Pharmacological interventions for antisocial personality disorder.

Area of Science:

• Psychiatry and Pharmacology
• Clinical Psychology
• Evidence-Based Medicine

Background:

• Antisocial personality disorder (AsPD) is linked to significant life difficulties, including criminality and relationship problems.
• Pharmacological interventions are being explored as potential treatments for AsPD.
• This review updates a previous Cochrane review from 2010.

Purpose of the Study:

• To evaluate the efficacy and safety of drug treatments for adults diagnosed with AsPD.
• To assess benefits and adverse effects of pharmacological interventions in AsPD.

Main Methods:

• Systematic review of randomized controlled trials comparing pharmacological interventions with placebo in adults with AsPD.
• Searched multiple databases up to September 2019, including CENTRAL, MEDLINE, and Embase.
• Assessed risk of bias and certainty of evidence using the GRADE framework; primary outcomes included aggression, reconviction, global functioning, social functioning, and adverse events.

Main Results:

• Eleven studies involving 416 participants were included, primarily conducted in North America with predominantly male participants.
• Data were available for only five drug comparisons (antiepileptic, antidepressant, dopamine agonist) against placebo, with very low-certainty evidence for all outcomes.
• One study suggested a potential reduction in aggression with phenytoin, but reported no difference in nausea; other studies showed no significant differences in social or global functioning for desipramine, nortriptyline, or bromocriptine.

Conclusions:

• The current evidence base is insufficient to support the use of pharmacological interventions for antisocial personality disorder.
• Existing studies suffer from methodological limitations, small sample sizes, and focus on older medications, leading to very low confidence in findings.
• Future research should focus on participants with a confirmed AsPD diagnosis, employ robust methodologies, and include relevant outcomes like reconviction.