Antisocial Personality Disorder.book

130 Pages·2011·0.57 MB·English

Prevention and treatment of the
antisocial personality disorder

Gezondheidsraad
Health Council of the Netherlands
To the Minister of Health, Welfare and Sport
Subject :presentation of advisory report Prevention and treatment of the
antisocial personality disorder
Your reference :GVM/2408440
Our reference :I-1627/AB/db/736-D
Enclosure(s) :1
Date :May 8, 2006
Dear Minister,
I hereby present to you the advisory report on Prevention and treatment of antisocial
personality disorder, as requested by you in a request for advice dated 30 October 2003.
The advisory report was drafted by a Committee of the Health Council of the Netherlands
and reviewed by the Standing Committee on Medicine and the Standing Committee on
Health Ethics and Health Law. In accordance with the request for advice, I have today also
submitted this advisory report to the Minister of Justice.
Psychiatric disorders that can result in disruption and damage have been the focus of
attention for some time now. This advisory report describes the scientifically proven
options for preventing an antisocial personality disorder and the care that can be provided to
people with this disorder. These options are important both for the psychiatric health of the
patients and for the safety of our society.
The Committee found few good studies on the treatment of antisocial personality disorder.
Nevertheless, there are indications that behavioural symptoms such as impulsiveness and
aggression can be decreased. The treatment of an additional addiction disorder can also
contribute to this. In practice, these options are not fully explored. The advisory report
explains how this situation can be changed. One important aspect is the reinforcement of
the cooperation between mental health care, the prison system and TBS clinics (clinics for
convicts placed under hospital orders). Developing joint guidelines for diagnosis and
treatment can form an initial step in this direction.
P.O.Box 16052 Visiting Address
NL-2500 BB The Hague Parnassusplein 5
Telephone [phone] NL-2511 VX The Hague
Telefax [phone] The Netherlands
E-mail: [email protected] www.healthcouncil.nl

Gezondheidsraad
Health Council of the Netherlands
Subject :presentation of advisory report Prevention and
treatment of the antisocial personality disorder
Our reference :I-1627/AB/db/736-D
Page :2
Date :May 8, 2006
The Committee wishes to emphasize the importance of prevention, particularly in view of
the current limitations on treatment options. In particular, the prevention and treatment of
behavioural disorders in children and adolescents can be an effective and efficient way of
preventing antisocial personality disorder at a later age. However, there is also still much
room for improvement concerning prevention in the practical setting. For example, the
expertise in the field of recognising risk situations and behavioural disorders can be
increased. Scientifically proven treatment methods should be used more often. The
development of a guideline is also important for the prevention and treatment of
behavioural disorders.
The advisory report also takes a stance for more research to support the efficacy of
interventions. The research culture in forensic psychiatry appears to require fortification,
both within a legal framework (prison system, TBS sector) and beyond (youth care, mental
health care). The Committee recommends that universities be included in the process.
I support the Committee’s recommendations.
Yours sincerely,
(signed)
Professor M. de Visser
Vice President
P.O.Box 16052 Visiting Address
NL-2500 BB The Hague Parnassusplein 5
Telephone [phone] NL-2511 VX The Hague
Telefax [phone] The Netherlands
E-mail: [email protected] www.healthcouncil.nl

Prevention and treatment of the
antisocial personality disorder
to:
the Minister of Health, Welfare and Sport
No. 2006/07E, The Hague, May 8, 2006
The Health Council of the Netherlands, established in 1902, is an independent
scientific advisory body. Its remit is “to advise the government and Parliament on
the current level of knowledge with respect to public health issues and health
(services) research...” (Section 22, Health Act).
The Health Council receives most requests for advice from the Ministers of
Health, Welfare & Sport, Infrastructure & the Environment, Social Affairs &
Employment, Economic Affairs, Agriculture & Innovation, and Education,
Culture & Science. The Council can publish advisory reports on its own
initiative. It usually does this in order to ask attention for developments or trends
that are thought to be relevant to government policy.
Most Health Council reports are prepared by multidisciplinary committees of
Dutch or, sometimes, foreign experts, appointed in a personal capacity. The
reports are available to the public.
The Health Council of the Netherlands is a member of the European
Science Advisory Network for Health (EuSANH), a network of science
advisory bodies in Europe.
The Health Council of the Netherlands is a member of the International Network
of Agencies for Health Technology Assessment (INAHTA), an international
collaboration of organisations engaged with health technology assessment.
INAHTA
This report can be downloaded from www.healthcouncil.nl.
Preferred citation:
Health Council of the Netherlands. Prevention and treatment of the antisocial
personality disorder. The Hague: Health Council of the Netherlands, 2006;
publication no. 2006/07E.
all rights reserved
ISBN: 978-90-5549-848-2
Contents
Executive summary 11
1 Introduction 17
1.1 Question 17
1.2 Methods 18
1.3 Structure of the advisory report 18
1.4 Evidence based medicine 19
2 Definition of terms, diagnosis and prevalence 21
2.1 Definition of terms 21
2.2 Diagnosis 23
2.3 Prevalence 25
2.4 Conclusion 26
3 Development and clinical course 27
3.1 Development 27
3.2 Clinical course 32
3.3 Conclusion 33
4 Prevention 35
4.1 Babies, toddlers and elementary school children 35
4.2 Adolescents 38
Contents 9
4.3 Cost-effectiveness 40
4.4 Conclusion 41
5 Treatment 43
5.1 Treatment goals 43
5.2 Data collection 44
5.3 Effectiveness of therapeutic interventions 44
5.4 Effectiveness of a prison sentence 51
5.5 Conclusion 51
6 Treatment prospects 53
6.1 Epidemiological clues 53
6.2 Theoretical perspectives 55
6.3 Conclusion 58
7 Prevention and treatment in practice 59
7.1 Prevention 59
7.2 Treatment 73
7.3 Conclusion 81
8 Conclusions and recommendations 83
8.1 Conclusions 83
8.2 Recommendations 86
References 91
Annexes 109
A The request for advice 111
B The Committee 115
C Definition of terms 117
D Prevention effect studies 123
E Treatment effect studies 125
10 Titel advies