A Cochrane review [Abstract] 1 included 8 RCTs with a total of 394 participants with antisocial personality disorder (AsPD). Data were available from 4 studies with 274 participants with AsPD. No study recruited only patients with AsPD, and only one study consisted only of AsPD patients. A total of 97% of patients were males. Eight different drugs were compared with placebo in 8 trials: antiepileptics (carbamazepine, phenytoin, valproate), antidepressants (desipramine, nortriptyline), dopamine agonists (bromocriptine, amantadine) and opioid antagonists (naltrexone). The duration of the interventions ranged between 6 and 24 weeks, none of the studies followed the patients after the intervention period. Primary and secondary outcomes were varied. All the available data were derived from unreplicated single reports. Only 3 drugs were effective compared to placebo in improving at least one outcome. Nortriptyline was reported in one study (n=20) as superior for men with alcohol dependency on mean number of drinking days and on alcohol dependence (p<0.05), but not for severity of alcohol misuse or on the patient's or clinician's rating of drinking. In the same study, both nortriptyline and bromocriptine were reported as superior on anxiety on one scale (Beck Anxiety Inventory, p<0.05), but not on another (anxiety subscale of the Symptom Check List-90). In one study, phenytoin was reported as superior on the frequency and intensity of aggressive acts (p<0.01) in male prisoners with impulsive aggression (n=30). In the remaining 2 studies, amantadine and desipramine were not superior for adults with opioid and cocaine dependence, and desipramine was not superior for men with cocaine dependence.
Comment: The quality of the evidence is downgraded by study quality (unclear allocation concealment, lack of blinding), inconsistency (heterogeneity in patients and outcomes), imprecise results (limited study size for each comparison) and indirectness of evidence (differences in studied patients).
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