Pharmacological interventions for antisocial personality disorder

This review updates a previous Cochrane Review published in 2010. The objectives were to assess the benefits and adverse effects of pharmacological interventions for adults with antisocial personality disorder (AsPD).

The review authors searched for randomised controlled trials comparing a pharmacological intervention with placebo up to September 2019.

They included 11 studies (three of which were new to this update), involving 416 adults, mostly (90%) male (mean age = 39.6 years), with AsPD. Most studies (10/11) were conducted in North America. Data were available from only four studies involving 274 participants with AsPD.

The review authors found very low-certainty evidence that phenytoin may reduce the mean frequency of aggressive acts per week in male prisoners with aggression (1 RCT, n = 60) compared to placebo. However, they found no evidence of a difference between placebo and:

  • phenytoin for the number of participants reporting the adverse event of nausea (1 RCT, n = 60);
  • desipramine for mean social functioning scores (1 RCT, n = 29);
  • nortriptyline for mean global state/functioning scores (1 RCT, n = 20); and
  • bromocriptine for mean global state/functioning scores (1 RCT, n = 18). In this last study, 12 patients given bromocriptine experienced severe side effects, five of whom dropped out of the study in the first two days due to nausea and severe flu-like symptoms. All very low-certainty evidence. 

All of the evidence comes from single studies, with methodological issues that limit confidence in the results.

The review authors concluded that there is insufficient evidence to draw any conclusions about the use of pharmacological interventions in the treatment of AsPD.

Read the full review on the Cochrane Library.