We think about ways to continuously improve our Psychiatry Consultation service and one of them is to have a weekly case conference, the Clinical Problems in Consultation Psychiatry (CPCP). It’s our quality improvement process to emphasize the core competency of Practice-Based Learning and Improvement. We pick an interesting and challenging situation that leads to a question which can be answered by looking at the medical literature for guidance, either from recent reviews or controlled studies. It gives us a chance to bring our knowledge base and skill set up to speed. Usually a resident or medical student picks the case and formulates a question, then does quick PubMed literature search.
This is a Clinical Problems in Consultation Psychiatry (CPCP) presentation by 3rd year medical student, Christine Petersen, who happens to be interested in pursuing a residency in surgery. Her presentation was about oxytocin and antisocial personality disorder. No studies have been done testing the effect of intranasal oxytocin on persons with ASPD. This presentation covered some basic background and other studies which may have implications about the question of what effects intranasal oxytocin might have on healthy volunteers appraisal of victims of crime as compared to their appraisal of the perpetrators of crime. This post is a companion to the post on 11/1/2012 on treating alcohol withdrawal with intranasal oxytocin.
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-Pair Bonding and attachment formation result in long-lasting attachment to one individuals compared to others -Peer recognition and social memory are the ability to remember an individual previously encountered -Social approach is the willingness to make contact with new individuals Evidence points to the conclusion that the social effects of oxytocin are often moderated by either contextual factors determined by features of the situation in which oxytocin is administered or by stable characteristics of the individuals to whom oxytocin is administered.
Benzodiazepines should not be used because of their abuse potential and because they may lead to behavioral dyscontrol.
Not only does is antisocial PD characterized by behaviors that oxytocin has been shown to modify – research has found that individuals with antisocial PD more commonly have variant forms of the oxytocin receptor gene. RMET – images of the eye region of faces are presented, and participants are asked to identify the emotion from this information.
Patients with Antisocial PD typically described as having a lack of empathy
Inclusionary criteria were that participants had to be males between the ages of 18 and 30 years, in good health, and able to understand the informed consent as assessed by the study physician. Participants were excluded if they had evidence of medical or psychiatric disorder that would compromise study participation, current or past history of drug or alcohol abuse or dependence, a history of hypersensitivity to OXT or vehicle, presence of or history of clinically significant allergic rhinitis, smoked more than 10 cigarettes per day and had experiences of any trauma involving either injury or threat of injury to themselves or a close family/friend member or of being a victim of or having witnessed a violent crime. There were also controls consisting of self-reported questionnaires concerning empathy, altruism, attachment styles, personality styles, anxiety, and affect. Events in the vignettes varied from low severity (such as theft) to high severity (kidnapping, rape, murder).
The ANCOVA revealed a significant covariate effect on ratings for empathic concern [F(1,37) = 5.46, P < 0.05]. Other covariates measured include: fantasy, attachment styles, personal distress, perspective taking, agreeableness, conscientiousness, neuroticism, openness, altruism, and belief about treatment conditions. Even after adjusting for this covariate effect, it was found that the oxytocin had an effect on ratings.
Rating (adjusted means ± s.e.m.) for criminal offenses: The oxytocin (OXT) group compared to the placebo (PLA) group produced significantly higher harm ratings for the victim but not for deserved punishment of the offender.