AD/HD and criminality: Differential diagnostic and therapetic/prophylactic aspects (A general literature study and a description of Norwegian challeges in the field) 774
Хартвиг П., PhD, психиатр, старший научный сотрудник Центра исследований и образования в области судебной психиатрии Университетcкого госпиталя г. Осло, Осло, Норвегия, email@example.com
The impact of AD/HD (Attention Deficit/Hyperactivity Disorder) as a background factor for criminal activity is under discussion, both in the society and among professionals within psychiatry/psychology and other medical disciplines. A central topic in the discussion is whether a useful reduction of such activity can be reached by pharmacological treatment of the disorder. Studies of relevant international literature, mainly through the last 15 years have been made in the Medline/PubMed databases by combination of the terms AD/HD, and ASPD (Antisocial Personality Disorder). Additional literature has also been gathered. The main focus has been on young adult persons and upwards in age, much less on childhood and early adolescence. The literature shows that adult AD/HD and ASPD show distinctly common features, but also definite differences, both in clinical and neuro-physiological/-chemical respects. A priori, a pharmacological treatment of well diagnosed adult AD/HD, even in co-morbidity with ASPD, might be beneficial. Mostly used are the central stimulants methylphenidate and dexamphetamine, but atomoxetine, related to modern antidepressants, has also been introduced and validated. In Norway there has been an initial optimism leading to many, and at times weakly grounded, attempts to treat imprisoned or paroled persons with central stimulants. The results have been varying and often disappointing. This process and a current opinion on state of the art of such treatment will be described in the last part of the article.
Through later years, the Norwegian and international media
have had many contributions regarding the possible causal effect from AD/HD
(Attention Deficit/Hyperactivity Disorder) on criminal behaviour, and there
seems to be uncertainty and partly disagreement among professionals in the
psychiatric field regarding to which degree this is a fact. On this background
the author has performed studies of relevant recent and older scientific
literature, which will be displayed and given reflections to. Only a limited
part of the studied literature will be referred specifically. The main focus in
the article is AD/HD among adults from young age and upwards; references to
studies in child and early youth ages are less focused.
There is both a qualitative and quantitative difference in
the occurrence of adult AD/HD in men and women. Trans-nationally, prevalence in
men of 4.1 and 2,7 % in women has been reported . Prevalence and
characteristics of the disorder in the population of female prisoners (in
Norway 5 % of the imprisoned) is an interesting research challenge, but the
gender aspect will be treated only to a small extent in this article.
Interested readers are referred to a recent German study on this aspect .
The core in the literature search has been associations between AD/HD and
Antisocial Personality Disorder (ASPD). These terms and others following in the
article are chosen from the American psychiatric diagnostic system DSM-IV ,
because this is most often used in international research connections. The
official diagnostic system in Norway and many other countries, ICD-10 , has
related, but not identical names for the corresponding diagnostic groups.
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