antisocial persoanlity disorder in the in-patient unit?
Started by drechie
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What kind of comorbid problems are you trying to treat? What kind of unit is it?
There’s some evidence that antisocials do worse in group therapy where they prey on other members and learn how to perpetuate/hide negative behaviors with psychiatric jargon. They tend to value candor and have a hard time with emotional identification and consequently its regulation.
It depends how much empathy and insight the patient has into their problems, and what things they are motivated to change. Malingering is a serious concern.
There’s some evidence that antisocials do worse in group therapy where they prey on other members and learn how to perpetuate/hide negative behaviors with psychiatric jargon. They tend to value candor and have a hard time with emotional identification and consequently its regulation.
It depends how much empathy and insight the patient has into their problems, and what things they are motivated to change. Malingering is a serious concern.
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Vaillant GE. Sociopathy as a human process. A viewpoint. Arch Gen Psychiatry. 1975 Feb;32(2):178-83.
Watts D, Morgan G. Malignant alienation. Dangers for patients who are hard to like. Br J Psychiatry. 1994 Jan;164(1):11-5
Taylor JB, Beach SR, Kontos N. The therapeutic discharge: An approach to dealing with deceptive patients. Gen Hosp Psychiatry. 2017 May;46:74-78.
Kontos N, Taylor JB, Beach SR. The therapeutic discharge II: An approach to documentation in the setting of feigned suicidal ideation. Gen Hosp Psychiatry. 2018 Mar-Apr;51:30-35
The Therapeutic discharge paper in particular is excellent reading for junior residents.
Watts D, Morgan G. Malignant alienation. Dangers for patients who are hard to like. Br J Psychiatry. 1994 Jan;164(1):11-5
Taylor JB, Beach SR, Kontos N. The therapeutic discharge: An approach to dealing with deceptive patients. Gen Hosp Psychiatry. 2017 May;46:74-78.
Kontos N, Taylor JB, Beach SR. The therapeutic discharge II: An approach to documentation in the setting of feigned suicidal ideation. Gen Hosp Psychiatry. 2018 Mar-Apr;51:30-35
The Therapeutic discharge paper in particular is excellent reading for junior residents.
How would even begin to "treat" this within 3-10 days? Probably not an appropriate or reasonable place for this, no? Jail? Outpatient referral if you feel that aren't a total psychopath and have actual mental health issues/disorders?
Determining if the patient is a true psychopath vs just antisocial (yes, they are different) can be helpful in terms of whether you can actually do something. With the former it will typically become fairly obvious rather quickly if you are looking for it and the treatment is discharge. The latter can be helped if they're motivated and I actually had a couple in residency who did very well for stretches of over a year once other psych problems were stabilized (typically substance problems but also trauma-related disorders). One in particular actually ended up working at the VA I treated him at as a lab tech for a couple years, was really productive, and was liked by a lot of the staff. Malingering is still very common though, and if they're not motivated for change then best option is to safety plan, provide assistance for basic resources, and discharge.
For reading, I like Resnick's papers and chapters on malingered psychosis.
For reading, I like Resnick's papers and chapters on malingered psychosis.
When you said you had an antisocial patient get hired by the VA my initial reaction was I figured you meant Secretary of VA or at least a hospital chief of staff. Then I saw it was as a lab tech. If Big VA hears about his particular talents (lack of remorse, disregard for other humans), his ascent will be rapid.
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