Incurable psychopaths?

Treatment, comprising pharmacotherapy and an educational program based on cognitive behavior therapy, of four psychopathic, criminal men fulfilling the criteria for borderline personality disorder and antisocial personality disorder is described. The diagnoses were made during a forensic psychiatric evaluation. An estimation of the capacity of the central serotonergic system was performed by analysing the platelet monoamine oxidase (MAO) activity. The pharmacotherapy was combined with an educational program involving strategies for developing better impulse control. All four men had earlier been regarded as resistant to conventional therapy. In the present cases, a combined psychosocial and biological approach seemed to be effective in developing an increased control of impulses, leading to improved coping strategies. Controlled studies are needed in order to clarify whether the described treatment program proves beneficial.