Schizophrenia Bulletin Advance Access originally published online on March 30, 2006
Schizophrenia Bulletin 2006 32(4):626-636; doi:10.1093/schbul/sbj068
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Conduct Disorder and Antisocial Personality Disorder in Persons With Severe Psychiatric and Substance Use Disorders
2 Departments of Psychiatry and Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire, and the New Hampshire-Dartmouth Psychiatric Research Center, Concord and Lebanon, New Hampshire
3 Department of Psychiatry, McGill University and Douglas Hospital Research Centre, Montreal, Canada
4 Department of Psychology, University of Connecticut, Storrs, Connecticut, and Research Division of the Connecticut Department of Mental Health and Addiction Services, Hartford, Connecticut
5 Mount Sinai School of Medicine, New York, New York, and the Mental Illness Research, Education, and Clinical Center at the Department of Veterans Affairs New York Healthcare System, Bronx, New York
1To whom correspondence should be addressed; e-mail: kim.t.mueser{at}dartmouth.edu.
Conduct disorder (CD) and antisocial personality disorder (ASPD) are established risk factors for substance use disorders in both the general population and among persons with schizophrenia and other severe mental illnesses. Among clients with substance use disorders in the general population, CD and ASPD are associated with more severe problems and criminal justice involvement, but little research has examined their correlates in clients with dual disorders. To address this question, we compared the demographic, substance abuse, clinical, homelessness, sexual risk, and criminal justice characteristics of 178 dual disorder clients living in 2 urban areas between 4 groups: No CD/ASPD, CD Only, Adult ASPD Only, and Full ASPD. Clients in the Adult ASPD Only group tended to have the most severe drug abuse severity, the most extensive homelessness, and the most lifetime sexual partners, followed by the Full ASPD group, compared with the other 2 groups. However, clients with Full ASPD had the most criminal justice involvement, especially with respect to violent charges and convictions. The results suggest that a late-onset ASPD subtype may develop in clients with severe mental illness secondary to substance abuse, but that much criminal behavior in clients with dual disorders may be due to the early onset of the full ASPD syndrome in this population and not the effects of substance use disorders.
Keywords: conduct disorder / antisocial personality disorder / dual disorders / substance abuse / schizophrenia/homelessness
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