Abstract:
BACKGROUND: This review analyses and summarises the recent advances in
understanding the neurobiology of violence and empathy, taxonomical issues on
defining personality disorders characterised by disregard for social norms,
evidence for efficacy of different treatment modalities and ethical implications
in defining 'at-risk' individuals for preventive interventions.
METHODS: PubMed was searched with the keywords 'antisocial personality disorder',
'dissocial personality disorder' and 'psychopathy'. The search was limited to
articles published in English over the last 10 years (1999 to 2009)
RESULTS: Both diagnostic manuals used in modern psychiatry, the Diagnostic and
Statistical Manual published by the American Psychiatric Association and the
International Classification of Diseases published by the World Health
Organization, identify a personality disorder sharing similar traits. It is
termed antisocial personality disorder in the diagnostic and statistical manual
and dissocial personality disorder in the International Classification of
Diseases. However, some authors query the ability of the existing manuals to
identify a special category termed 'psychopathy', which in their opinion deserves
special attention. On treatment-related issues, many psychological and
behavioural therapies have shown success rates ranging from 25% to 62% in
different cohorts. Multisystemic therapy and cognitive behaviour therapy have
been proven efficacious in many trials. There is no substantial evidence for the
efficacy of pharmacological therapy. Currently, the emphasis is on early
identification and prevention of antisocial behaviour despite the ethical
implications of defining at-risk children.
CONCLUSIONS: Further research is needed in the areas of neuroendocrinological
associations of violent behaviour, taxonomic existence of psychopathy and
efficacy of treatment modalities.
