Violence in Psychiatry

9781316135839

Focusing on violence from assessment, through underlying neurobiology, to treatment and other recommendations for practice, this book will be of interest to forensic psychiatrists, general adult psychiatrists, psychiatric residents, psychologists, psychiatric social workers and rehabilitation therapists.

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First published 2016

Previously published in CNS Spectrums (Journal of the Neuroscience Education Institute, October 2014 (vol. 19, iss. 5) and June 2015, (edited by Stephen M. Stahl). ISSN: 1092–8529, www.journals.cambridge.org/cns

Printed in the United Kingdom by TJ International Ltd. Padstow Cornwall

A catalog record for this publication is available from the British Library

Library of Congress Cataloging in Publication data
Names: Warburton, Katherine D., editor. | Stahl, Stephen M., 1951– , editor.

Title: Violence in psychiatry / edited by Katherine D. Warburton and

Stephen M. Stahl.

Description: Cambridge, United Kingdom ; New York : Cambridge

University Press, 2016. | Includes bibliographical references and index.

Identifiers: LCCN 2015042173 | ISBN 9781107092198 (Hardback)

Subjects: | MESH: Psychotic Disorders–drug therapy. | Violence–psychology.

| Forensic Psychiatry–methods. | Neuropsychiatry–methods. | Psychotic

Disorders–physiopathology.

Classification: LCC RC480.5 | NLM WM 600 | DDC 616.89/14–dc23 LC

record available at
http://lccn.loc.gov/2015042173

ISBN 978-1-107-09219-8 Hardback

Additional resources for this publication at www.stahlonline.org

Cambridge University Press has no responsibility for the persistence or accuracy of URLs for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate.

Every effort has been made in preparing this book to provide accurate and up-to-date information which is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this book. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use.

Section 1: Statement of the problem Chapter 1
Deinstitutionalization and the rise of violence E. Fuller Torrey
Chapter 2
The new mission of forensic mental health systems: managing violence as a medical syndrome in an environment that balances treatment and safety Katherine D. Warburton
Section 2: Assessment Chapter 3
The evolution of violence risk assessment John Monahan and Jennifer L. Skeem
Chapter 4
Assessment of aggression in inpatient settings Barbara E. McDermott and Brian J. Holoyda
Chapter 5
Clinical assessment of psychotic and mood disorder symptoms for risk of future violence Charles L. Scott and Phillip J. Resnick
Chapter 6
Inpatient aggression in community hospitals Katalin A. Szabo, Christopher L. White, Stephen E. Cummings, Raziya S. Wang and Cameron D. Quanbeck
Chapter 7
Prevalence of physical violence in a forensic psychiatric hospital system during 2011–2013: patient assaults, staff assaults, and repeatedly violent patients Charles Broderick, Allen Azizian, Rebecca Kornbluh and Katherine D. Warburton
Chapter 8
The psychiatrist’s duty to protect Knoll James L. IV
Section 3: Neurobiology Chapter 9
Deconstructing violence as a medical syndrome: mapping psychotic, impulsive, and predatory subtypes to malfunctioning brain circuits Stephen M. Stahl
Chapter 10
Aggression, DRD1 polymorphism, and lesion location in penetrating traumatic brain injury Matteo Pardini, Frank Krueger, Colin A. Hodgkinson, Vanessa Raymont, Maren Strenziok, Mario Amore, Eric M. Wassermann, David Goldman and Jordan H. Grafman
Chapter 11
Is impulsive violence an addiction? The Habit Hypothesis Stephen M. Stahl
Chapter 12
The neurobiology of psychopathy: recent developments and new directions in research and treatment Michael A. Cummings
Chapter 13
The neurobiology of violence Larry J. Siever and Daniel R. Rosell
Chapter 14
Impulsivity and aggression in schizophrenia: a neural circuitry perspective with implications for treatment Matthew J. Hoptman
Chapter 15
Serotonin and impulsive aggression Emil F. Coccaro, Jennifer R. Fanning, K. Luan Phan and Royce Lee
Section 4: Guidelines Chapter 16
California State Hospital Violence Assessment and Treatment (Cal-VAT) guidelines Stephen M. Stahl, Debbi A. Morrissette, Michael A. Cummings, Allen Azizian, Shannon M. Bader, Charles Broderick, Laura J. Dardashti, Darci Delgado, Jonathan M. Meyer, Jennifer A. O’Day, George J. Proctor, Benjamin Rose, Marie Schur, Eric H. Schwartz, Susan Velasquez and Katherine D. Warburton

Section 5: Psychopharmacology Chapter 17
Effectiveness of antipsychotic drugs against hostility in patients with schizophrenia in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study Jan Volavka, Pál Czobor, Leslie Citrome and Richard A. Van Dorn
Chapter 18
Clozapine: an effective treatment for seriously violent and psychopathic men with antisocial personality disorder in a UK high-security hospital Darcy Brown, Fintan Larkin, Samrat Sengupta, Jose L. Romero-Ureclay, Callum C. Ross, Nitin Gupta, Morris Vinestock and Mrigendra Das
Chapter 19
Augmentation of clozapine with amisulpride: an effective therapeutic strategy for violent treatment-resistant schizophrenia patients in a UK high-security hospital James E. Hotham, Patrick J. D. Simpson, Rosalie S. Brooman-White, Amlan Basu, Callum C. Ross, Sharon A. Humphreys, Fintan Larkin, Nitin Gupta and Mrigendra Das
Chapter 20
The psychopharmacology of violence: making sensible decisions Leslie Citrome and Jan Volavka
Chapter 21
Treating the violent patient with psychosis or impulsivity utilizing antipsychotic polypharmacy and high-dose monotherapy Debbi A. Morrissette and Stephen M. Stahl
Chapter 22
A rational approach to employing high plasma levels of antipsychotics for violence associated with schizophrenia: case vignettes Jonathan M. Meyer
Chapter 23
Illustrative cases to support the Cal-VAT guidelines Laura J. Dardashti, Eric H. Schwartz, Jennifer A. O’Day, Michael W. Barsom and George J. Proctor
Section 6: Treatment interventions Chapter 24
A new standard of care for forensic mental health treatment: prioritizing forensic intervention Katherine D. Warburton
Chapter 25
Forensic‐focused treatment planning: a new standard for forensic mental health systems Robert J. Schaufenbil, Stephen M. Stahl, Rebecca Kornbluh and Katherine D. Warburton
Chapter 26
Implementing an ecological approach to violence reduction at a forensic psychiatric hospital: approaches and lessons learned Shannon M. Bader and Sean E. Evans
Chapter 27
The appropriateness of treating psychopathic disorders Alan R. Felthous
Chapter 28
Psychosocial approaches to violence and aggression: contextually anchored and trauma-informed interventions Deborah Horowitz, Margaret Guyer and Kathy Sanders
Chapter 29
Comorbid mental illness and criminalness: implications for housing and treatment Robert D. Morgan and Nicole R. Bartholomew
Chapter 30
Crime, violence, and behavioral health: collaborative community strategies for risk mitigation Debra A. Pinals
Chapter 31
New technologies in the management of risk and violence in forensic settings John Tully, Thomas Fahy and Fintan Larkin
Chapter 32
Risk reduction treatment of psychopathy and applications to mentally disordered offenders Stephen C. P. Wong and Mark E. Olver

Index

List of Contributors

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Chapter 27 The appropriateness of treating psychopathic disorders Alan R. Felthous

Programmatic Treatment for Psychopathic Offenders
Impulsive Aggression in Psychopathic Disorders
Primary Impulsive Aggression
The Neurobiology of the Factor Domains of Psychopathy
Pharmacotherapy of Aggression in Psychopathic Disorders
Selecting an AIAA
Conclusions
Disclosure
References

Chapter 27 The appropriateness of treating psychopathic disorders

Alan R. Felthous

Violence in Psychiatry, ed. Katherine D. Warburton and Stephen M. Stahl. Published by Cambridge University Press. © Cambridge University Press 2016.

Introduction

Owing to their assaultive, destructive, and other antisocial acts, individuals with psychopathic disorders inflict untold harm on themselves, acquaintances, and strangers. The damage they inflict and the attempts at safe management by the criminal justice system amount to considerable economic cost to society. Yet the fatalistic conventional wisdom is that no treatment is effective for psychopathic disorders. From this perspective, efforts at treatment are counterproductive and a misuse of limited resources. Attempts to treat and cure the core defect of psychopathy may be futile in light of current medical and behavioral science.

Here the term “psychopathic disorders” is used with the same meaning as that in the comprehensive handbook on the topic [1,2]. The term follows “both taxonomical and dimensional approaches” and includes “diagnostic conditions characterized by antisocial behaviors,” but not “all antisocial or criminal behaviors regardless whether a disorder exists.” More specifically, psychopathic disorders include the Hare psychopathy concept and antisocial personality disorder (APD), as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), now in the fifth edition (DSM-5) [3]. In identifying psychopathic disorders, most of the studies cited in this review relied on either a version of the Psychopathy Checklist or an edition of the DSM diagnostic manual.

The treatment of psychopathic disorders is not so much different from other chronic mental disorders, such as schizophrenia for example. The pathogenesis of the “core defect,” if there is a single underlying defect, is neither fully understood nor curable by current therapeutic modalities. Yet with remarkable success, the more salient and disturbing symptoms of schizophrenia are treated, often with substantial improvement in overall functioning. If, instead of seeking to eliminate or overcome the “core defect” of psychopathy, treatment were to target specific troublesome cognitive, emotional, or behavioral symptoms, enough improvement might be attained to make treatment appropriate and worth the effort.

Reviewers who address the effectiveness of treating psychopathic disorders typically compare outcomes to programmatic approaches. Programs are different, psychopathic disorders vary in characteristics and severity, and follow-up treatment upon completing a given program is often lacking. Unsurprising then, studies produce apparently contradictory results, and reviews result in uncertain conclusions. After a brief summary of reviews of treatment programs, this article’s main focus is on evidence-based pharmacotherapy of the impulsive aggression of psychopathic disorders. To be noted is that outcome studies of treatment programs do not include pharmacotherapy of specific domains of psychopathy as part of the treatment and analysis of effectiveness.

The main focus here will then be on the pharmacotherapy of impulsive aggression, for which evidence-based effectiveness has been demonstrated even within the pathological context of a personality or psychopathic disorder. Whether impulsive aggression is a co-occurring condition (i.e., intermittent explosive disorder), a direct manifestation of the psychopathic disorder for which it is a diagnostic criterion, or a “domain” of the disorder may be more of a semantic or conceptual than a therapeutically practical distinction. At any rate, effective treatment ought not to be withheld because the patient also meets criteria for a psychopathic disorder, such as APD as delineated in (DSM-5) [3].

Index

2-component model for psychopathy

,

5-HT brain receptors and impulsive violence

5-HT1A brain receptor and mood disorders

5-HT1B brain receptor

and impulsive violence

and serotonin

5-HT2A brain receptor

and impulsive violence

and serotonin

5-HT3 brain receptor and dopamine levels

acute hospital settings

interventions

risk assessment for violence

addictions See substance abuse

aggression

and amygdala size

and dopamine levels in the brain

,

and psychopathy

and serotonin

Cal-VAT etiology guidelines

definitions of

intermittent explosive disorder

typology of

,

aggressive replacement therapy (ART)

agitation

and likelihood of future violence

,

Cal‐Vat

,

medications

psychopharmalogical interventions

,

rating scales for

alcohol

and 5-HT3 brain receptor

and depression

and violence risk

altruistic filicide

amisulpride

,

amygdala

and aggressive behaviors

,

and prefrontal cortex

,

and psychopathy

and schizophrenia

structural and functional studies

,

angry affect

and likelihood of future violence

,

and violence

in emotional interventions

,

anterior cingulate cortex (ACC)

and aggression

and amygdala responsivity

,

anti-impulsive aggressive agent (AIAA)

antipsychotic drugs

List of Contributors

Mario Amore
Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Genoa, Italy

Allen Azizian
Coalinga State Hospital, Coalinga, and Department of Criminology, California State University, Fresno, California, USA

Shannon M. Bader
California Department of State Hospitals, and Patton State Hospital, California, USA

Michael W. Barsom
Department of State Hospitals (DSH) – Metropolitan, Norwalk, California, USA

Nicole R. Bartholomew
Psychology Services, Federal Bureau of Prisons, Big Spring, Texas, USA

Amlan Basu
Broadmoor High Secure Hospital, West London Mental Health NHS Trust, and Institute of Psychiatry, King’s College, London, UK

Charles Broderick
California Department of State Hospitals, Sacramento, California, USA

Rosalie S. Brooman-White
Medical Sciences Division, John Radcliffe Hospital, University of Oxford, Oxford, UK

Darcy Brown
The School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK

Leslie Citrome
Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York, USA

Emil F. Coccaro
Clinical Neuroscience & Psychopharmacology Research Unit, Department of Psychiatry (MC#3077), Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA

Michael A. Cummings
Department of State Hospitals–Patton, Department of Psychiatry, Patton, California, USA; Department of Psychiatry and Human Behavior, University of California, Irvine, Orange, California, USA

Stephen E. Cummings
Department of Psychiatry, San Mateo Medical Center, San Mateo, California, USA

Pál Czobor
Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary

Laura J. Dardashti
California Department of State Hospitals, and Metropolitan State Hospital, California, USA

Mrigendra Das
Broadmoor Hospital, West London Mental Health Trust, Berkshire, amd School of Psychiatry, Oxford Deanery, Oxford, UK

Darci Delgado
California Department of State Hospitals, and Vacaville Psychiatric Program, California, USA

Sean E. Evans
Psychology Department, Department of State Hospitals, Patton, California, and Psychology Department, La Sierra University, Riverside, California, USA

Thomas Fahy
Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK

Jennifer R. Fanning
Clinical Neuroscience & Psychopharmacology Research Unit, Department of Psychiatry (MC#3077), Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA

Alan R. Felthous
Division of Forensic Psychiatry, Department of Neurology & Psychiatry, Saint Louis University School of Medicine, Saint Louis, Missouri, USA

E. Fuller Torrey
Department of Psychiatry, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland, USA; Stanley Medical Research Institute, Chevy Chase, Maryland, USA

David Goldman
Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA

Jordan H. Grafman
Rehabilitation Institute of Chicago, Chicago, Illinois, USA

Nitin Gupta
Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India

Margaret Guyer
Central Office Research Review Committee, Massachusetts Department of Mental Health, Massachusetts Mental Health Center Division of Public Psychiatry, and Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

Colin A. Hodgkinson
Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA

Brian J. Holoyda
Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, California, USA

Matthew J. Hoptman
Schizophrenia Research Division, Nathan Kline Institute for Psychiatric Research, Orangeburg, Department of Psychiatry, New York, USA, and University School of Medicine, and Department of Psychology, City University of New York, New York, USA

Deborah Horowitz
Office of Training and Development, Massachusetts Department of Mental Health, Westborough, Massachusetts, USA

James E. Hotham
Medical Sciences Division, John Radcliffe Hospital, University of Oxford, Oxford, UK

Sharon A. Humphreys
Broadmoor High Secure Hospital, West London Mental Health NHS Trust, London, UK

James L. Knoll IV
Division of Forensic Psychiatry, Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York, USA

Rebecca Kornbluh
California Department of State Hospitals, Sacramento, California, USA

Frank Krueger
Molecular Neuroscience Department, George Mason University, Fairfax, and Department of Psychology, George Mason University, Fairfax, Virginia, USA

Fintan Larkin
Broadmoor Hospital, West London Mental Health Trust, Berkshire, UK

Royce Lee
Clinical Neuroscience & Psychopharmacology Research Unit, Department of Psychiatry (MC#3077), Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA

K. Luan Phan
Department of Psychiatry, University of Illinois College of Medicine, Mental Health Service Line, Jesse Brown Veterans Administration Medical Center, and Departments of Psychology, and Anatomy and Cell Biology, University of Illinois at Chicago, Chicago, Illinois, USA

Barbara E. McDermott
Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, California, USA

Jonathan M. Meyer
Department of Psychiatry, University of California–San Diego, San Diego, California Department of State Hospitals, and Patton State Hospital, California, USA

John Monahan
School of Law, University of Virginia, Charlottesville, Virginia, USA

Robert D. Morgan
Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA

Debbi A. Morrissette
Neuroscience Education Institute, Carlsbad, California, Department of Biology, California State University, San Marcos, California, and Department of Biology, Palomar College, San Marcos, California, USA

Jennifer A. O’Day
California Department of State Hospitals, and Metropolitan State Hospital, California, USA

Mark E. Olver
Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada

Matteo Pardini
Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, and Magnetic Resonance Research Centre on Nervous System Diseases, University of Genoa, Genoa, Italy

Debra A. Pinals
Law and Psychiatry Program, Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, USA

George J. Proctor
California Department of State Hospitals, and Patton State Hospital, California, USA

Cameron D. Quanbeck
Department of Psychiatry, San Mateo Health System, San Mateo, California, USA

Vanessa Raymont
Department of Medicine, Imperial College London, London, UK

Phillip J. Resnick
Division of Forensic Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA

Jose L. Romero-Ureclay
Broadmoor Hospital, West London Mental Health Trust, Berkshire, UK

Benjamin Rose
California Department of State Hospitals, and Napa State Hospital, California, USA

Daniel R. Rosell
Department of Psychiatry, Icahn Medical School, Mount Sinai, New York, and Special Evaluation Program of Mood and Personality Disorders, Icahn Medical School, Mount Sinai, New York, USA

Callum C. Ross
Broadmoor Hospital, West London Mental Health Trust, Berkshire, UK

Kathy Sanders
Clinical and Professional Services, Massachusetts Department of Mental Health, and Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts, USA

Robert J. Schaufenbil
California Department of State Hospitals, Sacramento, California, USA

Marie Schur
California Department of State Hospitals, and Atascadero State Hospital, California, USA

Eric H. Schwartz
California Department of State Hospitals, and Vacaville Psychiatric Program, California, USA

Charles L. Scott
Division of Psychiatry and the Law, Department of Psychiatry and Behavioral Sciences, University of California–Davis School of Medicine, 5 Sacramento, California, USA

Samrat Sengupta
Broadmoor Hospital, West London Mental Health Trust, Berkshire, UK

Larry J. Siever
Department of Psychiatry, and Special Evaluation Program of Mood and Personality Disorders, Icahn Medical School, Mount Sinai, New York, and Department of Psychiatry and the VISN3 Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters VA Medical Center, Bronx, New York, USA

Patrick J. D. Simpson
Medical Sciences Division, John Radcliffe Hospital, University of Oxford, Oxford, UK

Jennifer L. Skeem
School of Social Welfare & Goldman School of Public Policy, University of California–Berkeley, Berkeley, California, USA

Stephen M. Stahl
California Department of State Hospitals, Sacramento, University of California San Diego, California, USA, and University of Cambridge, Cambridge, UK

Maren Strenziok
Department of Psychology, George Mason University, Fairfax, Virginia, USA

Katalin A. Szabo
Department of Psychiatry, San Mateo Health System, San Mateo, and Behavioral Health and Recovery Services, San Mateo, and Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA

John Tully
Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK

Richard A. Van Dorn
Research Triangle Institute International, Research Triangle Park, Durham, North Carolina, USA

Susan Velasquez
California Department of State Hospitals, and Patton State Hospital, California, USA

Morris Vinestock
Broadmoor Hospital, West London Mental Health Trust, Berkshire, UK

Jan Volavka
Department of Psychiatry, New York University School of Medicine, New York, USA

Raziya S. Wang
Behavioral Health and Recovery Services, San Mateo, California, USA

Katherine D. Warburton
California Department of State Hospitals, Sacramento, and Division of Psychiatry and the Law, University of California, Davis, California, USA

Eric M. Wassermann
Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA

Christopher L. White
Department of Psychiatry, San Mateo Health System, San Mateo, and Behavioral Health and Recovery Services, San Mateo, California, USA

Stephen C. P. Wong
Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada, School of Medicine, University of Nottingham, Nottingham, UK, and Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Australia

Violence in Psychiatry

9781316135839

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Medical Disclaimer

Table of Contents

Section 1: Statement of the problem

E. Fuller Torrey

Katherine D. Warburton

Section 2: Assessment

John Monahan and Jennifer L. Skeem

Barbara E. McDermott and Brian J. Holoyda

Charles L. Scott and Phillip J. Resnick

Katalin A. Szabo, Christopher L. White, Stephen E. Cummings, Raziya S. Wang and Cameron D. Quanbeck

Charles Broderick, Allen Azizian, Rebecca Kornbluh and Katherine D. Warburton

Knoll James L. IV

Section 3: Neurobiology

Stephen M. Stahl

Matteo Pardini, Frank Krueger, Colin A. Hodgkinson, Vanessa Raymont, Maren Strenziok, Mario Amore, Eric M. Wassermann, David Goldman and Jordan H. Grafman

Stephen M. Stahl

Michael A. Cummings

Larry J. Siever and Daniel R. Rosell

Matthew J. Hoptman

Emil F. Coccaro, Jennifer R. Fanning, K. Luan Phan and Royce Lee

Section 4: Guidelines

Stephen M. Stahl, Debbi A. Morrissette, Michael A. Cummings, Allen Azizian, Shannon M. Bader, Charles Broderick, Laura J. Dardashti, Darci Delgado, Jonathan M. Meyer, Jennifer A. O’Day, George J. Proctor, Benjamin Rose, Marie Schur, Eric H. Schwartz, Susan Velasquez and Katherine D. Warburton

Section 5: Psychopharmacology

Jan Volavka, Pál Czobor, Leslie Citrome and Richard A. Van Dorn

Darcy Brown, Fintan Larkin, Samrat Sengupta, Jose L. Romero-Ureclay, Callum C. Ross, Nitin Gupta, Morris Vinestock and Mrigendra Das

James E. Hotham, Patrick J. D. Simpson, Rosalie S. Brooman-White, Amlan Basu, Callum C. Ross, Sharon A. Humphreys, Fintan Larkin, Nitin Gupta and Mrigendra Das

Leslie Citrome and Jan Volavka

Debbi A. Morrissette and Stephen M. Stahl

Jonathan M. Meyer

Laura J. Dardashti, Eric H. Schwartz, Jennifer A. O’Day, Michael W. Barsom and George J. Proctor

Section 6: Treatment interventions

Katherine D. Warburton

Robert J. Schaufenbil, Stephen M. Stahl, Rebecca Kornbluh and Katherine D. Warburton

Shannon M. Bader and Sean E. Evans

Alan R. Felthous

Deborah Horowitz, Margaret Guyer and Kathy Sanders

Robert D. Morgan and Nicole R. Bartholomew

Debra A. Pinals

John Tully, Thomas Fahy and Fintan Larkin

Stephen C. P. Wong and Mark E. Olver

Chapter 27 The appropriateness of treating psychopathic disorders

Introduction

Index

List of Contributors