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Antisocial personality disorder
From WikEM
Contents
Background
A pervasive pattern of disregard for and violation of the rights of others
Clinical Features
- Three (or more) of the following criteria, occurring since age 15 years:[1]
- Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest.
- Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
- Impulsivity or failure to plan ahead.
- Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
- Reckless disregard for safety of self or others.
- Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
- Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.
- The individual is at least age 18 years
- There is evidence of conduct disorder with onset before age 15 years
- The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder
Differential Diagnosis
- Substance use disorders
- Schizophrenia and bipolar disorders
- Other personality disorders and personality traits
- Criminal behavior not associated with a personality disorder
Evaluation
A clinical diagnosis; however if entertaining other organic causes may initiate workup below
General ED Psychiatric Workup
- Point-of-care glucose
- CBC
- Chem 7
- LFTs
- ECG (for toxicology evaluation)
- ASA level
- Tylenol level
- Urine toxicology screen/Blood toxicology screen
- EtOH
- Urine pregnancy/beta-hCG (if female of childbearing age)
- Consider:
- Ammonia (see Hepatic encephalopathy)
- TSH (hypo or hyperthyroidism may mimic mental illness)
- CXR (for Tb screen or rule-out delirium in older patient)
- UA (for rule-out delirium in older patients)
- Head CT (to rule-out ICH in patients with AMS)
- Lumbar puncture (to rule-out meningitis or encephalitis)
Management
Referral for outpatient psychiatric treatment, although difficult to treat with psychotherapy. Antipsychotics, antidepressants and mood stabilizers can be used to control symptoms such as aggression and impulsivity
Disposition
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See Also
External Links
References
- ↑ American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
