© 2008 The Royal College of Psychiatrists
Correspondence |
Treatment of antisocial personality disorder
address supplied. Email: dr.martinlock{at}tiscali.co.uk
Edited by Kiriakos Xenitidis and Colin Campbell
M.P.L. provides independent psychiatric reports to solicitors of patients in DSPD units. He is also a member of the Mental Health Review Tribunal and sometimes sits on DSPD units.
Although Professor Maden's article was only 100 words long,1 it contained some profound and, I think, unfair and unsubstantiated, statements. Where is the evidence that patients with severe antisocial personality disorders who do not want to be treated, like many of those detained in the dangerous and severe personality disorder (DSPD) unit at Broadmoor Hospital, where Professor Maden is the clinical director, can be effectively treated?
Professor Maden criticises lawyers and independent experts but both he and others researching in the field have not produced independently verified evidence of efficacy. Professors Coid2 and Duggan,3,4 with others, have carried out meta-analyses and concluded that there was no evidence or that the evidence was very weak. Professor Duggan went as far as to suggest that this situation was ultimately unsustainable and would inevitably lead to legal challenges by those detained on the basis of their `treatability'.
The Canadians and Americans are concerned that psychological therapy with individuals with high scores on the Hare Psychopathy Checklist – Revised is making the situation worse and leading to increases in recidivism.5 They appear to have moved on and are investigating biological treatments such as hormone treatment for sex offenders or even addressing the putative causes with gene mapping.6
Is it really justifiable to blame lawyers and independent experts for pointing out this lack of evidence and that the DSPD project might not only be an expensive waste of time but it could be making the situation worse?
REFERENCES
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1
- Maden T. Can personality disorder be treated? 100 words.
Br J Psychiatry 2008;
192: 457.
[Free Full Text] 2 - Dolan B, Coid J. Psychopathic and Antisocial Personality Disorders: Treatment and Research Issues. Gaskell, 1993 . 3
- Binks CA, Fenton M, McCarthy L, Lee T, Adams CE, Duggan C. Pharmacological interventions for people with borderline personality disorder. Cochrane Database Syst Rev 2006; 1: CD005653 .[Medline] 4
- Binks CA, Fenton M, McCarthy L, Lee T, Adams CE, Duggan C. Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev 2006; 1: CD005652 .[Medline] 5
- Seto MC, Barbaree HE. Psychopathy, treatment behaviour, and sex
offender recidivism. J Interpers Violence 1999; 14: 1235
-48.
[Abstract/Free Full Text] 6 - Seto MC, Quinsey VL. Toward the future: translating basic research into prevention and strategies. In Handbook of Psychopathy (ed CJ Patrick): 589-601. Guilford Press, 2006.
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