From an antisocial personality to severe psychopathy

From an antisocial personality to severe psychopathy. Generally, these patients are diagnosed based on 'antisocial personality' criteria. However, these are insufficient to evaluate the degree of severity. Hare has established a list of psychopathic symptoms on a scale of I to 3. Subjects who obtain 30 out of 40 are considered to have 'antisocial personalities with severe psychopathy'. Criminal psychopaths are not receptive to treatment and some treatment can even increase their chances of recidivism. The therapeutic setting must have a certain capacity and indispensable security measures to insure a treatment without risk to the personnel. These patients feel little anguish or attachment. They systematically degrade others and find a sadistic pleasure in making others suffer, physically or psychologically. They have internalised few moral values. The clinician must critically study the various reactions that the psychopath triggers in the therapist. Among the various possible therapies, medication can reduce aggressiveness and violence. Family therapies or those involving the patient's environment are to be discussed on a case-by-case basis. Psycho-dynamical conceptions are very useful in helping the clinician understand the role of the unconscious factors at play. In conclusion, rules of caution, a patient and respectful clinic,cooperation with the family, mastery of counter-transference, a prolonged treatment and a very active supervision of therapeutic relationships allow the improvement of the prognostic and the reduction of relapses and recidivism. (C) 2001 Editions scientifiques et medicales Elsevier SAS.