also called Neuroleptics
-Phenothiazines (e.g. Thorazine), butyrophenones (e.g. Haldol), thioxanthenes (Navene)
-Block dopamine receptors, help with positive symptoms, reduce agitation, violent behavior, little effect on negative symptoms
helpful in 65% of cases
Extrapyramidal-side effects: parkinsonism (muscle tremors, shakiness), dystonia (slow, involuntary movement), akathesis (motor restlessness), neuroleptic malignant syndrome (muscle rigidity)
Tardive dyskinesia - side effect. abnormal movements of lips, tongue and jaw and may involve the trunk or arms as well.
Psychoeducation: helpful for families too
Individual Cognitive-Behavioral Therapy: may be helpful for higher functioning individuals. hallucination reinterpretation and acceptance. cognitive remediation to help with attention, planning, memory and problem solving. Two kinds of cognitive-behavior therapy are now used for people with schizophrenia, (1) cognitive remediation and (2) hallucination reinterpretation and acceptance . Cognitive remediation is an approach that focuses on the cognitive impairments that often characterize people with schizophrenia—particularly their difficulties in attention, planning, and memory ( Fan, Liao, & Pan, 2017 ; John et al., 2017 ). Here clients are required to complete increasingly difficult information-processing tasks on a computer. They may start with a simple task such as responding as quickly as possible to various stimuli that are flashed on the screen—a task designed to improve their attention skills. Once they can perform this task with considerable speed, they move on to more complex computer tasks, such as tasks that challenge their short-term memory. As they master each computer task, they keep moving up the ladder until they eventually reach computer tasks that require planning and social awareness. cognitive remediation A treatment that focuses on the cognitive impairments that often characterize people with schizophrenia—particularly their difficulties in attention, planning, and memory. Studies indicate that, for many people with schizophrenia, cognitive remediation brings about moderate improvements in attention, planning, memory, and problem-solving—improvements that surpass those produced by other treatment interventions ( Bustillo & Weil, 2018 ; Fan et al., 2017 ). Moreover, these improvements extend to the client's everyday life and social relationships.
Family Interventions (Multi-Family Group): Decrease expressed emotion
dramatic, emotional, erratic
antisocial personality disorder, borderline personality disorder (intense fluctuations in mood, self image and interpersonal relationships), histrionic (self-dramatization, exaggerated emotional expressions, attention seeking behaviors), narcissistic (exaggerated sense of self importance, exploitative, and lack of empathy
Not all APD are serial killers; behaviors occur on a spectrum. many break laws and show aggression; not all kill.
Not all killers have APD
The disorders that killers do have (sometimes) are schizophrenia, bipolar, severe mood, ptsd, or other personality disorders like borderline, schizotypal, and antisocial)
common traits shared by killers: severe feelings of anger/resentment, being persecuted or mistreated, or desire for revenge
Which disorders do killers have?
Not all killers have a diagnosable DSM disorder, but common ones include: Schizophrenia; bipolar; severe mood, ptsd, or other personality disorders (borderline, schizotypal).
Schizophrenia characteristics: various psychotic symptoms such as delusions, hallucinations, disorganized speech, restricted or inappropriate affect, and catatonia
Borderline personality disorder: 5 or more:
1) extreme attempts to avoid real or imagined abandonment
2) Impulsivity that is potentially self-damaging
3) anger control problems
4) Lack of a sense of self, or unstable self image
5) Recurrent suicidal behavior or self-mutilating behavior
6) Dissociation or paranoid thoughts that occur in response to stress.
7) Chronic feeling of emptiness
8) Intense and unstable interpersonal relationships
9) Affective instability due to a marked reactivity of mood
primary problems with poor emotion regulation and interpersonal difficulties
P --> paranoid ideas
R --> relationship instability
A --> anger; affect; abandoment
I --> impulsive behavior; identity disturbance
S--> suicidal behavior
E --> emptiness
Antisocial personality disorder:
common characteristics: Law breaking; unreliable and insincere; lack of anxiety and guilt; superficial charm and good intelligence; shallow emotions and lack of empathy; blame the victim; arrogant and inflated self-esteem; believe everyone is out for themselves.
A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15, as indicated by 3 or more of the following:
1) chronic failure to conform to social and legal codes (grounds for arrest)
2) deceitfulness (repeated lying, aliases, conning others for personal profit/pleasure)
3) impulsivity or failure to plan ahead
4) irritability and aggressiveness (physical fights, assaults)
5) reckless disregard for safety of self or others
6) consistent irresponsibility (lack of accountability)
7) lack of remorse
also at least 18 years of age
evidence of conduct disorder onset before age 15
Similarities Between ASPD and BPD
Both ASPD and BPD are classified as Cluster B personality disorders in the DSM-5. Cluster B disorders are characterized by overly emotional, dramatic, and unpredictable thinking and behavior. Among the similarities between ASPD and BPD:
Disinhibition: Both ASPD and BPD are associated with disinhibition. However, people with ASPD demonstrate disinhibition by engaging in impulsive behaviors "because they can," while people with BPD do so to combat negative emotions.
Hostility: People with ASPD and BPD will get inordinately angry over minor slights. People with ASPD tend to lash out with consciously cruel and hostile acts, while those with BPD remain persistently angry and may engage in self-harm.
Impulsivity burn-out: According to the DSM-5, by later middle age, people may be less likely to meet the diagnostic criteria for either ASPD or BPD. This is referred to as "burn-out," a state in which the emotional expression of the disorder changes with age.
Suicidality: The rate of suicide in both ASPD and BPD is between 3% to 10%.4
Differences in ASPD vs. BPD
There are just as many differences between ASPD and BPD as there are similarities, including:
Symptoms: ASPD consists of few emotions, while BPD consists of extreme emotions, mood swings, and an inability to regulate emotions.
Gender: Some research suggests that BPD is equally common in men and women, but that men are less likely to seek treatment. By contrast, ASPD is around five times more common in men than women.5
Age: There is no age requirement for BPD. However, you must be 18 or over to be diagnosed with ASPD.1
Treatment: Certain forms of cognitive-behavioral therapy (CBT), such as dialectical behavior therapy (DBT) and mentalization-based therapy (MBT), have been extremely effective in treating BPD.6 By contrast, ASPD is notoriously difficult to treat with psychotherapy.