Notes

Slide Show

Outline

1	PSYCHOPATHY & THE LIMITS OF T.F.P Michael H Stone, MD Prof. Clin. Psychiatry: Columbia
2	Psychopathy: Overall Picture
3	ANTISOCIAL P.D. in DSM-4 [in contrast to Psychopathy] Failure to conform to social norms Deceitfulness [lying, conning, aliases] Impulsivity: failure to plan ahead Reckless disregard for safety of others Irritability; aggressiveness Irresponsibility Lack of remorse [3 or > of the above]
4	HARE’S PSYCHOPATHY CHECKLIST “revised”: PCL-R [1991] CONSISTS OF 20 ITEMS, scored via interview & historical data: 0, 1, or 2 Total Score: Maximum of 40 Score of 30 or > [25 or > in Europe] makes the diagnosis Developed for forensic use, but now used in other contexts as well Can be used for adolescents also
5	HARE’S “FACTOR-1” [the narcissistic personality factor] GLIBNESS; SUPERFICIAL CHARM GRANDIOSE SENSE OF SELF-WORTH PATHOLOGICAL LYING CONNING; MANIPULATIVENESS LACK OF REMORSE OR GUILT SHALLOW AFFECT CALLOUSNESS FAILURE TO ACCEPT [COGNITIVELY] RESPONSIBILITY FOR ONE’S ACTIONS
6	HARE’S FACTOR-2: the impulsivity factor EXCESS NEED FOR STIMULATION PARASITIC LIFE-STYLE POOR BEHAVIORAL CONTROLS EARLY BEHAVIORAL PROBLEMS LACK OF REALISTIC LONG-TERM GOALS IMPULSIVITY IRRESPONSIBILITY JUVENILE DELINQUENCY FAILURE OF PAROLE
7	Additional Items of the PCL-R that do not map onto Factors #1 or #2 Promiscuous Sexual Behavior Many Short-Term or “De Facto” Relationships Criminal “Versatility” [by which is meant – a multiplicity of different types of criminal offenses]
8	CRIMINAL VERSATILITY: The Main Categories Theft Drug Offenses Murder Weapons Possession Major Auto Offenses Kidnapping Treason Obstruction of Justice Robbery Assault Fraud Sex Offenses Escape Arson Miscellaneous [viz., vandalsim]
9	DAVID COOKE’S RE-FACTORING OF THE PSYCHOPATHY CHECKLIST THE PERSONALITY FACTOR 1. Glibness 2. Grandiosity 3. Lying 4. Conning; Manipulativeness [an arrogant, deceitful personality]
10	DAVID COOKE’S RE-FACTORING OF THE PCL-R, cont’d THE AFFECT FACTOR 1. Shallow Affect 2. Callousness 3. Lack of Guilt 4. “Not Responsible” [deficient affective experience]
11	COOKE’S REFACTORING OF THE PCL-R, cont’d THE BEHAVIOR FACTOR 1. Easily Bored; Novelty Seeking 2. Impulsivity 3. Irresponsible Behavior 4. Parasitic Life-Style 5. No Reasonable Long-Term Goals [impulsive/irresponsible behavior]
12	“INSTRUMENTAL VIOLENCE”
13	Biological Factors in Psychopathy
14	BRAIN CORRELATES OF AGGRESSIVE PSYCHOPATHY Non-Specific EEG Abnormalities Resistance to Aversive Conditioning [similar to Cloninger’s LOW HARM AVOIDANCE LO Levels of 5-HIAA in CSF of adult psychopaths Neurologic Soft Signs
15	A SPECTRUM OF NARCISSISTIC DISORDERS
16	THE RANGE OF T.F.P. in relation to the NARCISSISTIC SPECTRUM
17	SOME CLINICAL EXAMPLES Narcissistic Traits NPD [DSM criteria] Malign.Narcissism Some ASPD Traits ASPD [DSM-IV] PCL-R 15-25 PCL-R > 29 Young Boxer Surgical Resident Company CEO Stalker/boyfriend Cocaine Addict Minister’s D’ghter Prodigal Son
18	Borderline Features: Severe Splitting in the not-fully psychopathic cases
19	What to Do with the Hot Potato??? [dealing with intense psychic pain]
20	Some Relevant Dynamics in the Less-than-fully Psychopathic Cases