Treatment

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It has been suggested that Antisocial Personality Disorder is a pretty difficult disorder to treat and that most individuals with ASPD do not necessarily want to be treated (Mayo, 2010). The idea is that antisocial personality disorder is a way of being, and not "a curable condition," in which case these individuals may "need close, long-term care and follow-up "(Mayo, 2010). However, most people with ASPD are comorbid with other disorders such as depression and anxiety and thus may need treatment for those (Mayo, 2010) hence, pharmacotherapy and psychotherapy.

Pharmacological interventions may be effective treatment for ASPD. They would target, "cognitive-perceptual, affective, impulsive-behavioural and anxious-fearful domains" (Khalifa, Duggan, Stoffers, Huband, Vollm, Ferriter & Lieb, 2010) One study found that, "carbamazepine showed improvement in over-activity, aggression and impulse control in psychopathic and antisocial personality disorders" (Khalifa et al., 2010). Also, Lithium maintenance treatment worked on impulsivity found in some with ASPD in a beneficial manner (Khalifa et al., 2010). Similarly, selective serotonin reuptake inhibitors (antidepressants, SSRIs) was shown to improve personality disorder symptoms and anger (Khalifa et al., 2010). However, research suggests that the overall evidence for pharmacological interventions seems to be very weak, therefore, drugs should be given to supplement other types of interventions (Khalifa et al., 2010).

= = = __**How Drugs May Work on the Brain**__ =
 * Several research studies have argued that personality disorders such as ASPD are associated with neurochemical abnormalities that are either inherited or from physical or psychological trauma (Khalifa et al., 2010). Thus, the idea of using pharmacological interventions is the hope that the drugs may alter neurotransmitter function and possibly correct the imbalances in the central nervous system to a more balanced state (Khalifa et al., 2010).
 * The main neurotransmitter function in Antisocial Personality Disorder is the serotonergic system (Khalifa et al., 2010). Research has shown that, "impulsive and aggressive characteristics of ASPD have been linked to serotonergic system deficits" (Khalifa et al., 2010). Unfortunately, this system has been found to be less responsive to pharmacotherapy as it doesn't seem to increase serotonin levels in people with ASPD as it does in non-ASPD individuals (Khalifa et al., 2010)
 * The main neurotransmitter function in Antisocial Personality Disorder is the serotonergic system (Khalifa et al., 2010). Research has shown that, "impulsive and aggressive characteristics of ASPD have been linked to serotonergic system deficits" (Khalifa et al., 2010). Unfortunately, this system has been found to be less responsive to pharmacotherapy as it doesn't seem to increase serotonin levels in people with ASPD as it does in non-ASPD individuals (Khalifa et al., 2010)

= __**Pharmacotherapy Interventions**__ =

[[image:http://www.nature.com/jp/journal/v25/n9/images/7211352f1.jpg width="301" height="258" align="right" caption="Process of SSRIs"]]
Although it has been suggested that there are no specific medications to treat ASPD as a whole, several types of psychiatric medications help treat numerous symptoms associated with this disorder (Mayo, 2010). Therefore, some symptoms can be treated pharmacologically (Miller, 2001). Thus, any drugs that reduce irritability, aggressiveness and impulsiveness may be useful for psychopathic symptoms (Miller, 2001; Mayo, 2010; Ros et al., 2008). The following are examples:
 * **Serotonin-Enhancing Antidepressants**
 * Eg. fluoxetine (Prozac), SSRIs
 * Antidepressants help improve depressed mood and anger.
 * **Antipsychotic Drugs**
 * Helpful if there is psychosis such as losing touch with reality.
 * **Anticonvulsants**
 * Used as a mood stabilizer, decreasing impulsiveness, irritability, mood swings and aggression.
 * **Antianxiety Drugs**
 * Help with anxiety, agitation or insomnia
 * **Lithium**
 * Mood stabilizer

However, there are a few issues associated with pharmacological treatment. One major issue is that individuals with ASPD are not reliable to take their drugs unless it gives them immediate pleasure. Secondly, there is always a risk that they may combine prescription drugs with alcohol, opiates or stimulants (Miller, 2001).



= __**Alternative Therapeutic Interventions**__ = Many methods have been used to treat Antisocial Personality Disorders such as (Miller, 2001; Mayo, 2010):
 * **Family Therapy** (for the young)
 * **Individual Psychotherapy**
 * Behavioural therapy uses the token economy to reward and punish behaviour.
 * Cognitive therapy tries to change psychopathic thinking with the goal that the feelings and actions will also change. It also tries to teach[[image:http://whiteneck.net/whiteneckpic/image%20001.jpg width="367" height="252" align="right"]] these individuals new ways to solve their problems and express themselves in addition to develop self-control.
 * Psychoeducation teaches those about ASPD, coping strategies and problem-solving skills
 * **Group Psychotherapy**
 * Self-help groups allows individuals to give and receive candid criticism
 * **Therapeutic Communities**
 * **Education and Skills Training**

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