Although reduced by 2 points). These results

Although there has been limited research on the use of clozapine to treat antisocial personality disorder, in the last few years, it has been researched on and being used to treat ASPD and improve their symptoms associated with the disorder. In a study done by Brown et al. (2014), researchers studied the treatment of clozapine on antisocial personality disorder on seven patients with ASPD and high psychopathic traits, as well as having a significant history of serious violence. The researchers concluded the patients with ASPD that were taking the clozapine medication showed remarkable signs of improvement (Brown et al., 2014). The clozapine was able to reduce all symptom domains of ASPD especially impulsive behavioral dyscontrol and anger. The number of violent incidents committed by the patients was reduced significantly (Brown et al., 2014). One patient, in particular, was in 22 violent incidents 90 days prior to their use of clozapine, and zero violent incidents in the most recent 90 days on clozapine. Furthermore, to display the patients’ results and improvements, the patients each took a Clinical Global Impression (CGI) test before and after using the clozapine treatment. 1 of the 7 patients had a CGI score that exhibited “vast improvement” (CGI reduced by 4 points), 1 showed “major improvement” (CGI reduced by 3 points), and the 5 other patients displayed “significant improvement” (CGI reduced by 2 points). These results signify that each patient’s severity of illness decreased notably. Also, the researcher explains about improvements in other symptom domains including:  6 of the 7 patients showed improvement in the cognitive-perceptual domain. All of the patients showed improvement in impulsive-behavioral dyscontrol. All patients showed improvement in some aspect of affective dysregulation; specifically, 4 showed improved symptoms of low mood, 5 in anxiety, all demonstrated improved anger control, and 6 of the 7 improved mood lability (Brown, 2014). These improvements definitely display the positive effects of clozapine on patients with antisocial personality disorder by benefiting all symptom domains. This case study is the first to show the effects of clozapine on patients with antisocial personality disorder, but there have been more studies since of its beneficial use. The researchers of the study took the step to use an already beneficial treatment to treat another disorder that they believed would reduce the symptoms, which led to a new way to treat those who are diagnosed with antisocial personality disorder. As there is a limited number of effective treatment for ASPD, this type of research leads to new ways to treat this disorder. It can be seen in this case study, the clozapine treatment was effective and had benefited the ASPD patients, if clozapine is used for many others that are diagnosed with the disorder, it may benefit them too.  Another drug that is used to treat antisocial personality disorder specifically the symptom of aggression, is lithium carbonate. The medication is a mood stabilizer and is mainly used to treat bipolar disorder (DrugBank, 2017). Lithium works by dispersing in the central nervous system and interacting with certain neurotransmitters and receptors, which include decreasing norepinephrine release and increasing serotonin synthesis. Lithium is commonly used for psychopathic patients because of its ability to reduce impulsive and emotionally unstable behaviours (Lee, 2017). A study done by Sheard et al. (1976) looked at the effect of lithium on aggressive behaviour. The researchers conducted a double-blind study where 66 prisoners were each given either the lithium medication or a placebo. The patients received the medication for up to three months. The researchers concluded that, “there was a significant reduction in aggressive behavior in the lithium group as measured by a decrease in infractions involving violence” (Sheard, 1976). The researchers also believe that lithium as medication has a very beneficial effect for impulsive aggressive behaviour and that lithium may be the closest to being a medication specifically for the control of aggressive outbursts in patients with personality disorders (Sheard, 1976). This may mean that people who suffer from aggression and impulsive behaviour which is commonly associated with antisocial personality disorder can use this medication as a way to diminish the symptoms. In another double-blind study done by Malone et al. (2000), lithium showed a beneficial effect on aggressive children with conduct disorder. The subjects were hospitalized because of severe and chronic aggression. Each patient was randomly given either the lithium medication or a placebo to reduce any bias. The patients received the medication (or placebo) for four weeks. The researchers concluded that the, “Lithium was statistically and clinically superior to placebo” (Malone et al., 2000). Using a scale specifically for the measure of aggression, the ratings for the patients using lithium on the Overt Aggression Scale decreased significantly versus the patients using the placebo. There are aversive effects like most drugs, the lithium caused side effects to the patients including nausea, and vomiting; although many may believe the side effects outweigh the consequences of aggression and impulsive behaviour. If the patient is willing to experience these side effects, the lithium medication can be seen as an effective and safe treatment for reducing some symptoms of antisocial personality disorder specifically aggressive behaviour. However, there are not only drugs that are effective in the treatment of ASPD. There are also therapeutic treatments available. This paper will look at some of the therapeutic treatments that have been proven effective specifically mentalization-based treatment, impulsive lifestyle counselling, and multisystemic therapy.   To begin with, mentalization-based therapy (MBT) is a type of psychodynamically-oriented psychotherapy mainly designed for people with borderline personality disorder (BPD) (Grohol, 2016). It is used to improve the capacity to make sense of others and the patient’s self. This specific therapy has been proven very effective for people with BPD by reducing severe self-harm and suicide attempts (Bateman et al., 2009). Although, it has been proven effective for comorbid ASPD by a study done by Bateman et al. (2009). The study was done to actually study if mentalization-based therapy is more effective than structured clinical management (SCM) for patients with comorbid ASPD and BPD. Forty patients were randomized to one of the two treatment programs, with 21 participating in MBT and 19 in SCM. The patients receiving MBT participated in 18 months of weekly combined individual and group sessions. The results of the study show that MBT was able to reduce symptoms of ASPD including the number of suicide attempts, self-harm, anger, and hostility (Bateman et al., 2009). In particular, after eighteen months, zero percent of the patients presented suicide attempts, while before treatment, 90.48 % (19 out of 21 patients) presented suicide attempts. The researchers also noted that MBT was able to reduce negative mood, general psychiatric symptoms, interpersonal problems, and social adjustment (Bateman et al., 2009). From this case study, it can be seen the benefits of mentalization-based therapy for people with antisocial personality disorder as it reduced many symptoms of the disorder and symptoms of other mental disorders associated with ASPD such as depression and anxiety. Since many ASPD patients do not get any treatment for their disorder, it is better that they get this therapeutic treatment than nothing at all even though it may not get rid of the disorder all together as it does reduce many symptoms. Another type of psychological intervention used to treat ASPD is psychoeducation. Psychoeducation is used to help people understand the condition they have been diagnosed with and how it affects themselves and others (GoodTherapy.org, 2016). In a study done by Thylstrup et al. (2015), they examined the effectiveness of psychoeducation for ASPD. Specifically, they found the program, Impulsive Lifestyle Counselling (ILC) to have an impact on substance use for patients with ASPD (Thylstrup, 2015). The purpose of the intervention is to “…support the patient in awareness raising, in recognizing the opportunity to change lifestyle and in taking responsibility for addressing behavioral problems.” In the study, 142 patients were each randomly chosen to either ILC or to receive their treatment as usual (TAU). Those included in the results were 64 assigned to TAU and 78 to ILC. The results show that patients randomized to the ILC group reported 4.3 more days abstinent at the three month follow-up than the TAU group (Thylstrup, 2015). Also, the ILC had less severe drug use as it can be seen in these results: The ILC group reduced their drug use composite score by a small effect size at 3 months (SMD?=?0.23, p?=?0.042) and at 9 months (SMD?=?0.42, p?=?0.000). The TAU group increased their drug use composite score by a small effect size at 3 months (SMD?=??0.12, ns) and reduced it by a small effect size at 9 months (SMD?=?0.27, p?=?0.001) (Thylstrup, 2015). The ILC program was able to have a short-term impact on substance use for these patients with substance use disorders as well as ASPD. It can be seen that this therapeutic intervention is effective as the program requires minimal training of clinicians, but still has an impact on substance use. As many people with ASPD do not get treatment for their behavioural problems, many get help for their drinking and drug problems (Thylstrup, 2015). This program can be an effective treatment for those suffering from ASPD that also have a substance use problem. The last form of therapy that this paper will discuss is multisystemic therapy (MST). Multisystemic treatment addresses systemic factors such as family and school that contribute to problematic behaviour as well as individual ones. MST is delivered in the family’s home and community to allow natural settings to be present. MST has been proven to be effective in a few case studies, this paper will discuss a case study done by Ogden et al. (2004). The purposes of the study were to examine the effectiveness of MST outside of the United States of America and to see if the findings replicated those obtained by MST’s developers. The patients were 100 adolescents and their families in Norway who received MST because of their very serious antisocial behaviour. The 100 patients were randomly assigned to MST or usual Child Welfare Services (CS) which resulted in 62 families being assigned to MST and 38 families to CS. The main significant result from the study was that the, “… youth in the MST condition demonstrated a significantly greater decrease in internalising behaviour and a marginally significantly greater decrease in externalising behaviour post treatment than did their CS counterparts ” (Ogden et al, 2004).,  Other results include that the MST patients displayed a remarkable increase in social competence and family cohesion. The researchers summarized and believed that MST was more effective than the CS. Another important observation from the case study was that the families receiving MST were more satisfied with their treatment than those receiving CS (Ogden et al, 2004). It is notable that the patients are enjoying receiving the treatment and not feel forced as that may make them more aggressive. The outcomes of the study suggest that multisystemic treatment is effective in treating those with antisocial behaviour. In conclusion, it can be seen that there are effective treatments in both drug and therapeutic form available for patients with ASPD. Clozapine, an effective antipsychotic used mainly to reduce symptoms in schizophrenia have shown remarkable efficacy for patients with ASPD. The mood stabilizer, lithium was effective at reducing aggression and impulsive behaviour, two very common symptoms of ASPD. The therapeutic intervention of mentalization-based treatment was efficient at reducing hostility and self-harm while impulsive lifestyle counselling was effective at having an impact on substance use. The last treatment examined in this paper was multisystemic therapy, this treatment was significant at decreasing internalized and externalized behaviours associated with ASPD.  Indeed, this paper has discussed efficient treatments, though, the disorder still needs to be researched more on as ASPD is a very serious disorder that many still do not look in to. Hopefully, as more research is done, more effective treatments will be available. Also, it is not only important that there are effective treatments, but that ASPD patients actually get treated. As many ASPD patients do not believe they have a disorder and need to be treated, family members and friends must know how to spot warning signs. If they think someone is at-risk at developing ASPD, they should make sure that this person gets intervention as soon as possible.