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Advice dealing with Antisocials

Discussion in 'Psychiatry' started by DO-Riz, May 15, 2007.

  1. DO-Riz

    DO-Riz Member
    7+ Year Member

    Nov 22, 2002
    Likes Received:
    Hey Guys
    Just wanted to know some tips/advice in dealing with people with Antisocial traits who act very demanding and cause conflicts with Nursing stafff, who get angry and frustrated by their behaviour:
    Had a recent consult on 19 y.o guy , came to MICU for DKA, hx. of Cocaine/THC dependence, no other psych history, who was acting very rude apparently and dropping F bombs when he wouldnt get his way. For example since he was on Diabetic diet, he was unsatisfied with his food and demanded more, although he knows he has Diabetes and is not good for him.
    Apparently he has gotten ill before by not taking his Insulin in a control issue with his mother. He was very defensive and would not cooperate during interview, stating it was his choice to do these things and was being patronizing. I def had alot of counter-transference,,,,,,,,,and found myself getting pretty irritated with his behaviour/attitude.
    What type of interview style worke better in these cases.....
    any thoughts/comments.....
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  3. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
    Physician Moderator Emeritus SDN Advisor 10+ Year Member

    Dec 2, 2004
    Likes Received:
    Attending Physician
    First, is he really anti social? Does he have the hx of defiance of authority, legal issues? Is he really unable to empathize with others? I think it's more likely that he's got an oppositional/defiant defensive style which can be pretty common chronically ill teens. You mention that insulin (and I suppose MJ/cocaine now, too) has been a control issue with him and mom. It's a way of taking back forcibly what they feel they've lost by getting a raw deal, biologically. He's in a vulnerable position as a patient, doesn't like it, and is acting out in defense.

    You might want to appeal to his desires to be an independent adult and to make choices that will maximize the outcomes he desires for himself. Use some motivational interviewing techniques to find out what he really wants--and gently point out that his current style of interacting with staff, while understandable "given how much stress he is under" (Choke back the eye rolls, if you can) is going to get in the way of others wanting to help him acheive these goals.

    Now admittedly, at 19, and possibly a bit more underdeveloped emotionally d/t chronic illness and drug use--his frontal lobe myelination may not yet be at a stage where he can start putting it into practice. However--he might understand that if he doesn't want nurses coming in at 3 am with ice water enemas, he'd better stop cussing the staff out--and that if he doesn't take charge of his own diabetes management pretty damn soon, his penis will fall off :eek: along with other vital appendages.

    Bottom line--find out what motivates him, and apply it repeatedly and shamelessly to elicit his cooperation.
  4. whopper

    whopper Former jolly good fellow
    Physician Faculty 10+ Year Member

    Feb 8, 2004
    Likes Received:
    Attending Physician
    My question exactly.

    Just because he's annoying doesn't make him antisocial. Sounds like he's more borderline or histrionic.

    Remember the DSM criteria for antisocial PD.

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