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[Hans Asperger and his patients--a retrospective examination of the spectrum of autistic disorders].

In 1944 the Viennese paediatrician Hans Asperger described for the first time a number of boys with so-called "autistic psychopathy" but failed to give a detailed quantitative-descriptive phenomenology of the condition. The aim of this second part of a retrospective analysis of the clinical case records of children diagnosed by Asperger and his team is to provide a quantitative, in-depth description of these children, as well as to investigate Asperger's idea of a transition from autistic psychopathic personality traits towards "normality". We examined 181 case records of children seen between 1950 and 1986 who were either clearly diagnosed with autistic psychopathy (AP) or showed autistic features (AZ). Consequently, features common to both the AP and AZ groups and the differences between them are described and compared to the current ICD-10 criteria for Asperger's syndrome. Children with AZ shared the high intelligence, the social handicap and the impairment of "instincts", but showed less severe symptoms and more distinct skills, as well as fewer co-morbid disorders than children with AP. Results suggest that there is indeed something like an "autistic phenotype" with certain deficits and assets that can be found in less handicapped children with autistic impairments. The current ICD-10 criteria do not seem to fully capture Asperger's original account of the syndrome and should be discussed anew if Asperger's syndrome is reconsidered for inclusion into diagnostic criteria in the future.

Asperger Syndrome↗

Psychopathy and violent recidivism among young criminal offenders.

OBJECTIVE: To investigate the predictive validity of psychopathic personality traits (assessed with the revised psychopathy checklist, PCL-R; Hare, 1991) for violent criminal recidivism among young offenders. METHOD: The relationship between PCL-R psychopathy and violent re-offending was studied in 98 young (M=18.40, range 15-20 years) violent and sex offenders subjected to forensic psychiatric evaluation in Sweden during 1988-95. Subjects were followed during detainment and for 24 months in the community to first reconviction for a violent offence. RESULTS: We found a modest but significant association between PCL-R scores and violent recidivism, almost exclusively accounted for by behavioural criteria. Among 13 possible confounders tested, conduct disorder before age 15 and a young age at first conviction eliminated the relationship between psychopathy and violent recidivism in pair-wise logistic regression models. CONCLUSION: PCL-R psychopathy may be a less valid predictor for violent criminal recidivism among severe youthful offenders than among adult offenders.

Adolescent↗

Psychopathy and conduct problems in children.

Factor analysis of a measure of psychopathy was conducted in a sample of 95 clinic-referred children between the ages of 6 and 13 years. These analyses revealed 2 dimensions of behavior, one associated with impulsivity and conduct problems (I/CP) and one associated with the interpersonal and motivational aspects of psychopathy (callous/unemotional: CU). In a subset of this sample (n = 64), analyses indicated that scores on the I/CP factor were highly associated with traditional measures of conduct problems. In contrast, scores derived from the CU factor were only moderately associated with measures of conduct problems and exhibited a different pattern of associations on several criteria that have been associated with psychopathy (e.g., sensation seeking) or childhood antisocial behavior (e.g., low intelligence, poor school achievement, and anxiety). These analyses suggest that psychopathic personality features and conduct problems are independent, yet interacting, constructs in children, analogous to findings in the adult literature.

Adolescent↗

Pursuing the psychopath: capturing the fledgling psychopath in a nomological net.

The present article reports on an attempt to import the concept of psychopathy at the childhood level. Childhood psychopathy was assessed in 430 boys ages 12 and 13 years by using caretaker reports on a translation of an adult psychopathy assessment instrument. A systematic construct validation approach revealed that childhood psychopathy fits into the nomological network surrounding adult psychopathy. Children with psychopathic personalities, like their adult counterparts, were serious and stable offenders, impulsive, and more prone to externalizing than internalizing disorders. Childhood psychopathy also provided incremental validity in predicting serious stable antisocial behavior in adolescence over and above other known predictors and one other classification approach. These results suggest that psychopathy has a childhood manifestation that can be measured reliably. Implications and future directions are outlined.

Adolescent↗

Early identification of the fledgling psychopath: locating the psychopathic child in the current nomenclature.

This research attempted to test D. R. Lynam's (1996) hypothesis regarding the developmental relation between adult psychopathy and children with symptoms of hyperactivity, impulsivity, and attention problems (HIA) and concurrent conduct problems (CP). In a large sample of adolescent boys, 4 groups (non-HIA-CP, HIA only, CP only, and HIA-CP) were compared on measures found to discriminate between psychopathic and nonpsychopathic offenders. In line with predictions, the HIA-CP boys most closely resembled psychopathic adults. HIA-CP boys scored higher than HIA-only and non-HIA-CP boys on a measure of psychopathic personality. As with their adult counterparts, HIA-CP boys were the most antisocial, were the most disinhibited, and tended to be the most neuropsychologically impaired of all the groups. Implications for treatment, research, and the study of comorbidity are discussed.

Adolescent↗

Applicability of traditional and revised models of psychopathy to the Psychopathy Checklist: screening version.

Recently, psychopathy has become virtually synonymous with the Psychopathy Checklist (PCL) measures. However, the "gold standard" 2-factor model that underlines these measures has been questioned for its uncertain empirical support and emphasis on antisocial behavior that is not specific to psychopathic personality deviation. This study (N = 870 civil psychiatric patients) compares the fit of the traditional 2-factor model with that of a revised 3-factor model of psychopathy. The revised model better describes the structure of the Screening Version of the PCL (PCL:SV) than the traditional model. Although the revised model's exclusion of some items that assess antisocial behavior reduces the PCL:SV's power in predicting patient violence, this model arguably assesses psychopathy in a more specific, theoretically coherent fashion that may reduce misapplications of the construct. Implications for future research are discussed.

Adult↗

Nonschizophrenic paranoid syndromes.

After presenting their model for the description of delusions, the authors report some results of two catamnestic studies in patients with delusional syndromes. There is evidence for the hypothesis that the usual classification of such patients as paranoid schizophrenics is frequently not justified. A reasonable number of the cases might belong to cyclothymia or at least approach it. Disappearance of delusions and complete restitution frequently occur in this group, while chronicity seems connected with persistent psychopathological signs in the accompanying symptomatology supposed to represent--in part--organic brain syndromes or congenital or acquired psychopathic personalities.

Adolescent↗

Conditions predisposing to suicide: a review.

By reviewing causes of death among cohorts of various major disease entities or conditions, one may infer that a large majority of suicides are associated with a relatively small number of conditions. From the available follow-up studies, we might estimate that the following percentage of affected individuals will die by suicide: primary (endogenous) depression, 15 per cent; reactive (neurotic) depression, 15 per cent; alcoholism, 15 per cent; schizophrenia, 10 per cent; psychopathic personality, 5 per cent; opiate addiction, 10 per cent or more. Rough estimates of the number of suicides per year in the United States attributable to each condition might be as follows (using low incidence figures): depression, 12,900; alcoholism, 6,900; schizophrenia, 3,800; psychopathy, 2,000 (?); drug addiction, 900.

Age Factors↗

Epilepsy in the adolescence.

The impact of recurrent seizures during childhood has a different influence upon the brain condition and mental activity of young epileptics at certain ages. Epilepsy has specific clinical features and characteristic EEG abnormalities, which occur at the developmental stage. Adolescence causes more extra burden to epileptic patients, particularly in the development of mental and/or emotional levels. In this paper, the authors report on two types of age-related phenomena--one benign in nature, and the other malignant. That is, RD (= rolandic discharge) is shown as a benign EEG feature with which sylvian seizure of Lombroso is associated. As a malignant example, psychopathic personality which appeared after the disappearance of epileptic fits, around puberty, was described. We epileptologists are convinced that children with epilepsy, particularly in puberty, have a considerable psychiatric or psychological problem, and must be treated with effective medicines, including medical service and social care.

Adolescent↗

Relationships between N1, P300, and contingent negative variation recorded at age 15 and criminal behavior at age 24.

Recent event-related potential (ERP) studies indicate that antisocial and psychopathic behavior is in some circumstances characterized by heightened attentional processes. This prospective study assesses whether ERP measures of attention recorded in adolescence are capable of predicting criminality status in adulthood. N1, P300, and contingent negative variation (CNV) were recorded during a CNV paradigm in a representative sample of 101 male schoolchildren at age 15, and related to criminality status at age 24. Criminals-to-be were characterized by larger N1 amplitudes and faster P300 latencies to the warning stimulus. Psychopathic personality within the criminal group was associated with larger N1 and CNV amplitudes. A discriminant function analysis using N1 and P300 measures correctly classified 74% of cases. It is concluded that enhanced early attentional processing may be of etiological significance in the development of criminality and that ERP measures may be of value in the early prediction of criminal behavior.

Adolescent↗

Parental rearing patterns and drug abuse. Preliminary report.

Results from a controlled study on a sample of 91 imprisoned drug dependents on perceived parental rearing practices using the EMBU and on parental family characteristics are presented. While few differences were observed between drug dependents and imprisoned controls-father less warm and mother more permissive in drug dependent group--comparisons of drug dependents with a general population sample revealed more differences between the two populations: drug dependents perceive both parents compared to the general population group as less rejective, very permissive, their mother as warmer and more overprotective and their father more inconsistent and less favouring them than siblings. Supportive evidence on the dependents' family psychopathology is provided by studying family characteristics. While our findings seem to support the prevailing view in the literature on the role of the mother of the drug dependent characterised by strong emotional bonds and overprotection as well as of the rather emotionally distant father, the question is raised on the contribution of other factors, such as psychopathic personality, on the above findings.

Adult↗

Baby stealing.

Analysis of 13 cases of baby stealing by women distinguished four groups of cases. (1) Girls of subnormal intelligence, who stole a baby to play with. (2) Schizophrenic patients, whose offence was motivated by delusional ideas. (3) Psychopathic personalities, characterized by a previous history of delinquency, hysterical personality traits, and a preoccupation with their desire to have children. Their baby stealing seemed motivated by an attempt to compensate for their emotional deprivation, and they usually stole children whom they had previously helped to care for. (4) A "manipulative" group with a milder degree of personality disorder, in whom the motive for baby stealing was an attempt to influence a man by whom they had become pregnant and with whom their relationship was insecure. The offence was precipitated by a crisis such as a miscarriage or the threat of desertion. These women presented the stolen baby to their partner pretending that the child was his.Baby stealing seems usually to be an attempt to compensate for emotional deprivation or frustrated maternal feelings, and a real or imaginary miscarriage may be a predisposing or precipitating factor. The offence rarely seems premediated, though there was evidence of previous planning in some cases, particularly in the manipulative group. The stolen babies were well cared for and were usually quickly recovered.

Abortion, Spontaneous↗

Late suicide in former mental patients.

Results from the long-term follow-up studies "The Enquĕte of Lausanne" are presented, concerning the incidence of suicide in old age of former mental patients. Among 1,891 studied deaths, 107 (5.6%) known suicides occurred; the suicide rate for all diagnostic groups, except mental retardation (only females), being considerably higher than in the general Swiss population of the same age, especially for depressions, alcoholism, neurotic and psychopathic personality disorders.

Adult↗

Effect of response distortion on the assessment of divergent facets of psychopathy.

Recent evidence suggests that the Psychopathic Personality Inventory (PPI) is composed of two orthogonal factors, one representing traits such as dominance and low anxiety (PPI-I) and a second that reflects more socially deviant aspects of psychopathy (PPI-II). To assess whether response sets differentially affect these factors, the present research reanalyzed data from two dissimulation studies in which college students completed the PPI both honestly and with instructions either to "fake good" (n = 186) or "fake bad" (n = 143). PPI-II scores decreased significantly in the fake-good condition (d = -.86) and increased significantly when faking bad (d = 2.65). PPI-I scores were unaffected by attempts to feign serious psychopathology (d = .10) and actually increased in the fake-good condition (d = .53). These findings significantly qualify previous conclusions about the effect of response distortion on the PPI.

Adolescent↗

Social deviance in a day hospital.

A search was made of records available for 65 nonpsychotic patients referred to a psychiatric day hospital. Assessments were made of whether they had shown various specified types of deviant social conduct, such detailed objective surveys of social conduct being regarded as superior to the use of concepts such as "psychopathic personality". The correlational structures of the areas of deviance produced four factors, i.e. deviant family roles, poor social integration, violence, and a more heterogeneous antisocial behaviour factor. The relationship was examined between areas of deviance and indices of the course and outcome of day hospital admission. The prognostic significance of social deviance was different for men and women; for example, only men showed a correlation between the number of areas of social deviance and the outcome of day hospital admissions. Violence and poor social integration showed no relation to outcome at all. It is suggested that there is no basis for excluding such patients from day hospitals on the assumption that they are less likely to be helped than other non-psychotic patients.

Antisocial Personality Disorder↗

Law, psychiatry and women's imprisonment. A sociological view.

This paper analyses the legal and other social conditions under which the concept of 'psychopathic personality disorder' continues to play a strategic part in both the repeated imprisonment of female petty offenders and in the justifications put forward for the rigidity of the disciplinary regimes in women's prisons.

Antisocial Personality Disorder↗

Understanding perpetrators of nonphysical sexual coercion: characteristics of those who cross the line.

Sexual coercion is defined here as a form of male sexual misconduct in which nonphysical tactics (e.g., verbal pressure) are utilized to gain sexual contact with an unwilling female partner. This study compares the risk characteristics of sexually coercive (n=81) and nonoffending college males (n=223) across several domains. Results revealed that sexual coercers differed from nonoffenders in that they more often subscribed to rape myths, viewed interpersonal violence as more acceptable, reported greater hostility toward females, and perceived male-female relationships as more inherently adversarial. In addition, compared to nonoffenders, sexually coercive males showed stronger indicators of promiscuity and delinquency, reported more psychopathic personality traits, had more empathic deficits, and were more likely to have experienced certain forms of childhood abuse. In most respects, coercers did not differ from those who reported engaging in more severe forms of sexual assault involving the use of physical force. These results suggest important differences between nonoffending males and those who "cross the line" by engaging in sexually coercive acts. In addition, consistent parallels can be drawn between the predictors of sexual coercion identified in this study and those documented in the sexual aggression (e.g., forcible rape) literature.

Antisocial Personality Disorder↗

[Differences in serotonin and dopamine metabolism in psychopathy and sluggish schizophrenia].

The studies established some differences in the serotonin metabolism in psychopaths and in patients with sluggish schizophrenia (261+/-9 ng/ml and 329+/-7 ng/ml of whole blood respectively). A comparison of the homovanilin acid content in the blood serum of patients in both groups (normals -62.1+/-9.3 ng/ml, psychopathic personalities -86.0+/-10.1 ng/ml, schizophrenic patients -34.5+/-8.6 ng/ml) points to a tendency towards an intensification of the dopamine metabolism in patients with psychopathy and a drop in the intensity of dopamine metabolism in schizophrenic patients.

Adult↗