Conduct Disorder and Antisocial Personality Disorder in Persons With Severe Psychiatric and Substance Use Disorders

Department of Psychiatry and Community, Dartmouth Medical School, Hanover, New Hampshire, USA.
Schizophrenia Bulletin (Impact Factor: 8.45). 11/2006; 32(4):626-36. DOI: 10.1093/schbul/sbj068
Source: PubMed


Conduct disorder (CD) and antisocial personality disorder (ASPD) are established risk factors for substance use disorders in both the general population and among persons with schizophrenia and other severe mental illnesses. Among clients with substance use disorders in the general population, CD and ASPD are associated with more severe problems and criminal justice involvement, but little research has examined their correlates in clients with dual disorders. To address this question, we compared the demographic, substance abuse, clinical, homelessness, sexual risk, and criminal justice characteristics of 178 dual disorder clients living in 2 urban areas between 4 groups: No CD/ASPD, CD Only, Adult ASPD Only, and Full ASPD. Clients in the Adult ASPD Only group tended to have the most severe drug abuse severity, the most extensive homelessness, and the most lifetime sexual partners, followed by the Full ASPD group, compared with the other 2 groups. However, clients with Full ASPD had the most criminal justice involvement, especially with respect to violent charges and convictions. The results suggest that a late-onset ASPD subtype may develop in clients with severe mental illness secondary to substance abuse, but that much criminal behavior in clients with dual disorders may be due to the early onset of the full ASPD syndrome in this population and not the effects of substance use disorders.

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    • "These results have been confirmed in a recent study in outpatients in methadone maintenance treatment, where 34.2% of the participants were diagnosed with APSD (Carpentier, van Gogh, Knapen, Buitelaar, & De Jong, 2011). Paranoid and depressive PD have been found to predict early dropout (Miller, Brown, & Sees, 2001) and SUD patients with APSD have higher substance use severity scores than patients without APSD (Mueser et al., 2006). It has also been shown that PD is associated with worse substance-related outcomes in SUD patients compared to SUD patients without PD (Van den Bosch & Verheul, 2007). "

    European Journal of Psychological Assessment 09/2015; DOI:10.1027/1015-5759/a000282 · 2.53 Impact Factor
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    • "Research examining the influence of ASPD and the associations between psychiatric illnesses, substance misuse, and criminal involvement suggest that ASPD forms a critical link between substance use and violence among mentally disordered offenders (Swanson et al., 2008). In fact, it has been suggested that ASPD in people with CODs accounts for involvement in the criminal justice system above and beyond the influence of CODs alone (Mueser et al., 2006). As ASPD appears to be such a dominant factor, for this study the effects of ASPD will be analyzed in addition to CODs (i.e., CODs will only include comorbid psychotic/affective/anxiety disorders and SUDs). "
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    ABSTRACT: Despite the number of studies investigating co-occurring disorders, and more recently, co-occurring disorders and criminal offending, few studies have considered samples from forensic mental health services. The present study was conducted to investigate the relationship between mental illness, substance use disorders, antisocial personality disorder, and offending. The prevalence of co-occurring disorders was investigated in 130 male offenders who had contact with the statewide forensic mental health service in Victoria, Australia. Offense histories and severity of offending were compared among participants diagnosed with a single mental illness (or no mental illness), co-occurring mental illness and substance use, and co-occurring disorders plus antisocial personality disorder. The majority of participants had co-occurring mental and substance use disorders; a significant minority met the criteria for antisocial personality disorder. Participants with co-occurring mental illness and substance use disorders, and those who had an additional diagnosis of antisocial personality disorder, were responsible for more serious and frequent offending than those with mental illness alone. Forensic mental health services must take into account the effect that co-occurring disorders have on clients' functioning and offending. Those who work with people with psychiatric disabilities and co-occurring substance use disorders must ensure that the substance disorders are addressed to help ensure recovery from the mental illness and to reduce the likelihood of offending. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Psychiatric Rehabilitation Journal 03/2015; 38(1):16-23. DOI:10.1037/prj0000088 · 0.75 Impact Factor
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    • "A small group with no prior history of aggressive behaviobehaviorr engages in serious violence, usually against a caregiver, after many years of illness. Among men with schizophrenia, those with a history of CD prior to age 15, are convicted for more non-violent and violent crimes (Crocker et al., 2005; Fulwiler & Ruthazer, 1999; Mueser et al., 2006), commit a more diverse array of crimes (Hodgins, 2004), and have criminal histories similar to those of non-mentally ill offenders who also have a childhood history of conduct problems (Hodgins & C^ ot e, 1993; Schug, Raine, & Wilcox, 2007). In addition, almost all display a pattern of substance misuse going back to early adolescence (Fulwiler, Grossma, Forbes, & Ruthazer, 1997). "
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    ABSTRACT: Conduct disorder (CD) prior to age 15 identifies a subgroup of men with severe mental illness (SMI) who present a high risk for violence that persists across the life span. The present study examined male violent offenders with SMI in a forensic hospital in Spain, comparing those with SMI+CD and those without SMI-CD on the HCR-20 and PCL:SV. Violent offenders with SMI+CD obtained higher HCR-20 and PCL: SV total scores, and much higher H and factor 2 scores as compared to those without prior CD. Men with SMI+CD present a challenge to forensic psychiatric services.
    International Journal of Forensic Mental Health 08/2014; 13(3):217-226. DOI:10.1080/14999013.2014.922137 · 1.05 Impact Factor
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