Antisocial personality disorder: Difference between revisions
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==Background== | ==Background== | ||
A pervasive pattern of disregard for and violation of the rights of others | *A pervasive pattern of disregard for and violation of the rights of others | ||
==Clinical Features== | ==Clinical Features== | ||
| Line 11: | Line 11: | ||
**Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations. | **Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations. | ||
**Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another. | **Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another. | ||
*The individual is at least age 18 years | *The individual is at least age 18 years | ||
*There is evidence of conduct disorder with onset before age 15 years | *There is evidence of conduct disorder with onset before age 15 years | ||
| Line 17: | Line 16: | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Substance use disorders | *[[substance abuse|Substance use disorders]] | ||
*Schizophrenia and bipolar | *[[Schizophrenia]] and [[bipolar disorder]] | ||
*Other personality disorders and personality traits | *Other [[personality disorders]] and personality traits | ||
*Criminal behavior not associated with a personality disorder | *Criminal behavior not associated with a personality disorder | ||
==Evaluation== | ==Evaluation== | ||
A clinical diagnosis; however if entertaining other organic causes may initiate workup below | *A clinical diagnosis; however if entertaining other organic causes may initiate workup below | ||
{{General ED Psychiatric Workup}} | {{General ED Psychiatric Workup}} | ||
==Management== | ==Management== | ||
Referral for outpatient psychiatric treatment, although difficult to treat with psychotherapy. Antipsychotics, antidepressants and mood stabilizers can be used to control symptoms such as aggression and impulsivity | *Set clear boundaries and expectations | ||
*Referral for outpatient psychiatric treatment, although difficult to treat with psychotherapy. Antipsychotics, antidepressants and mood stabilizers can be used to control symptoms such as aggression and impulsivity | |||
==Disposition== | ==Disposition== | ||
*Discharge | |||
==See Also== | ==See Also== | ||
*[[Personality disorders]] | |||
==External Links== | ==External Links== | ||
==References== | ==References== | ||
Latest revision as of 16:18, 10 October 2019
Background
- A pervasive pattern of disregard for and violation of the rights of others
Clinical Features
- Three (or more) of the following criteria, occurring since age 15 years:[1]
- Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest.
- Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
- Impulsivity or failure to plan ahead.
- Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
- Reckless disregard for safety of self or others.
- Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
- Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.
- The individual is at least age 18 years
- There is evidence of conduct disorder with onset before age 15 years
- The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder
Differential Diagnosis
- Substance use disorders
- Schizophrenia and bipolar disorder
- Other personality disorders and personality traits
- Criminal behavior not associated with a personality disorder
Evaluation
- A clinical diagnosis; however if entertaining other organic causes may initiate workup below
General ED Psychiatric Workup
- Point-of-care glucose
- CBC
- Chem 7
- LFTs
- ECG (for toxicology evaluation)
- ASA level
- Tylenol level
- Urine toxicology screen/Blood toxicology screen
- EtOH
- Urine pregnancy/beta-hCG (if female of childbearing age)
- Consider:
- Ammonia (see Hepatic encephalopathy)
- TSH (hypo or hyperthyroidism may mimic mental illness)
- CXR (for Tb screen or rule-out delirium in older patient)
- UA (for rule-out delirium in older patients)
- Head CT (to rule-out ICH in patients with AMS)
- Lumbar puncture (to rule-out meningitis or encephalitis)
Management
- Set clear boundaries and expectations
- Referral for outpatient psychiatric treatment, although difficult to treat with psychotherapy. Antipsychotics, antidepressants and mood stabilizers can be used to control symptoms such as aggression and impulsivity
Disposition
- Discharge
See Also
External Links
References
- ↑ American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.