based functional MRI or functional connectivity studies that examined associations between neural response to reward and loss, and dimensional and categorical measures of adult AB and/or psychopathy. Across studies, there was evidence that AB is associated with variability in neural functioning during both reward and loss processing. In particular, impulsive-antisocial traits appeared to be specifically associated with hypersensitivity in the ventral striatum during the anticipation, but not the receipt, of rewards. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Topics: Antisocial Personality Disorder; Brain; Functional Neuroimaging; Humans; Impulsive Behavior; Magnetic Resonance Imaging; Reward
PubMed: 30080060
DOI: 10.1037/per0000308 -
Tijdschrift Voor Psychiatrie 2018Death threats are common in the therapist's office. Many therapists don't know how to handle these.
AIM: To provide background information and tools for the... (Review)Review
Death threats are common in the therapist's office. Many therapists don't know how to handle these.
AIM: To provide background information and tools for the practitioner who receives a homicidal threat from a patient.
METHOD: A systematic literature review of the epidemiology, diagnostics, risk assessment and treatment of homicidal threats.
RESULTS: During consultation, a death threat is not equatable with the announcement of murder. There are far more instances where the patient does not follow through with their threat. A psychotic disorder, an antisocial personality disorder, alcohol abuse, (bipolar) depression, long-existing (severe) domestic violence, possession of a weapon or a previous conviction for a death threat are important risk increasing factors. The risk assessment evaluates the motives and the proclivity to act. emdr and aggression regulation therapy appear to be effective treatments for underlying trauma and anger. However, psycho-dynamic aspects and feelings of countertransference should also be taken into account during therapy. Three Dutch guidelines about professional secrecy are important when making an assessment about whether or not one should break the rules of confidentiality.
CONCLUSION: Any practitioner who may be faced with a homicidal patient should have ready access to the relevant guidelines. Mental health institutions are encouraged to actively support this process.Topics: Aggression; Dangerous Behavior; Homicide; Humans; Practice Guidelines as Topic; Psychiatry; Psychotic Disorders; Violence
PubMed: 29638238
DOI: No ID Found -
Psychiatry Research Jan 2018Although several authors have suggested that a single externalizing spectrum encompassing both antisocial behavioral syndromes and substance use disorder is to be... (Review)
Review
BACKGROUND
Although several authors have suggested that a single externalizing spectrum encompassing both antisocial behavioral syndromes and substance use disorder is to be preferred, this assumption has not been evaluated systematically throughout studies.
PURPOSE
The objective was to establish the generalizability of transdiagnostic models of externalizing disorders across different types of disorders and populations, in regard to the strength of the evidence.
METHOD
We conducted a systematic literature review using combinations of two sets of keywords: 1) "antisocial", "externalizing", "conduct disorder", "disruptive behavior disorder", "substance abuse", "substance-related disorder", "cannabis", "cocaine", "hallucinogen", "alcoholism", "opioid"; 2) "latent structure", "factor analysis", "multivariate analysis".
RESULTS
Models supporting a superordinate factor appeared dominant in a limited set of different populations, on which the majority of the research sample was focused.
CONCLUSIONS
Although the externalizing spectrum model is a promising angle for future research and treatment, extending research on this model in a higher diversity of populations is recommended to enhance the understanding and applicability of the externalizing spectrum model.
Topics: Antisocial Personality Disorder; Attention Deficit and Disruptive Behavior Disorders; Conduct Disorder; Humans; Substance-Related Disorders; Syndrome
PubMed: 29120851
DOI: 10.1016/j.psychres.2017.11.007 -
NeuroImage. Clinical 2017Antisocial behavior (AB), including aggression, violence, and theft, is thought be underpinned by abnormal functioning in networks of the brain critical to emotion... (Review)
Review
Antisocial behavior (AB), including aggression, violence, and theft, is thought be underpinned by abnormal functioning in networks of the brain critical to emotion processing, behavioral control, and reward-related learning. To better understand the abnormal functioning of these networks, research has begun to investigate the connections between brain regions implicated in AB using diffusion tensor imaging (DTI), which assesses white-matter tract microstructure. This systematic review integrates findings from 22 studies that examined the relationship between white-matter microstructure and AB across development. In contrast to a prior hypothesis that AB is associated with greater diffusivity specifically in the uncinate fasciculus, findings suggest that adult AB is associated with greater diffusivity across a range of white-matter tracts, including the uncinate fasciculus, inferior fronto-occipital fasciculus, cingulum, corticospinal tract, thalamic radiations, and corpus callosum. The pattern of findings among youth studies was inconclusive with both higher and lower diffusivity found across association, commissural, and projection and thalamic tracts.
Topics: Antisocial Personality Disorder; Diffusion Tensor Imaging; Humans; Neural Pathways; White Matter
PubMed: 28180079
DOI: 10.1016/j.nicl.2017.01.014 -
Borderline Personality Disorder and... 2016Risk assessments identify the presence of a Personality Disorder diagnosis as relevant to future violence. At present, risk assessments focus on the presence of the... (Review)
Review
A systematic review on the relationship between antisocial, borderline and narcissistic personality disorder diagnostic traits and risk of violence to others in a clinical and forensic sample.
Risk assessments identify the presence of a Personality Disorder diagnosis as relevant to future violence. At present, risk assessments focus on the presence of the disorder rather than identifying key traits related to risk. Systematic searches of three databases were conducted from January 2000 until August 2014. Of 92,143, 15 studies met the inclusion criteria. A lack of empirical research was found focusing on individual traits; instead most considered PD diagnosis as a sole entity. A preliminary model has been developed detailing the link between potential interactions of diagnostic traits and risk of violence. Recommendations for future research are made.
PubMed: 27777779
DOI: 10.1186/s40479-016-0046-0 -
Journal of Child Psychology and... May 2016Children and adolescents with callous unemotional (CU) traits are at risk of severe and persistent antisocial behavior. It is commonly assumed that these children are... (Review)
Review
BACKGROUND
Children and adolescents with callous unemotional (CU) traits are at risk of severe and persistent antisocial behavior. It is commonly assumed that these children are difficult to treat but it has been proposed that they may benefit from being involved in interventions that go beyond typical parent training programs. This systematic review sought to answer two previously unanswered questions: do interventions involving young people reduce levels of CU traits? Do CU traits predict the effectiveness of interventions for antisocial behavior involving young people?
METHOD
Studies were included that adopted an randomized controlled trial, controlled or open trial design and that had examined whether treatment was related to reductions in CU traits or whether CU traits predicted or moderated treatment effectiveness.
RESULTS
Treatments used a range of approaches, including behavioral therapy, emotion recognition training, and multimodal interventions. 4/7 studies reported reductions in CU traits following treatment. There was a mixed pattern of findings in 15 studies that examined whether CU traits predicted treatment outcomes following interventions for antisocial behavior. In 7/15 studies, CU traits were associated with worse outcomes, although three of these studies did not provide data on baseline antisocial behavior, making it difficult to evaluate whether children with high CU traits had shown improvements relative to their own behavioral baseline, despite having the worst behavioral outcomes overall. CU traits did not predict outcomes in 7/15 studies. Finally, a single study reported that CU traits predicted an overall increased response to treatment.
CONCLUSIONS
Overall, the evidence supports the idea that children with CU traits do show reductions in both their CU traits and their antisocial behavior, but typically begin treatment with poorer premorbid functioning and can still end with higher levels of antisocial behavior. However, there is considerable scope to build on the current evidence base.
Topics: Adolescent; Antisocial Personality Disorder; Child; Humans; Outcome Assessment, Health Care
PubMed: 26686467
DOI: 10.1111/jcpp.12494