help on antisocial personality speech

Davey Do · Dec 5, 2010

nbrown77:

Antisocial Personality Disorder is an interesting diagnosis. Although symptoms parallel Borderline Personality Disorder, the manipulative behavior with ASPD is done to gain material gratification. The DSMIV also states that ASPD must be distinguished from criminal behavior. That's gotta be difficult.

Wow. In all my years as a Psych Nurse, Community and State Hospitals and Mental Health Clinics, I don't recall ever seeing an axis I of ASPD.

However, one reason the treatment with the close relative of ASPD, Borderline Personality Diasorder, is controversial is because medications have little to no affect on the Individual. It's all a personality thing. It's not a chemical imbalance thing as much as it is the way they are wired. Any intervention is futile without the total cooperation of the Individual. And we know that most people don't change unless there's a major trial, like a major life crisis, that results in an illuminating revelation. And how often does someone see the light due to a difficult experience? Not often. Especially in our Society full of Victimized Litigators.

Interesting. I can't be much help, but good luck on your speech.

Dave

justashooter · Dec 12, 2010

Agreed that ASPD is not a diagnosis suitable for nursing intervention. It is a condition based upon a lack of moral character, and you, as a nurse, are not charged with affecting such. It is important for you to understand as a nurse what you may and may not do with patients you may be asked to see. If you are asked to work with an ASPD in reference to their diagnosis you have no ability whatsoever, other than to understand the disorder and it's origins/manifestations.

You may, however, be asked to work with someone who has ASPD in relation to medical conditions they may have that are not related to the psyc diagnosis. People with ASPD are often violent types, and may present with injuries asa result of their propensity toward violence. You may also be asked to work with a victim of an ASPD, perhaps even an intimate partner of such. You may be asked to work with an ASPD in relation to substance abuse, which is common among ASPD.

In any of the possible clinical roles in which you might interact with an ASPD it is important for you to understand that their disorder wil affect their response to a standard treatment plan. The motivations of an ASPD (explore) are different enough that typical treatments may be refused, subverted, or disregarded. ASPD people also lie with impunity, so relying on patient information when dealing with one is not advised.

An ASPD in a medical care setting also presents special problems in regard to client and staff safety, and this diagnosis should be taken seriously in this light. ASPD patients or relations have no ability to see reality in any light other than their own, and generally have little regard for the comfort, well being, or safety of others.

Treatment of ASPD (generally CBT) is typically ineffective, so these people usually end up in the criminal justice system. The reason why treatment is ineffective is that the disorder is one of personality, and that ASPD people generally have no desire to change. It is almost impossible to motivate them to change in a logical manner because their "logic" is based on a deviant reality. They may fly thru the psych ward on their way to jail, but they are rarely in for long.

Interestingly enough, there are patterns of medical diagnosis related to ASPD. Typically, a deficiency in development of the frontal lobe presents, and seratonin levels are notably lower than established norms. Anxiety is rarely seen in ASPD; this may be related to lowered autonomic response. This panorama of clinical symptons may be the result of a childhood deficient in positive parental interaction (lack of ideals in neurological stimulus), or may be a purely biological presentation. Chicken or egg? Perhaps it's a little bit of both.

Perhaps an increased understanding of the clinical presentations could lead us into a new era of pharmacological approach? Perhaps SSRI should be prescribed for fully evolved clients. Perhaps educational programs designed to increase positive parenting in at risk families would yeild positive results. Perhaps chemical adjustment of the autonomic response in prodromals would reduce rate and severity of presentation in later years? Who Knows?

Nobody does, and that is part of the problem. There is lots of room for exploration. A good psych nurse would of course be of value in studies designed to produce interventions. An RN level of understanding of brain chemistry is always of value when dealing with treatment resistant psych patients, and an RN could be a valuable part of a treatment team, providing info that clinical social workers do not have, and observing at a level that psychiatrists might no schedule time to.

Anyway, HTH you begin to consider the many facets of the question that you might explore.

Davey Do · Dec 13, 2010

Wow, justashooter, you said a mouthful. And in your mouthful, you said some interesting stuff. I had no idea of some of the information you relayed. The stuff about a defiency in frontal lobe development and decreased seritonin levels was fascinating! Where did you learn this frome? I'd be interested in studying up on it a bit.

Your statement about predisposing factors, nuture or nature, reminds me of a book I read several years ago. I believe it was called Born That Way by an author whose name was, I believe, William White. A study was done on adults that were identical twins separated in infancy. The simularity between personality traits, even with those identical twins raised in different cultures, were amazing. So, according to this author, the genetically predisposing personality far outweighs any sort of environmental stimulus.

But who knows? It's all a bunch of conjecture, as interesting as it is.

It'd be interesting to hear how nbrown's speech turned out.

Dave

justashooter · Dec 13, 2010

Thanks for the compliment, Dave. I am just an adult nursing student intending to specialise in psych. I have seen the manifestations of many disorders in the years I spent in industry, having worked at all levels up to and including management of degreed professional engineers. I have also been married twice (once to a primitive borderline, and once into a foreign culture), have lived in foreign cultures on 3 continents, and am just now learning how to describe all of the things that I have seen.

The medical diagnosis related to ASPD can be found in any recent text on abnormal psychology. Perhaps your training was taken before technology was able to adequately measure the deficiencies, or before the studies of origin were done. Learning to see ASPD seperately from general criminal behaviour is a trick, and few even today know where to, or have the patience to, draw the line. It is easier just to throw them into jail and ignore the problem. Trouble is, that's like crossing coyotes with house dogs. The progeny is smarter and more dangerous.

The seratonin question is of special interest, but problematic when viewed as a treatment method. SSRI would increase the sensation our clients "feel", thereby reducing their drive to commit provocative and maleficient behaviours to gain "thrill", but getting the client to take the prescription is easier said than done. The deficience in frontal lobe development is best considered in light of the romanian orphanage studies, in which neglected children were followed in later years and noted to have deficient frontal development.

The frontal lobe is the repository of our experience, and houses the logic framework by which we react or act in light of present experience. If there is no positive interaction in early childhood to provoke the formation of synaptic chains that found a positive logic congress then there is little hope of resultant positive interaction. If the child discovers early on that only negative behaviours result in a response in terms of interaction then the child will develop into an adult that uses such logic, as it is hardwired into the synapses of their brain.

The power we obtain thru an understanding of this reality is the knowledge of the value of abandonment. Abandonment is a powerful tool in any kind of relationship, even that between an ASPD (or Borderline) and those they interact with. Perhaps it is our best tool in SCBT (sub-cognitive BT). A therapist or clinician who refuses contact with an ASPD as consequence of negative behaviour disrupts the logic chain upon which such behaviour is based.

This principle is much more easily enacted in an inpatient setting, and would be viewed by many bleeding-heart social workers as insensitive (or possible increasingly dangerous) in an outpatient setting. As with any interaction, it should be considered in light of the individual circumstances, and in respect to the peculiarities of the individual client. Such is the practice, in general.

zenman · Dec 13, 2010

Agreed that ASPD is not a diagnosis suitable for nursing intervention.

So, if someone with this diagnosis shows up on your unit, you do nothing? Don't put that in your speech, lol!