ABSTRACT
Background and aims: Antisocial personality disorder is an enduring mental disorder associated with significant disease burden and treatment difficulties. This is apparent within forensic populations. There is growing evidence to suggest that treatment with oxytocin could have some benefit in treating a range of psychiatric disorders. There are no reviews studying the use of oxytocin for patients with ASPD. We aim to present the first literature review on the use of oxytocin in patients with ASPD. Method: We searched relevant databases for original research on effect of oxytocin upon persons with a diagnosis of ASPD or healthy participants with symptoms seen in ASPD. Studies were included if they included healthy participants that evaluated the effect of oxytocin on symptoms relevant to ASPD, including empathy, inhibitory control, compliance, conformity, aggression, violence, and moral responsibility. Results: Thirty-six studies were included. There were a range of study designs, including randomized controlled trials, double blinded, single blinded, and unblinded controlled trials. The sample sizes in studies ranged from 20 to 259 participants. Studies looked at participants with a diagnosis of ASPD and participants with symptoms relevant to ASPD, including empathy, inhibitory control, compliance, conformity, aggression, violence, and moral responsibility. Oxytocin was found to demonstrate diversified effects, in most cases being associated with socially positive or non-criminogenic behaviors. However, some studies found opposite, and non-desirable, effects, e.g., an increase in violent inclinations to partners. The two studies looking at participants with ASPD had a number of limitations and had conflicting results on the impact that OT has on aggression in ASPD. Conclusions: This is the first systematic literature review exploring the potential use of oxytocin in managing ASPD and the symptoms of ASPD. It is apparent that there is a body of evidence addressing related symptoms in healthy individuals. There were diversified effects with oxytocin showing some benefits in promoting positive effects on symptoms of ASPD, but there were also studies showing non-desirable effects. It is difficult to draw any direct inferences from healthy control studies. Further high quality large sample studies are required to explore the effects of oxytocin in those with ASPD.
ABSTRACT
BACKGROUND: Psychiatric patients are known to have poorer physical health than the general population and to have premature mortality, but the impact of institutional care on the physical health of patients is less clear. AIMS: This study aimed to compare mortality rates and causes of death between a high-security psychiatric hospital cohort and the general population in England for the periods 1920-1961 and 1972-2000. METHOD: Data were obtained from various clinical and non-clinical archives and death certificates. Standardised mortality ratios were calculated for all causes of patient death for each International Classification of Diseases, 10th Edition category. RESULTS: Mortality rates of men ever resident in Rampton Hospital were similar to those of men in the general population, but women in Rampton Hospital had nearly twice the national death rate. Younger men in the latest time period (1972-2000), however, had a higher mortality rate. Higher mortality rates in the hospital than in the general population were accounted for by infectious and parasitic diseases as well as diseases of the nervous system; rates of neoplasms and diseases of the blood and of circulatory or respiratory diseases were lower among the patients. CLINICAL IMPLICATIONS: Specific-cause mortality rates were compatible with our working hypothesis that the hospital could in some ways pose risks and in other ways be protective. Morbidity and causes of premature death may be environment-specific, so recognition of the types of illness linked to premature death among high-security hospital patients could inform improvements in the physical health of long-stay patients. Further longitudinal studies should be undertaken to monitor trends and inform changes needed to reduce premature mortality. Copyright © 2015 John Wiley & Sons, Ltd.
