Antisocial Personality Disorder Subscale (Chinese Version) of the Structured Clinical Interview for the DSM-IV Axis II Disorders: Validation Study in Cantonese-Speaking Hong Kong Chinese

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Violence, according to the Cambridge Advanced Learner's Dictionary, is defined as "actions or words which are intended to hurt people". Antisocial personality disorder (ASPD) is described by the DSM-IV-TR as a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood and persists through adulthood. (1) Many studies have found that patients with mental disorders, especially those with a diagnosis of ASPD, are more likely to be engaged in aggressive acts. (2-6) A study in Finland indicated that while schizophrenia increased the odds ratio of homicidal violence by approximately 8-fold in men and 6.5-fold in women, ASPD increased the odds ratio by over 10-fold in men and over 50-fold in women. (7) The prevalence of any personality disorder in self-reported violent incidents in Britain over a 5-year period was reported to be 29%, while ASPD was reported to be 4 times more likely to result in injury to a victim compared with other personality disorders. (8) Moreover, ASPD further triples the risk of violence in an individual intoxicated with alcohol or drugs. (8) Individuals with ASPD demonstrated strong association with injury in victims including family, partner, known persons, strangers and police, etc, and their violence was shown to be repetitive in terms of incidents and different victims. (9)

Cluster B personality disorders, including ASPD, are associated with an increased risk of early institutional care, criminal conviction, and imprisonment. This cluster of personality disorder is positively correlated with functional psychosis, affective/anxiety disorder, and alcohol dependence. (4) Antisocial personality disorder itself was significantly associated with poor treatment outcome and persistent alcohol, cannabis, and nicotine use disorders. (10)

The relationship between ASPD and criminal conviction was reconfirmed in another large-scale review undertaken by Fazel and Danesh in 2002. (11) This systematic review of 62 surveys involving 22,790 prisoners suggested that compared with the general American or British population of similar age, prisoners have about a 2- to 4-fold excess of psychotic illness or major depression, and about a 10-fold excess of ASPD. (11)

It is believed that the rate of ASPD fluctuates significantly across different settings. Epidemiological studies in western countries identified an ASPD prevalence between 0.6 and 3.6% in community samples, (12) 3.6% among psychiatric outpatients, (13) from 3.5 to 18.2% in psychiatric inpatients, (14,15) and as high as 78% and 50% among male and female prisoners, respectively in England and Wales. (16) This disorder is 4 to 5 times more common in men than in women. (2,17)

Antisocial personality disorder is a relatively under-researched topic among the Chinese population. From the limited available data, great variability in its prevalence across different settings is observed. While the prevalence was 0.3% in a community sample in Taiwan, (18) and 0.2 to 0.8% in a group of psychiatric outpatients in Shanghai, (19) another study identified 14% of patients attending a psychological counselling centre in Shanghai as having ASPD. (20) In a mass screening for personality disorders in South China, 67% of 2961 prison inmates were identified as having ASPD. (21)

In Hong Kong, a priority follow-up (PFU) system was established in 1982 aiming to facilitate close monitoring of patients with mental disorders with a propensity to violence or a record of criminal violence. Whereas patients with minimal violent propensity would be allocated into the non-PFU group, attending psychiatrists would categorise patients with a risk of violence into either the target group or sub-target (PFU-ST) group, according to the level of propensity to violence. Patients considered as posing a lower risk of violence or who had committed less serious offences previously were categorised into the target group. …


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