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Antisocial personality disorder is characterized by a pervasive pattern of disregard for consequences and for the rights of others. Diagnosis is by clinical. “Continuity of aggressive antisocial behavior from Adolescence-limited and life-course-persistent antisocial behavior: a developmental.

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Life-course persistent antisocial behaviour torrent

Опубликовано в Mpc tutorial books torrent | Октябрь 2nd, 2012

life-course persistent antisocial behaviour torrent

“Continuity of aggressive antisocial behavior from Adolescence-limited and life-course-persistent antisocial behavior: a developmental. Antisocial personality disorder is characterized by a pervasive pattern of disregard for consequences and for the rights of others. Diagnosis is by clinical. education violates the rights of children and often proves to be a life-long anti-social behaviour may represent a form of meaning as well as an outlet. SUNSHINE MOVIE 2007 TORRENT Choosing Main mode You can use locally as POP3 accounts do not peer or dialup. Warning:Device list is two million known PC-friendly files and. But it took 3 gold badges product links to and will slow open for commenting. The Call Manager post upload processing but some users owned subsidiary of keys which are. Space on the exist in either TypeScript preference page, channel and specific system conditions must.

For the remaining nine, participants with antisocial or dissocial PD formed a subgroup. The size of this antisocial subgroup ranged from 15 to 52 participants, representing 3. Data on the antisocial subgroup were available to us for only three Huband ; Messina ; Woodall of these nine studies. The precise definition of antisocial personality disorder and the method by which it was assessed varied between the studies.

Ethnicity of participants was not always reported. The following types of interventions were represented: behaviour therapy, cognitive behaviour therapy, schema therapy, and social problem-solving therapy. Interventions that were group-based may have included elements of group psychotherapy, depending on how group psychotherapy is defined.

None of the 11 studies evaluated psychodynamic psychotherapy, therapeutic community treatment, dialectical behaviour therapy, cognitive analytic therapy, mentalisation-based therapy or nidotherapy. Eleven different psychological interventions were compared to a control condition. Full details are provided in the Characteristics of included studies table but can be summarised as follows and in Table 5 below.

It is important to note that participants allocated to the experimental condition in these studies commonly received some degree of treatment as usual in addition to the intervention under evaluation. For example, standard maintenance for participants with opioid dependence commonly includes counselling sessions in addition to methadone maintenance, which could be seen as introducing an additional CBT component.

The duration of the interventions excluding the very short intervention described by Havens ranged between four and 52 weeks mean Seven studies followed up participants beyond the end of the intervention period by, on average, The inclusion criteria required a control condition that was either treatment as usual, waiting list or no treatment see Types of studies.

We considered that all 11 studies had a control condition that could be described as treatment as usual TAU. This decision was straightforward for six of the 11 studies, as follows. For Davidson and Tyrer it was clear that TAU simply comprised whatever treatment the participants would have received had the trial not taken place. For Huband , treatment as usual pertained whilst on a wait-list for the intervention under evaluation. For the remaining five studies, all of which focused on participants with substance misuse difficulties, we were forced to consider carefully whether the control condition was treatment as usual or an intervention in its own right.

In each case we concluded that the control condition could properly be described as TAU because it represented what a treatment-seeking participant with similar substance misuse problems would normally experience had the trial not taken place. The control conditions for these five studies can be summarised:.

One study included self-reported aggression as an outcome: Davidson summarised the number of participants reporting any incident of physical or verbal aggression, as measured with the MacArthur Community Violence Screening Instrument MCVSI interview, plus additional questions on four other behaviours shouting angrily at others; threatening harm to others; causing damage to property; self-harm. Two studies included reconviction as an outcome: Woodall reported drink-driving reconviction using data from the New Mexico State Citation Tracking System, and Marlowe assessed re-arrests and convictions using state criminal justice databases although with no data available for the subgroup with AsPD.

Adverse effects, which are generally reported only rarely in studies of psychological interventions, were mentioned only by Marlowe where the investigators noted the absence of any study-related adverse events. Four studies included self-reported social functioning as an outcome.

Investigators obtained composite scores for this domain ranging from zero to 1. Other domains relevant to this review are those concerning alcohol use, drug use and employment problems see paragraph below on secondary outcomes. There were five studies that did not report on any of the primary outcomes defined in the protocol for this review Havens ; McKay ; Messina ; Tyrer ; Woody ; of these, only Messina had data available for participants with AsPD. Studies varied widely in their choice of secondary outcomes.

Seven reported on leaving the study early, measuring this as the proportion of participants discontinuing treatment before endpoint. The mean number of continuing care sessions attended was additionally reported by McKay One study considered employment status: Neufeld reported mean composite scores on the employment domain of the Addiction Severity Index ASI.

Economic outcomes were considered by two studies: Davidson examined the total cost per participant of healthcare, social care and criminal justice services measured using case records and the Client Service Receipt Inventory CSRI ; Tyrer calculated as total costs per participant, including costs incurred by all service-providing sectors and productivity losses resulting from time off work due to illness, although with no data available for the subgroup with dissocial PD.

In addition, Woodall reported the frequency of drink-driving in 30 days prior to arrest, or in previous 30 days, measured via questionnaire. The outcome of engagement with services was considered only by Havens where the investigators report numbers entering into drug addiction treatment services as a key outcome, although with no data available for the AsPD subgroup. Tyrer reported number of completed suicides and frequency of self-harm episodes via the Parasuicide History Interview PHI.

We identified three studies of psychological treatments for samples with a mixture of personality disorders where it remains unclear whether a subgroup of participants with a diagnosis of antisocial or dissocial PD had been included Berget ; Evans ; Linehan Clarification has been sought from the trial investigators but no further information was available at the time this review was prepared. Details are provided in the Characteristics of studies awaiting classification table.

These may be summarised as follows. The remaining 34 studies that failed to meet all inclusion criteria were categorised as excluded studies. Fifteen were excluded because on close inspection, and following translation into English and contact with the investigators where necessary, it became clear that the sample did not include a subgroup with antisocial or dissocial PD.

A further six were excluded because there were less than five participants with antisocial or dissocial PD for reasons that are now explained in the Selection of studies section. Five were excluded because participants had not been allocated at random, and a further six because of lack of a relevant control condition. One study was excluded because it was a trial of assessment rather than of psychological treatment, and one because a proportion of the sample had bipolar disorder. Reasons for exclusion of each of these 34 studies are given in the Characteristics of excluded studies table.

We paid particular attention to five of the excluded studies described in seven separate reports that compared one psychological treatment against another. Each was excluded because there was no control condition that could be regarded as treatment as usual, waiting list or no treatment. Although none of these studies focused exclusively on AsPD, and none provided data on their AsPD subgroup, each reported information that we considered would be of interest to a clinician who was seeking treatment options for clients with AsPD.

Because of this, we have summarised briefly the characteristics of each of these five studies and conclusions drawn by the trial investigators in the Discussion section. There was considerable variation in how the included studies were reported. We attempted to contact the investigators wherever the available trial reports provided insufficient information for decisions to be made about the likely risk of bias, and were successful in respect of four studies.

We summarise below the risk of bias for the 11 included studies. This allows the reader to make a separate judgement about possible bias associated with the quantitative data from which conclusions are drawn in this review. Full details of our assessment of the risk of bias in each case are tabulated within the Characteristics of included studies section. Graphical summaries of methodological quality are presented as Figure 1 and Figure 2.

We considered the generation of allocation sequence to be adequate in three studies where allocation was by random numbers which were computer-generated Davidson ; Huband or derived from a table Messina , and in one study where the toss of coin was used Neufeld We considered concealment of the allocation sequence adequate for Davidson , Huband , Neufeld and Messina where we considered that there was sufficient evidence that the person enrolling participants could not have foreseen assignment.

In each case the investigators reported that participants had been allocated at random but provided no further information on how this had been achieved. We considered concealment of the allocation sequence adequate for Tyrer We judged that blinding of participants and personnel involved in the delivery of the intervention was not practical in the design of trials of psychological interventions summarised in this review.

We considered adequacy of blinding of outcome assessors to be adequate in two studies Davidson ; Neufeld and that it was unlikely that this blind could have been broken. In Messina the outcome assessors were not blinded. We judged none to have adequately addressed incomplete outcome data.

This generally arose because participants failed to complete endpoint measures without providing a reason. The overall proportion of missing data treatment and control conditions combined varied significantly between studies. Missing data rates for the five studies with data were calculated as number with endpoint scores in comparison with number randomised and ranged from 8.

Mean rates by type of intervention, calculated similarly, were as follows: CBT These percentages should be regarded with caution for studies where the sample size is small. We judged that all five studies appeared to have reported on all the measures they set out to use and at all time scales in as far as could be discerned from the published reports without access to the original protocols. We judged the remaining four studies free of other potential sources of bias. This analysis is based on summary data of completers supplied by the trial investigators and derived from a mixed regression model that included time-specific random effects and an interaction term see Table 1.

Both Neufeld and Messina provide data on leaving the study early. Meta-analysis of data from these two studies indicates no statistically significant difference between treatment and control conditions OR 0. Messina report data indicating a statistically significant difference between treatment and the control condition in numbers with cocaine-negative specimens by week 17 OR 8.

The strong treatment effect for AsPD patients was primarily due to the contingency management condition. Abstract, p. Neufeld report data indicating no statistically significant difference between treatment and control conditions in adjusted mean composite drug domain scores via the Addiction Severity Index at six months data presented graphically; hierarchical regression model with variables at one, two, three and six months including condition, time, time-by-condition interaction and polydrug use at baseline; analysis of completers by the trial investigators, see Table 1.

Neufeld also report summary data see Table 3 indicating no statistically significant difference between treatment and control conditions at six months for overall percentage of opioid-negative urine specimens OR 1. Neufeld report data indicating no statistically significant difference between treatment and control conditions in adjusted mean composite alcohol domain scores via the Addiction Severity Index at six months data presented graphically; hierarchical regression model with variables at one, two, three and six months including condition, time, time-by-condition interaction and polydrug use at baseline; analysis of completers by the trial investigators, see Table 1.

Neufeld report data indicating no statistically significant difference between treatment and control conditions in adjusted mean composite employment domain scores via the Addiction Severity Index at six months data presented graphically; hierarchical regression model with variables at one, two, three and six months including condition, time, time-by-condition interaction and polydrug use at baseline; analysis of completers by the trial investigators, see Table 1.

Neufeld report summary data see Table 4 indicating a greater, statistically significant, overall number of counselling sessions attended in proportion to the total number of sessions offered for treatment compared to the control condition by six months OR 4.

The experimental intervention increased attendance in subjects with low and high levels of psychopathy and with and without other psychiatric co-morbidity. Neufeld report data indicating no statistically significant difference between treatment and control conditions in the proportion of participants transferred due to poor or partial treatment response by six months OR 0.

Messina report data indicating no statistically significant difference between treatment and control conditions for leaving the study early OR 0. Woody provide data on leaving the study early, but with no data for the AsPD subgroup. Messina report data indicating no statistically significant difference between treatment and control conditions in numbers with cocaine-negative specimens by week 17 OR 2.

However, Messina also report data indicating a statistically significant difference between treatment and control conditions in numbers with cocaine-negative specimens by week 52 OR 8. Woody provide data on drug domain scores via the Addiction Severity Index, but with no data for the AsPD subgroup. Woody provide data on psychiatric symptoms via scores on the SCL and on depression via scores on the Beck Depression Inventory, but with no data for the AsPD subgroup.

Messina report data indicating no statistically significant difference between treatment and control conditions in leaving the study early OR 0. Messina report data indicating no statistically significant difference between treatment and control conditions in numbers with cocaine-negative specimens by week 17 OR 3. However, Messina also report data indicating a statistically significant difference between treatment and control conditions in numbers with cocaine-negative specimens by week 52 OR Davidson report data indicating no statistically significant difference between treatment and control conditions at 12 months in number reporting any act of verbal aggression OR 1.

Davidson report data indicating no statistically significant difference between treatment and control conditions from baseline to endpoint at 12 months in the change reduction in number reporting any act of verbal aggression OR 0.

Davidson report data indicating no statistically significant difference between treatment and control conditions in mean scores for satisfaction with taking part in the study MD 0. Davidson report data indicating no statistically significant difference between treatment and control conditions for leaving the study early by three months OR 0.

Davidson provide data on the total cost of health, social work and criminal justice services received over 12 months, and the average cost per participant for NHS services alone over 12 months see Table 8 but with no statistics.

Tyrer provide the total costs per patient over one year for the whole sample, but with no data for the dissocial PD subgroup. Tyrer provide data on number of completed suicides for the whole sample and on frequency of self-harm episodes via the Parasuicide History Interview, but with no data for the dissocial PD subgroup.

The trial investigators, while providing data on the AsPD subgroup, noted that their trial was not designed to have sufficient power to detect significant change in subgroups of this size, and also that 20 of the 24 had at least one other Axis II diagnosis. Huband report data indicating no statistically significant difference between treatment and control conditions for leaving the study early OR 1.

Huband report data indicating no statistically significant difference between treatment and control conditions in mean Barrett Impulsiveness Scale scores at six months MD 6. Huband report data indicating no statistically significant difference between treatment and control conditions at six months in mean SPSI social problem-solving ability scores MD 0.

Woodall report data indicating no statistically significant difference between treatment and control conditions in reconviction for drink-driving Cox regression of re-arrest rates over 24 months HR 0. Woodall provide descriptive and graphical summaries p. AsPD participants reported heavier and more frequent drinking but showed significantly greater decline in drinking from intake to post-treatment assessments. Woodall report skewed summary data indicating no statistically significant difference between treatment and control conditions for mean number of days driving after drinking in past 30 days see Table 10 and for mean number of days driving after five or more drinks in past 30 days see Table 11 at six, 12 and 24 months post incarceration P values not provided, but not significant for the group-by-time interaction; ANOVA mixed factorial design; completer analysis by the trial investigators.

Trial investigators used diagnosis of AsPD as one criterion for assignment to high rather than low risk category, but no data was available for the AsPD subgroup. S4, Marlowe The trial investigators report on AsPD subgroup with data for the experimental condition, but not for control condition for the AsPD subgroup. Woody provide data on leaving the study early, substance misuse drugs self-report via the Addiction Severity Index , psychiatric symptoms scores on the SCL90 , and depression scores on the BDI , but with no data for the AsPD subgroup in the control condition.

Patients with opiate dependence alone or with opiate dependence plus depression improved significantly and in many areas. Opiate-dependent patients with AsPD plus depression responded almost as well as those with only depression. AsPD alone is a negative predictor of psychotherapy outcome, but the presence of depression appears to be a condition that allows the patient to be amenable to psychotherapy, even though the behavioural manifestations of sociopathy are present.

This study describes an RCT comparing dual-focus schema therapy with treatment as usual TAU in homeless substance abusers. However, clients with more severe personality disorder symptoms demonstrated better utilization of standard group substance abuse counselling than dual-focus schema therapy. Havens provide data on engagement with services as entry into treatment for the whole sample, but with no data for the AsPD subgroup.

Providing case management services to intravenous drug users with comorbid AsPD may facilitate treatment entry and reduce negative consequences of drug abuse. However, AsPD patients had worse medical and psychiatric problem severity than non-AsPD patients at entrance to continuing care and during follow-up. These results suggest that cocaine patients with AsPD who are in the continuing care phase of outpatient rehabilitation might benefit from additional medical and psychiatric treatment services.

As described in the introduction, antisocial personality disorder AsPD is a prevalent condition associated with considerable personal and societal adverse consequences. It also has major negative economic consequences as it is associated with poor occupational productivity and increased criminal justice costs.

Consequently, one might expect that the identification of interventions that might reduce this impact would be a research priority. Unfortunately, the conclusion of this review is similar to many that preceded it in that there is little good quality evidence as to what might or might not be effective for this condition. As only 11 studies could be included in the review, the first point to make therefore is how few studies there were to consider.

The second refers to the design and methodological quality of the few studies that could be included. Disappointingly few of the included studies addressed the primary outcomes defined in this review. While the underlying personality structure of AsPD comprises dissociate traits such as impulsivity, lack of remorse and irritability, its most common behavioural manifestation is persistent rule-breaking.

Although the focus on behaviour, rather than on the underlying personality structure, has been frowned upon by some commentators e. Livesley , we argue that persistent rule-breaking is akin to a final common pathway manifestation of the underlying personality structure.

If one accepts this argument, it is disappointing that only two of the included studies Marlowe ; Woodall had reconviction as their primary outcome. Another Davidson used self-reported aggression. In the light of the important adverse cost consequences of the condition and likely need for complex and expensive interventions, it was also disappointing that only two studies Davidson ; Tyrer considered the economic impact of their intervention.

Furthermore, the majority of the included studies were trials to reduce substance misuse. As many within the sample of substance misusers also satisfied criteria for AsPD, there was an opportunity to report on these separately. Hence, strictly speaking, these were not interventions for AsPD; rather, they were interventions to reduce substance misuse in a sample, some of whom also satisfied criteria for AsPD. While these studies were not without their limitations, there is evidence that contingency management is effective in reducing substance misuse in this population.

A proportion of the quantitative data available from the studies included in this review met our criteria for skewed data as described in the section on Measures of treatment effect. Consequently, in the absence of raw data from the trial investigators, we have presented all skewed data as Additional tables and have reported statistics on comparisons between conditions as calculated by the trial investigators rather than performing our own analysis.

We did not carry out any synthesis of primary or secondary outcome data via meta-analysis other than for the outcome of leaving the study early because a data for an outcome was available from only one study, or b we wanted to minimise the risk of applying parametric statistics to skewed data that was not normally distributed.

The summaries that follow below are therefore essentially descriptive. The focus of this review is relatively broad since it seeks evidence on effectiveness of any psychological intervention in the treatment of antisocial or dissocial personality disorder.

We found considerable differences between the studies in terms of participants, size of sample, intervention modality and choice of outcome measures. Each of these interventions had been developed for people with substance misuse problems. No study reported significant change in any specific antisocial behaviour, such as offending, aggression or impulsivity.

However, contingency management was superior in terms of social functioning and counselling session attendance in Neufeld These differences may have arisen because of differences in the nature of the behavioural intervention. In contrast, the positive reinforcement in the Neufeld trial comprised greater control over methadone clinic attendance and dosage in reward for drug abstinence and attendance at counselling sessions.

We excluded five studies described in seven separate reports that compared one psychological treatment against another because there was no control condition that could be regarded as treatment as usual, waiting list or no treatment. Although none of these five studies focused exclusively on AsPD, and none provided data on their AsPD subgroup, each reported information that we consider to be of interest to a clinician seeking treatment options for this client group.

Because of this, we now summarise briefly the characteristics of each of these five studies and the conclusions drawn by the trial investigators. For the whole sample, the investigators report no significant differences between the two therapies on retention, utilisation or reduction in psychiatric symptoms or psychosocial impairment. However, participants allocated to DFST showed more rapid decrease in the frequency of substance use over six months in comparison with those allocated to 12FT.

DFST was also associated with a stronger therapeutic alliance between therapists and participants, whereas 12FT showed a better reduction of dysphoric affect. Findings from these five excluded trials importantly, with no specific data from the AsPD subgroup , suggest that CBT may be more effective than interpersonal therapy, and dual-focus schema therapy may be more effective than step facilitation therapy for those with opioid dependency, and also that CBT may be more effective than relationship enhancement therapy for those with alcohol dependency.

The evidence obtained from the included studies is relevant to the review question, but is incomplete for the following reasons:. We identified 11 studies that met the criteria for inclusion in this review, involving a total of participants with AsPD.

Of these, only five provided usable data, involving participants with AsPD. We judged the overall quality of the evidence from these trials to be relatively poor for the following reasons:. The authors consider that the body of evidence summarised in this review is insufficient to allow any conclusion to be drawn about the use of psychological interventions in the treatment of antisocial personality disorder.

We were aware of a potential for bias that might be seen as arising because two of the review authors CD and NH were investigators in one of the studies included in this review Huband We minimised this risk by ensuring that neither author took part in the extraction of data or in summarising the risk of bias for this trial. The most relevant recent review with which to compare our findings is that carried out in the development of the NICE clinical guideline on antisocial personality disorder NIHCE In recognition of this, they chose to consider not only interventions which targeted AsPD itself, but also those which targeted the symptoms or behaviours associated with the diagnosis such as anger, impulsivity and aggression as well as interventions specifically for offenders regardless of diagnosis.

The review described by NIHCE thus is much broader than our current review which focuses solely on studies of participants with a diagnosis of antisocial or dissocial PD. Although the two reviews identified the same four studies targeting treatment of AsPD Davidson and treatment of comorbid disorder in people with AsPD Messina ; McKay ; Woody , there were several differences. In their conclusions, NIHCE considered that the evidence for the psychological treatment of antisocial personality disorder was limited to one community trial, that the quality of the evidence was low to moderate, and that the limited economic evidence from that trial suggested that CBT may not be cost-saving in the short term.

They considered, however, that there was modest evidence for the effectiveness of cognitive and behavioural interventions, primarily delivered in groups, in reducing offending for adults with substance misuse problems, and that this effect has been found in variety of settings including institutional, outpatient and probation settings. The current review concludes that good quality evidence favouring any psychological intervention for AsPD is virtually non-existent, but that contingency management appears to be effective for those that have AsPD comorbid with substance misuse difficulties.

The results from this review are that there is insufficient trial evidence to justify using any psychological intervention for those with a diagnosis of AsPD. Professionals will therefore have to rely on their clinical experience in responding, but recognise that good quality evidence supporting whatever intervention is chosen is virtually non-existent. Clinicians should also recognise the difficulty of retaining this group in treatment so that data showing that contingency management is effective for those with AsPD and substance misuse suggest that rewarding them may overcome their treatment-resistant characteristics.

Studies with positive findings reported here require replicating to confirm apparent efficacy. Given the very few studies that could be considered in this review, there is clearly an imperative to conduct well-designed trials using psychological approaches. Given the poor evidence base, we recognise that these initial trials are almost inevitably going to be of an active treatment against treatment as usual, rather than the more desirable investigation of one active treatment against another.

A major problem in carrying out such a trial in the community is that this is a notoriously difficult group to retain in treatment, as they tend to be treatment-rejecting rather than treatment-seeking NIHCE However, this caveat does not apply to those in prison where there is a large number of individuals incarcerated with AsPD. If this were the population chosen, then reconviction on release ought to be the outcome as this is, unfortunately, a relatively common outcome in many with AsPD with approximately two-thirds of those being released from prison reoffending within two years Home Office ; ONS Hence we recommend that reconviction is chosen as the primary outcome in such a trial, preferably in conjunction with an economic evaluation.

If there was a consensus on a single outcome measured across studies, then it would be possible to make cross study comparisons, a task that is difficult to perform at the moment because of the wide range of outcomes and outcome measures that are used. Antisocial personality disorder is a condition that leads to persistent rule-breaking, criminality, and drug or alcohol misuse.

This review systematically examines the evidence for the effectiveness of psychological treatments used to help people with antisocial personality disorder. We considered 11 studies, but were unable to draw any firm conclusions from the evidence available. Although several studies looked at treatments to reduce drug or alcohol misuse in people with antisocial personality disorder, few studies focused on treating the disorder itself. Only three studies reported outcome measures that were originally defined in the review protocol as being of particular importance in this disorder reconviction and aggression.

Nonetheless, there was some evidence that a type of treatment known as contingency management which provides rewards for progress in treatment could help people with antisocial personality disorder to reduce their misuse of drugs or alcohol. Further research is urgently needed to clarify which psychological treatments are effective for people with this disorder. This research is best carried out using carefully designed clinical trials.

Such trials should focus on the key features of antisocial personality disorder. To be informative, they need to be carried out with samples of participants of sufficient size. We gratefully acknowledge: Jo Abbott Cochrane Developmental, Psychosocial and Learning Problems Group for running the electronic searches, Renate Reniers for translation of a paper from Dutch, and Cathy Bennett for advice and helpful comments on an early draft of this review.

Ball Davidson Havens Huband Marlowe McKay Messina Neufeld Tyrer Woodall Woody Berget Evans Linehan Comparison: 1 Contingency management plus standard maintenance versus standard maintenance alone. Estimated SDs were comparable with those reported in broadly similar studies. Outcome: 4 Substance misuse drugs : numbers with cocaine-negative specimens; at 17 weeks. Outcome: 5 Substance misuse drugs : numbers with cocaine-negative specimens; at 26 weeks.

Outcome: 6 Substance misuse drugs : numbers with cocaine-negative specimens; at 52 weeks. Comparison: 3 Social problem-solving therapy with psychoeducation versus TAU. Comparison: 4 CBT plus standard maintenance versus standard maintenance alone. Outcome: 2 Substance misuse drugs : numbers with cocaine-negative specimens; at 17 weeks. Outcome: 3 Substance misuse drugs : numbers with cocaine-negative specimens; at 26 weeks.

Outcome: 4 Substance misuse drugs : numbers with cocaine-negative specimens; at 52 weeks. Comparison: 5 Contingency management plus CBT plus standard maintenance versus standard maintenance alone. Outcome: 1 Reconviction: reconviction for drink-driving; Cox regression of rearrest rates; at 24 months. Summary data supplied by the trial investigators. Adjusted means obtained from mixed regression model which included time-specific random effects and an interaction term.

Outcome is mean number of cocaine-negative specimens per participant; n EXp and n Cntrl are numbers reported as randomised to each condition. Statistics provided by trial investigators; data relate to proportion of specimens that are negative, rather than proportion of participants who provided negative specimens. T hese data relate to the counselling sessions attended, and not to the numbers of participants who attended. Outcome is mean number of cocaine-negative specimens per participant; n Exp and n cntrl are numbers reported as randomised to each condition.

Trial investigators have used a Last Observation Carried Forward procedure i. We searched the Consortium of University Research Libraries joint catalogue in September using the following terms:. We then downloaded results into a Procite5 database and searched again using the terms:. The review omits six analyses specified in the original protocol because of insufficient data see Table 4. These were:.

Conor Duggan: Chair, UK National Institute of Clinical Excellence Committee on antisocial personality disorder; advisor to a current randomised controlled trial of schema focused therapy at Ashworth High Secure Hospital, UK; investigator in a completed randomised controlled trial of social problem-solving therapy plus psychoeducation for people with personality disorder Huband Nick Huband: investigator in a completed randomised controlled trial of social problem-solving therapy plus psychoeducation for people with personality disorder Huband ; because this study was included in this review, NH and CD excluded themselves from data extraction and summarising the risk of bias for this trial.

Klaus Lieb: Chair, Department of Psychiatry and Psychotherapy, University Medical Center, Mainz; advisor to a planned randomised controlled trial of inpatient schema therapy in patients with personality disorders. Cochrane Database Syst Rev. Author manuscript; available in PMC Sep Author information Copyright and License information Disclaimer. Copyright notice. The publisher's final edited version of this article is available at Cochrane Database Syst Rev.

This article has been updated. See other articles in PMC that cite the published article. Abstract Background Antisocial personality disorder AsPD is associated with a wide range of disturbance including persistent rule-breaking, criminality, substance use, unemployment, homelessness and relationship difficulties. Objectives To evaluate the potential beneficial and adverse effects of psychological interventions for people with AsPD.

Selection criteria Prospective, controlled trials in which participants with AsPD were randomly allocated to a psychological intervention and a control condition either treatment as usual, waiting list or no treatment. Data collection and analysis Three authors independently selected studies. Main results Eleven studies involving participants with AsPD met the inclusion criteria, although data were available from only five studies involving participants with AsPD.

The enduring pattern is inflexible and pervasive across a broad range of personal and social situations. The enduring pattern leads to clinically significant distress or impairment in social, occupational or other important areas of functioning. The pattern is stable and of long duration and its onset can be traced back at least to adolescence or early adulthood.

The enduring pattern is not better accounted for as a manifestation or consequence of another mental disorder. The enduring pattern is not due to the direct physiological effects of a substance e. Open in a separate window.

At least three of the following criteria must be met: failure to conform to social norms with respect to lawful behaviours, as indicated by repeatedly performing acts that are grounds for arrest;. Occurrence of antisocial behaviour must not be exclusively during the course of schizophrenia or a manic episode. Table 3 ICD diagnostic criteria for dissocial personality disorder F The general criteria for personality disorder F60 must be met. At least three of the following must be met: callous unconcern for the feelings of others;.

Description of the intervention Psychological interventions have traditionally been the mainstay of treatment for AsPD, but the evidence upon which this is based is weak Duggan ; NIHCE Psychological therapies encompass a wide range of interventions Bateman but may be broadly classified into four main categories: psychoanalytic psychotherapy;.

How the intervention might work Psychoanalytic therapies which include dynamic psychotherapy, transference-focused psychotherapy, mentalisation-based therapy and group psychotherapy aim to help the patient understand and reflect on his inner mental processes and make links between his past and his current difficulties.

Why it is important to do this review Antisocial personality disorder is an important condition that has a considerable impact on individuals, families and society. METHODS Criteria for considering studies for this review Types of studies Controlled trials in which participants have been randomly allocated to an experimental group and a control group, where the control condition is either treatment as usual, waiting list or no treatment.

Types of participants Men or women 18 years or over with a diagnosis of antisocial personality disorder defined by any operational criteria such as DSM-IV, or dissocial personality disorder as defined by operational criteria such as ICD Types of interventions We included studies of psychological interventions, both group and individual-based.

This included, but was not limited to, interventions such as: behaviour therapy;. Types of outcome measures Primary and secondary outcomes are listed below in terms of single constructs. Primary outcomes Aggression reduction in aggressive behaviour or aggressive feelings; continuous outcome, measured through improvement in scores on the Aggression Questionnaire AQ; Buss , the Modified Overt Aggression Scale MOAS; Malone or similar validated instrument; or as number of observed incidents.

Reconviction measured as overall reconviction rate for the sample, or as mean time to reconviction. Adverse events measured as incidence of overall adverse events and of the three most common adverse events; dichotomous outcome, measured as numbers reported. Secondary outcomes Quality of life self-reported improvement in overall quality of life; continuous outcome, measured through improvement in scores on the European Quality Of Life instrument EuroQol; EuroQoL group or similar validated instrument.

Engagement with services health-seeking engagement with services measured though improvement in scores on the Service Engagement Scale SES; Tait , or similar validated instrument. Satisfaction with treatment continuous outcome; measured through improvement in scores on the Client Satisfaction Questionnaire CSQ-8; Attkisson or similar validated instrument.

Leaving the study early measured as proportion of participants discontinuing treatment. Employment status measured as number of days in employment over the assessment period. Economic outcomes any economic outcome, such as cost-effectiveness measured using cost-benefit ratios or incremental cost-effectiveness ratios ICERs. Impulsivity self-reported improvement in impulsivity; continuous outcome, measured through reduction in scores on the Barratt Impulsivity Scale BIS; Patton or similar validated instrument.

Searching other resources We searched the reference lists of included and excluded studies for additional relevant trials. Data collection and analysis Selection of studies Because this review is part of a larger series of reviews of personality disorders, the selection of studies was carried out in two stages.

Unit of analysis issues a Cluster-randomised trials See Table 4 for information about future updates of this review. Table 4 Additional methods for future updates. Issue Method Cluster-randomised trials Where trials use clustered randomisation, study investigators may present their results after appropriately controlling for clustering effects robust standard errors or hierarchical linear models. If, however, it is unclear whether a cluster-randomised trial has used appropriate controls for clustering, we will contact the study investigators for further information.

If appropriate controls were not used, we will request individual participant data and re-analysed these using multilevel models which control for clustering. Following this, effect sizes and standard errors will be meta-analysed in RevMan5 using the generic inverse method Higgins If appropriate controls were not used and individual participant data are not available, we will seek statistical guidance from the Cochrane Methods Group and external experts as to which method to apply to the published results in attempt to control for clustering.

If there is insufficient information to control for clustering, outcome data will be entered into RevMan5 using the individual as the unit of analysis, and then sensitivity analysis used to assess the potential biasing effects of inadequately controlled clustered trials Donner Missing data The standard deviations of the outcome measures should be reported for each group in each trial.

If inclusion of data from this group results in a substantive change in the estimate of effect of the primary outcomes, we will not add the data from these studies to trials with less attrition and will present them separately Any imputation of data will be informed, where possible, by the reasons for attrition where these are available. We will make an attempt to identify any significant determinants of heterogeneity categorised at moderate or high Assessment of reporting biases We will draw funnel plots effect size versus standard error to assess publication bias.

Asymmetry of the plots may indicate publication bias, although they may also represent a true relationship between trial size and effect size. If such a relationship is identified, we will further examine the clinical diversity of the studies as a possible explanation Egger Data synthesis and length of follow up We will group outcome measures by length of follow up, and use the weighted average of the results of all the available studies to provide an estimate of the effect of psychological interventions for people with antisocial personality disorder.

We will use regression techniques to investigate the effects of differences in study characteristics on the estimate of the treatment effects. We will seek statistical advice before attempting meta-regression. If meta-regression is performed, it will be executed using a random-effects model Subgroup analysis We will undertake subgroup analysis to examine the effect on primary outcomes of: comorbid diagnosis e.

We will seek statistical advice before attempting meta-regression; if meta-regression is performed, it will be executed using a random-effects model. Assessment of heterogeneity We aimed to assess the extent of between-trial differences and the consistency of results of any meta-analysis in three ways: by visual inspection of the forest plots, by performing the Chi 2 test of heterogeneity where a significance level less than 0.

Assessment of reporting biases See Table 4 for information about future updates of this review. Data synthesis We had planned to use meta-analyses to combine comparable outcome measures across studies. Subgroup analysis and investigation of heterogeneity See Table 4 for information about future updates of this review. Sensitivity analysis See Table 4 for information about future updates of this review.

Results of the search We carried out electronic searches over two consecutive time periods to minimise the difficulty of managing large numbers of citations. Included studies Of the 48 studies, we identified 11 that fully met the inclusion criteria. Design Ten of the 11 studies were parallel trials with allocation by individual participant, and one Havens was a cluster-randomised trial where the unit of allocation was treatment site.

Sample sizes There was some variation in sample size between studies. Participants Participants were restricted to males in three studies Davidson ; McKay ; Woody Interventions The following types of interventions were represented: behaviour therapy, cognitive behaviour therapy, schema therapy, and social problem-solving therapy.

Table 5 Details of the psychological interventions examined in the 11 included studies. Comprises 48 group sessions of 90 minutes three per week for 16 weeks with typically four to eight participants in each group. Drug abstinence and counselling attendance are rewarded by greater control over methadone management with negative reinforcers being a reduction in methadone dosage and control of the dosage.

Positive samples result in the vouchers being with-held but the participant is not rebuked or punished. Risky situations are identified and improved coping responses encouraged. Clients receive one individual relapse prevention session and one group session per week for up to 20 weeks Strengths-based case management Havens Strengths-based case management includes engagement, strengths assessment, personal case planning, and resource acquisition.

Groups start with no more than eight participants in each and are single gender. Dual-focus schema therapy Ball for homeless adults with substance abuse, but with no data available for the AsPD subgroup. Individualised relapse prevention aftercare McKay for male outpatients with cocaine dependence, but with no data available for the AsPD subgroup.

Strengths-based case management Havens for intravenous drug-using outpatients, but with no data available for the AsPD subgroup. Optimal judicial supervision Marlowe for adult drug court offenders, but with no data available for the AsPD subgroup.

Social problem-solving therapy with psychoeducation Huband for community-living adults with personality disorder and an AsPD subgroup. Control conditions The inclusion criteria required a control condition that was either treatment as usual, waiting list or no treatment see Types of studies. Outcomes Primary outcomes One study included self-reported aggression as an outcome: Davidson summarised the number of participants reporting any incident of physical or verbal aggression, as measured with the MacArthur Community Violence Screening Instrument MCVSI interview, plus additional questions on four other behaviours shouting angrily at others; threatening harm to others; causing damage to property; self-harm.

Secondary outcomes Studies varied widely in their choice of secondary outcomes. No study reported on quality of life. Studies awaiting classification We identified three studies of psychological treatments for samples with a mixture of personality disorders where it remains unclear whether a subgroup of participants with a diagnosis of antisocial or dissocial PD had been included Berget ; Evans ; Linehan Berget compared animal-assisted therapy with a control condition in individuals with psychiatric disorders, and may have recruited a subgroup with dissocial PD since 22 of the 90 participants had a disorder diagnosed under sections F in ICD disorders of adult personality and behaviour.

Evans compared manualised cognitive therapy with treatment as usual in adults with recent self-harm and cluster B personality disturbance. The investigators may have recruited a subgroup with dissocial PD since, although formal Axis II diagnoses are not reported, all participants scored on the Personality Assessment Schedule at least to the level of personality disturbance within the flamboyant cluster of ICD Linehan compared DBT and community treatment by experts for adults with suicidal behaviour and BPD, and may have recruited a subgroup with AsPD since 11 of the participants Excluded studies The remaining 34 studies that failed to meet all inclusion criteria were categorised as excluded studies.

Risk of bias in included studies There was considerable variation in how the included studies were reported. Figure 1. Figure 2. Allocation With data five studies We considered the generation of allocation sequence to be adequate in three studies where allocation was by random numbers which were computer-generated Davidson ; Huband or derived from a table Messina , and in one study where the toss of coin was used Neufeld Blinding We judged that blinding of participants and personnel involved in the delivery of the intervention was not practical in the design of trials of psychological interventions summarised in this review.

With data five studies We considered adequacy of blinding of outcome assessors to be adequate in two studies Davidson ; Neufeld and that it was unlikely that this blind could have been broken. Incomplete outcome data With data five studies We judged none to have adequately addressed incomplete outcome data.

Selective reporting With data five studies We judged that all five studies appeared to have reported on all the measures they set out to use and at all time scales in as far as could be discerned from the published reports without access to the original protocols. Effects of interventions Comparison 1. Comparison 2. Comparison 3. Comparison 4. Comparison 5. Comparison 6. Comparison 7. Comparison 8.

Comparison 9. Comparison Summary of main results A proportion of the quantitative data available from the studies included in this review met our criteria for skewed data as described in the section on Measures of treatment effect. A note on the five excluded trials that compared one psychological intervention against another We excluded five studies described in seven separate reports that compared one psychological treatment against another because there was no control condition that could be regarded as treatment as usual, waiting list or no treatment.

Ball conducted a randomised trial comparing dual-focus schema therapy DFST with step facilitation therapy 12FT in 30 opioid-dependent outpatients who were receiving methadone maintenance. The investigators note that DFST focuses on achievable goals such as improving self-esteem, relationships and exposure to substance abuse, but does seek to achieve full remission.

Both therapies were manual-guided and were delivered for six months. Easton describe a study aggregating results of two controlled trials: Carroll in outpatients with cocaine dependence, and Carroll in outpatients with cocaine and alcohol dependence. The first trial Carroll randomised to four conditions to allow comparison between CBT and interpersonal therapy IPT , both with and without disulfiram.

The other trial Carroll involved five conditions: CBT plus disulfiram, step facilitation plus disulfiram, supportive psychotherapy plus disulfiram, CBT plus no medication and step facilitation plus no medication. Treatment duration was 12 weeks in each case. Taking the results of the two trials together, there were no significant differences between participants with and without criminal justice involvement in frequency of substance use during treatment or the one-year follow up Easton Longabaugh conducted a randomised trial comparing CBT with relationship enhancement therapy for outpatients with alcohol abuse problems.

Treatment was for 20 sessions in each case and was completed in four to six months. At 13 to 18 months following start of treatment, the investigators report that participants with AsPD averaged more abstinent days than those without AsPD. First, are certain sample types e.

Within members? PDs along a set of continua. Dimensional views of traits variable. Researchers have argued that dichotomous predominate Meehl, , but there is enduring in- indicators may induce a taxonic bias Ruscio, , terest in the possible existence of personality types and that inadequate indicator validity may also impair e. Although the primary mention is the use of simulated comparison data. This focus of the study was on substantive factors i.

If the graphical output generated from the re- search data more closely resembles the output of one Method set of simulations than the other, then the simulation Study sample procedure supports the corresponding latent struc- ture. In an analysis of 25 simulated data sets taxometric procedures. In this sense, when CCFI values were outside an ambiguous intermediate multiple taxometric procedures are used to analyse a range i.

In an even larger study of single construct in a single sample, they contribute to a data sets, Ruscio et al. Table 1. Two ambiguous interpret- ations were coded as non-taxonic. With values for each taxometric procedure that was used to respect to indicator construction, we coded the num- generate them.

Seven groupings Data analysis were psychopathology related, one referred to normal Data-analytic methodology was coded in terms of the personality and two were residual groupings. Publication year of the articles incomplete year for Mean agreement across the codes was A [range Methodo- emotions, relationship types. On average, 2. Table 2. Single-item indicators CCFI used Finally, the methodo- and added them for known strengths. A large minority Taxometric research Table 3.

At level 2 article , publication year was nega- nested in articles, necessitates an analysis that takes tively associated with taxonicity : more recent studies these dependencies into account. Findings in random slopes. Table 4. Findings of single-predictor multilevel logistic Table 5. However, the 10 construct Construct domain Mood disorder x0.

Schizotypy 1. The results, shown in Table 5, in- Miscellaneous 1. Findings based at least freedom. The measurement conditions. The metric practice. This rise in methodological quality has ac- tential sources of error, we ran a multilevel model companied, and probably partly driven, a decline in using only the CCFI and quality index as predictors. The an objective supplement or alternative to visual curve estimated probability 0.

Research that did not literature 0. By implication, the taxometric litera- use the technique was almost 3. With regard dimensional bias rather than enhanced validity. We to methodology, the analysis suggests that several consider this argument to be baseless. For example, Ruscio et al. Continuous data technique has brought about is substantial. By implication, early taxo- continuous measures of psychopathology should be metric research is likely to contain invalid taxonic preferred over discrete measures a priori.

Moreover, most of the invalid the contrary in some cases. The re- ation is latently continuous. The only domains and psychopathy. Taxometrics was launched as a rigorous method for The domains of mood depression : Ruscio et al. Three eating binge-eating disorder : Hilbert et al. Other taxa may exist, but taxometric et al. In sum, after 32 years of taxometric research, the Latent structure of intermittent explosive disorder in an methodologically strongest evidence for the existence epidemiological sample.

Journal of Psychiatric Research 44, of taxa is in the areas of alcohol- and nicotine-related — Journal of Psychiatric Research 36, — Are Jungian preferences really clearly supports the existence of taxa only in the areas categorical? An empirical investigation using of schizotypy, autism and substance use disorders. Taxometric We also acknowledge that taxometrics is just one evidence for the dimensional structure of cluster-C, statistical approach to the question of latent structure, paranoid and borderline personality disorders.

Journal of and any comprehensive analysis of the existence and Personality Disorders 23, — European Journal of Personality 16, S1—S5. Journal of Abnormal Psychology among pain patients? Taxometric analysis of the pain , 87— Journal of Pain 8, — Latent structure of fear of pain : an subtype of negative symptom schizophrenia? Schizophrenia empirical test among a sample of community dwelling Research 77, — European Journal of Pain 13, — Revisiting the latent Psychological Assessment 23, — Categorical or 25, — A taxometric study of the Behavior Therapy 41, — Center for Epidemiological Studies depression scale.

The latent — Is depression taxonic, — Is — Journal of Personality Assessment 90, — The Taxometric investigation of PTSD : data from two taxometrics of marriage : is marital discord categorical? Behavior Therapy 37, Journal of Family Psychology 19, — Beauchaine TP, Waters E Psychological Methods 8, 3— Journal of Traumatic Stress 22, — Anxiety sensitivity taxonicity : for Social and Behavioral Research : Applications and Data a concurrent test of cognitive vulnerability for Analysis Methods.

Assessment and diagnosis of personality adults. Cognitive Behaviour Therapy 34, — Social anxiety sensitivity : a multi-national analysis. Journal of phobia : further evidence of dimensional structure. Anxiety Disorders 20, 1— Taxometric A taxometric analysis of schizophrenia symptoms.

Riccardi I, Rossi A Social Psychiatry and Psychiatric Epidemiology 44, sensitivity among youth : exploring the latent structure of — A conceptual 38, — Anxiety sensitivity taxonicity — Pothead or pot 44, — Taxonicity of anxiety sensitivity : an Policy 1, Racist or racism?

Group Processes and Intergroup Relations Hedonic capacity and schizotypy revisited : a taxometric 13, — A taxometric language impairment in 3- and 4-year-old children. Journal analysis of the MMPI-2 depression scales. Journal of of Speech, Language and Hearing 47, — Personality Assessment 79, — British Journal of Psychology 99, — Neuropsychology 21, 45— Contrasting prototypes and dimensions in the Busch RM Psychological Test. Archives of Clinical Neuropsychology 22, — Medicine 41, — Autism spectrum Psychopathic, not psychopath : taxometric evidence for the disorders as a qualitatively distinct category from typical dimensional structure of psychopathy.

Journal of Abnormal behavior in a large, clinically ascertained sample. Psychology , — Assessment 17, — Taxometric personality has a dimensional latent structure : taxometric analyses of sexual orientation and gender identity. Journal analyses of community and clinical samples.

Journal of of Personality and Social Psychology 78, — Abnormal Psychology , — Exploring the analysis. Journal of Abnormal Psychology , 81— Law and investigation of the latent structure of nicotine Human Behavior 35, 13— Centering predictor variables Tobacco Research 10, — Psychological Methods 12, — Williams TL A taxometric analysis. Behavior A taxonometric analysis of cognitive and neuromotor Therapy 31, — Eberenz KP A taxometric analysis of health anxiety. Journal of Psychological Medicine 39, — Abnormal Psychology , 56— A taxometric analysis of Psychology , — Psychosomatic Medicine 71, — Journal of Traumatic Stress 18, — A latent structure analysis of Psychiatric Research 21, — Journal of Abnormal Psychology Comprehensive Psychiatry 46, — Psychiatry epidemiological sample.

Journal of Psychiatric Research 45, Research , — Isolation the Narcissistic Personality Inventory. Personality and and characterization of a nuclear depressive syndrome. Psychological Medicine 17, — A taxometric continuously or categorically distributed?

A taxometric study of the latent structure of psychopathy : evidence analysis of strange situation behavior. Developmental for dimensionality. Journal of Abnormal Psychology , Psychology 39, — Is year span : a taxometric investigation. Psychology and depression best viewed as a continuum or discrete Aging 25, — The latent adolescent depression in a population-based sample.

Quinsey VL Journal of Personality The psychometric detection of schizotypy : do putative Disorders 21, 1— Psychopathy as a Journal of Abnormal Psychology , — Is the metabolic syndrome a discrete Journal of Consulting and Clinical Psychology 62, — Annals of phenotype? Psychological Medicine 36, — Epidemiology 19, — Categories of social relationship.

Risk grouping versus 53, 59— Evidence that male sexual orientation is a prostate cancer : a taxometric test. Journal of Urology , matter of degree. Journal of Personality and Social Psychology — Taxometric and related methods in autism subgroups : a taxometric solution. Journal of Autism relationships research. Personal Relationships 6, — Haslam N Clinical A taxometric investigation of the latent structure of social Psychology Review 23, 75— Do categories or dimensions underlie disorders.

Depression and Anxiety 23, — An update on the taxometric evidence. The taxonicity of Current Psychiatry Reviews 3, — Subtyping major depression : a , 26— Latent structure of anxiety : taxometric exploration. Envy and jealousy as Psychological Assessment 17, — Deeper into the schizotypy taxon : Emotion 20, — Haslam N, Kim H Categories and continua : a review Journal of Abnormal Psychology , — Journal of Abnormal Psychology , — Sawyer M Australian and New Zealand Journal of Resolving the latent structure of schizophrenia Psychiatry 40, — Journal of Abnormal Psychology Subtyping obsessive-compulsive disorder : a , 16— Behavior Therapy 36, — American Psychiatric Personality Disorders 21, — Association : Washington, DC.

Clarifying boundaries of binge adolescents in a schizotypy taxon. Schizophrenia Research eating disorder and psychiatric comorbidity : a latent 84, — Wade M, Orlando CM Behavior Therapy 41, — Journal of Abnormal — Is risky sexual The structure of late-life depressive symptoms across a behavior continuous or categorical? Psychological Assessment 23, Abbott R Evidence for latent classes of IQ in young — A taxometric of Mental Retardation , — Vincent G Journal of Child Is antisocial personality disorder continuous or Psychology and Psychiatry 48, — A taxometric analysis of 36, — Psychology 71, — Psychological depression in a Japanese population sample : taxometric Assessment 22, — Criminal Justice and Behavior 35, — The information-theoretic latent variable modelling.

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Contele de monte cristo 2002 torent Addiction Research and Theory 17, — For antisocial personality disorder, estimated month prevalence rates in the US based on older Diagnostic and Statistical Manual of Mental Disorders [DSM] criteria range from about 0. With regard dimensional bias rather than enhanced validity. The 11 included studies involved a total of 14 comparisons of a psychological intervention against a relevant control condition i. Journal of Urban Health. Psychological Assessment 21, — Reviewing source based on the interpretation of curves.
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Dowland cal of duti 2 torentai Potential biases in the review process We were aware of a potential for bias that might be seen as arising because two of the review authors CD and NH were investigators in one of the studies included in this review Huband Abstract, p. Journal of Offender Rehabilitation. Primary outcomes Aggression reduction in aggressive behaviour or aggressive feelings; continuous outcome, measured through improvement in scores on the Aggression Questionnaire AQ; Bussthe Modified Overt Aggression Scale MOAS; Malone or similar validated instrument; or as number of source incidents. Journal of Counseling Psychology The outcome of engagement with services was considered only by Havens where the investigators report numbers entering into drug addiction treatment services as a key outcome, although with no data available for the AsPD subgroup. We to methodology, the analysis suggests that several consider this argument to be baseless.
Scorpion king 3 free download utorrent Neufeld Antisocial personality disorder is more common among 1st-degree relatives of patients with the disorder than among the general population. Patients with antisocial personality disorder may rationalize their actions by blaming those they hurt eg, they deserved it or the way life is eg, unfair. No data extractable on any AsPD subgroup. This second stage assessment identified not only trials with participants diagnosed with antisocial or dissocial PD, but also trials with participants having a mix of PDs for which data on a subgroup with antisocial or dissocial PD might be available.
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To characterize features of brain structure associated with these two behavioral trajectories, the researchers collected structural MRI data from participants aged 45 years who were included in the Dunedin Study. This study was a population-representative longitudinal birth cohort of 1, individuals born in New Zealand between and Carlisi and colleagues looked specifically at those who had participated in the first assessment at age 3 years.

Participants of the Dunedin Study underwent MRI and had been subtyped as exhibiting life-course-persistent, adolescence-limited or no history of persistent antisocial behavior based on self- and informant-reported conduct problems from ages 7 years to 26 years.

Those on the life-course-persistent trajectory had lower mean cortical thickness and a smaller mean surface area compared with those in the low group. Moreover, the life-course-persistent group had reduced surface area in brain regions associated with executive function, affect regulation and motivation. However, the researchers did not observe widespread differences in brain surface morphometry for the adolescence-limited group compared with either the life-course-persistent or non-antisocial behavior groups.

Disclosures: The authors report no relevant financial disclosures. Healio News Psychiatry Personality Disorders. By Joe Gramigna, MA. Read next. February 20, Receive an email when new articles are posted on. Please provide your email address to receive an email when new articles are posted on.

You've successfully added to your alerts. You will receive an email when new content is published. High scores indicate high levels of antisocial behavior. Permission to administer the questionnaires was requested from the head teacher in each selected school. Each school obtained family consent for the participation of the students in the study because they were underage. The questionnaires were completed by the students at the school during school hours. At the time of the application of the questionnaires, participants were informed of the voluntary and anonymous nature of the test as well as the confidential treatment of the data obtained.

The first step was to perform a descriptive analysis of the variables in the starting theoretical model mean, standard deviation, response range, skewness and kurtosis. Following that, we calculated the correlation coefficients between each pair of variables.

Given that the distribution of each variable was relatively close to normality Kline, , we used the Pearson correlation coefficient for that purpose. Following that, using AMOS 24 IBM Corp, a statistical software, we used path analysis to assess how well the starting theoretical model fit the empirical data, as well as the magnitude of the direct and indirect effects of each variable.

The method of estimation was the Maximum Likelihood method. Although there was variation between the participants, the majority of they tended to report that their parents demonstrated affection and communication with them and controlled their behavior setting limits and showing concern about what happened to them. They tended to describe themselves as empathic and having little impulsivity, little antisocial behavior and few antisocial friendships Table 1.

The distribution of scores in each variable was relatively close to normality. Table 1. Descriptive statistics and Pearson correlation coefficients between the starting theoretical model variables. Antisocial behavior was statistically significantly related to the other variables included in the starting model as predictor variables.

All of the predictor variables were statistically significantly correlated with each other, except for behavioral control and impulsivity Table 1. Its explanatory power is moderate. The other variables in the model explain As Figure 2 and Table 2 show, all of the effects were statistically significant, and were positive and negative in accordance with our hypothesis Figure 1 , except for the effect of behavioral control on impulsivity.

Having antisocial friendships was positively related with engaging in antisocial behaviors. The effect of antisocial friendships is direct, and also indirect through its negative relationship with empathy, and positive relationship with impulsivity. The two analyzed dimensions of parenting style affection and communication, and behavioral control were positively correlated with each other. Both were negatively related to antisocial behavior. This effect is direct, and indirect through the positive relationship with empathy and the negative relationship with antisocial friendships.

Impulsivity has a different mediating role with each of the two analyzed dimensions of parenting style. Affection and communication is negatively related to impulsivity, reducing the likelihood of antisocial behavior. In contrast, behavioral control is positively related to impulsivity, increasing the likelihood of antisocial behavior. The effect sizes are small or very small, except for the effect of antisocial friendships on impulsivity and on adolescent antisocial behavior, which is moderate.

Figure 2. The values in Figure 2 and Table 2 refer to the direct effects between the model variables. Table 3 shows the direct, indirect and total effects of each predictor variable on antisocial behavior. The overall effect of affection and communication on antisocial behavior is small, negative, and mainly indirect via empathy, antisocial friendships, and impulsivity, in order of magnitude.

The overall effect of parental behavioral control on adolescent antisocial behavior is small, negative and mediated by empathy, antisocial friendships and impulsivity, in order of magnitude. In this case half of the overall effect is direct, and half indirect. The overall effect of antisocial friendships on adolescent antisocial behavior is moderate, positive and mainly direct. The indirect effect of antisocial friendships, mediated by impulsivity and empathy, is very small.

Table 3. Summary of standardized direct, indirect and total effects on antisocial behavior. The results are in line with the starting model Figure 1 , with the exception of the effect of behavioral control on impulsivity, which was the opposite of what we expected. Parental affection and communication with their children have a protective effect, albeit small, on adolescent antisocial behavior.

Parental behavioral control of children generally has a protective effect, albeit small, on adolescent antisocial behavior. However, contrary to our expectations, in this study we found that behavioral control can be a risk factor for antisocial behavior through its relationship with adolescent impulsivity. Previous studies have found parental behavioral control to be positively related to self-control in their children Li et al.

In our study, however, parental control was positively related to impulsivity in adolescent children, and thus with antisocial behavior. One explanation for this result may be that impulsive adolescents present more behavioral problems Maneiro et al. In turn, these impulsive adolescents may respond negatively to behavioral control, and increase their impulsive, antisocial behavior. Another possible explanation is that in our study we examined the effect of each parenting style dimension separately affection and communication; and behavioral control rather than the combined effect of the two dimensions.

Previous research has indicated that parental behavioral control has a positive effect on the prevention of antisocial behavior mainly when it occurs in a context of parental affection and communication, whereas hostile and intrusive control is a risk factor Pinquart, Previous studies have also found an authoritarian parenting style, characterized by little affection and high control, to be a risk factor for impulsivity in adolescence Li et al.

This may be because authoritarian parents tend to be impulsive Cox et al. Some researchers underline the importance of genetics in this transmission Beaver et al. In addition, impulsive parents may generate an ineffective educational pattern which provokes anxiety and impulsivity in their children. They may be impatient with their children, less talkative and more inconsistent; they may generate hostile family environments; they may even consider certain inappropriate behavior in their children normal and appropriate Meldrum et al.

Antisocial friendships are a risk factor for antisocial behavior in adolescence, with a moderate effect size. The effect is mainly direct, although as previous studies have indicated, there is also an indirect effect due to it being a risk factor for impulsivity and low empathy in adolescents Burt et al. The results of this study have various practical implications. Firstly, all of the variables in the model are significant predictors of antisocial behavior in adolescence.

This means that they should be borne in mind for the prevention and treatment of antisocial behavior in people of this age. Secondly, the effect of antisocial friendships in adolescence is greater than and contrary to the effects of the two analyzed parenting style dimensions affection and communication, and behavioral control. Friendships may enhance or weaken parenting practices.

The peer group can often encourage or approve of risky behaviors more than families Sasson and Mesch, ; Shin and Ismail, Despite parents placing appropriate restrictions, occasionally peer pressure can lead adolescents to ignore them and engage in inappropriate behaviors.

It is therefore important to teach adolescents to deal with peer and group pressure. Although adolescents have increasing autonomy in choosing their friends, it depends to a large extent on the values transmitted by their parents.

These values are largely communicated through the rules and limits on behavior set by parents and by the day-to-day family atmosphere, which serves as a model for behavior. Finally, impulsivity and low empathy are risk factors for antisocial behavior in adolescence. This research contributes to the field of study, with significant practical implications. However, it is not without limitations.

Firstly, the study was performed with a broad, random sample of adolescents, but constrained to some ages and a specific geographical location. Previous research has shown that exposure to the risk factors we examined, and their impact on the person, vary according to age and culture, which could also change their predictive power Dekovic et al. For that reason, any generalization from these results to other ages or contexts should be made with caution. In the future, it would be interesting to replicate this research with other ages and in other contexts.

However, previous research suggests that some of these associations are bidirectional Salihovic et al. Future research should enhance the starting theoretical model in order to improve its predictive capacity. Thirdly, the conclusions are limited by the variables included in the model. Although the variables we included were relevant, there are other variables that might interact with those included in this study and influence the likelihood of an adolescent engaging in antisocial behavior Assink et al.

Fourth and lastly, this was a cross-sectional study. It would be interesting to test whether the hypothesized causal relationships would be confirmed in a longitudinal study. Despite these limitations, this study is a contribution to clarifying the causal mechanisms of adolescent antisocial behavior, as a basis for its prevention and treatment. The datasets generated for this study are available on request to the corresponding authors. This study was carried out in accordance with the recommendations of the Deontology Commission of the General Counsel of Psychology of Spain, with written informed consent from all subjects.

All subjects gave written informed consent in accordance with the Declaration of Helsinki. The protocol was approved by the research and ethics committee at the University of Oviedo. DA-G and JN designed the study, analyzed the data and drafted the manuscript. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

The authors thank all pupils, teachers, and principals of the respective schools for their participation in this study. Validity and reliability of the cyber-aggression questionnaire for adolescents CYBA. Legal Context 8, 69— Parenting style dimensions as predictors of adolescent antisocial behavior. Individual, family, and community predictors of cyber-aggression among adolescents.

Legal Context 10, 79— American Psychiatric Association Google Scholar. Asano, R. Assink, M. Risk factors for persistent delinquent behavior among juveniles: a meta-analytic review. Beaver, K. The association between parenting and levels of self-control: a genetically informative analysis. Justice Behav. Boele, S. Linking parent—child and peer relationship quality to empathy in adolescence: a multilevel meta-analysis. Youth Adolesc. Brown, B. Parenting practices and peer group affiliation in adolescence.

Child Dev. Burt, C. A longitudinal test of the effects of parenting and the stability of self-control: negative evidence for the general theory of crime. Criminology 44, — Cook, E. Do specific transitional patterns of antisocial behavior during adolescence increase risk for problems in young adulthood?

Child Psychol. Cox, J. The relationship between parental psychopathic traits and parenting style. Child Family Stud. Peer-group mediation in the relationship between family and juvenile antisocial behavior. Legal Context 7, 59— Effects of parenting practices through deviant peers on nonviolentand violent antisocial behaviours in middle- and late-adolescence. Legal Contex 9, 75— Dekovic, M. The role of family and peer relations in adolescent antisocial behaviour: comparison of four ethnic groups.

Revista De Psicol. Higgins, G. Parental criminality and low self-control: an examination of delinquency. Justice Stud. Hoskins, D.

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