Managing ASP

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Antisocial patients who seek help can be evaluated on an outpatient basis. A careful psychiatric interview supplemented by information from informants is the best way to assess ASP, because there are no diagnostic tests. Cognitive therapy has recently been used to treat ASP and involves helping patients to recognize and correct situations in which their distorted beliefs and attitudes interfere with their functioning. Antisocial patients can be very difficult to treat because they typically blame others for their problems, have a low tolerance for frustration, are impulsive, and rarely form trusting relationships.

Several drugs have been shown to reduce aggression, the chief problem of many antisocials, but no medications are routinely used or specifically approved for the treatment of ASP. Lithium carbonate and phenytoin have both been found to reduce anger, threatening behavior, and assaul-tiveness among prisoners. Other drugs used have been used to treat aggression primarily in brain-injured or mentally retarded patients, including carbamazepine, valproate, propranolol, buspirone, trazodone, and the antipsychotics. Medication targeted at comorbid major depression, anxiety disorders, or ADD may help to reduce antisocial behavior. Antisocial substance abusers who stop abusing are less likely to engage in antisocial or criminal behaviors, and they have fewer family conflicts and emotional problems.

Antisocials with spouses and families may benefit from marriage and family counseling. Bringing family members into the counseling process may help antisocial patients recognize the impact of their disorder on others. Therapists who specialize in family counseling may be helpful in addressing antisocials trouble in maintaining enduring attachments to their spouse or partner, their inability to be effective parents, their problems with honesty and responsibility, and the anger and hostility that can lead to domestic violence.

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