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Psycology » Psychiatry and psychotherapy » Personality disorder » Cerebral pathology and the development of the central nervous system

People with antisocial personality type is so different from normal and are so similar in their behavior in some patients who have had a brain injury, it has been suggested that an organic causes. Convincing direct evidence to link the development of antisocial personality in adult life with brain injury in children is not available. But there is a hypothesis that antisocial behavior in childhood may be caused by minor degrees of brain damage (minimal brain dysfunction), and obtained data linking antisocial behavior in childhood with antisocial personality type in adult life. Taken together, these observations could provide indirect evidence of the connection between brain damage in childhood and antisocial personality type in adult life. However, along with the presence of sufficiently strong evidence to support the continuity between behavioral problems in childhood and antisocial personality type in adult life (see Chap. 20, subsection on prognosis of mental disorders in children), there is only weak evidence in favor of the assumption that minimal brain dysfunction is the cause of behavioral disorders in childhood (see the appropriate section in Sec. 20).
Related account of the views is the view that antisocial personality disorder may be a result of a delay in brain development. Electroencephalographic abnormalities corresponding delays ripening, have been found in people with antisocial personality type. For example, NS (1952) as a result of uncontrolled survey targeted 194 antisocial and aggressive subjects, none of whom suffered from epilepsy, found three types of anomalies, all of which could be caused by defects of maturation. The most commonly encountered a bilateral predominance of slow waves (tetaaktivnost) and hearths 3-5 cycles per second activity in the posterior temporal areas. Both types of anomalies were mostly bilaterally, in the case prtivnom more prevalent on the right side. Deviations were less common in older subjects. Williams (1969) confirmed these data in the study of 333 people convicted of serious crimes, of which 206 were usually aggressive, and about 127 were aware that they had only once observed aggressive outbursts, usually provoked. After exclusion of subjects suffering from mental retardation, epilepsy or previously suffered a head injury, the deviations in the EEG were recorded in 57% of individuals from the group habitually aggressive compared to only 12% of those with sporadic outbursts of aggression. Deviations often detected in perednevisochnoy area. Williams suggested that this may indicate a primary disorder in the reticular activating system or limbic structures. He came to the conclusion that a violation of the physiological processes in the brain plays an important role in the development of dangerous propensity to aggressive behavior as a predisposing factor, although sporadic outbreaks usually triggered by environmental factors.
The idea that repeated aggressive behavior, especially in the absence of adequate provocation, may be partly due to brain damage, was further developed by Bachy-Rita et al. (1971), who described Syndrome episodic diskontrolya. They saw it as a disorder that has more than one organic cause, and in the initial group included some patients with epilepsy. Later Maletzky (1973) in his study conducted study 22 men, excluding those who have had symptoms of epilepsy, pathological intoxication, schizophrenia, or acute drug reaction. All subjects observed pattern of behavior with occasional outbreaks of violence described Bachy-Rita et al., And 14 of them have caused serious injury to the victim (often a family member), and five committed murder. After the attacks of aggression frequently noted aura, headache and drowsiness; 12 surveyed reported amnesia for this period. The frequency of these episodes varied from one to several per day per year, averaging four month. Alcohol, even in small amounts, increases the likelihood of an attack, and the authors suggested that such an action could have and benzodiazepines. We surveyed marked soft neurological signs, 14 people have registered on the EEG deviations (usually in the temporal areas). Subsequent prolonged observation has been conducted, but on the basis of clinical experience, the author suggests that the syndrome may soften with age. Maletzky also reported dramatic improvements during treatment with phenytoin (phenytoin), but since there was no control group receiving a placebo, an objective assessment of these data is not possible. It remains unclear whether the syndrome episodic diskontrolya independent nosological unit or only represents a small group of patients with undiagnosed epilepsy combined with unusually aggressive personality.


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