Pseudopsychopathy: symptoms, causes and treatment

The human brain is a complex organ that is susceptible to damage and injury. Sometimes these damages can cause alterations in the personality.

A dementia or injury to a very specific area, the prefrontal area (located in the frontal lobe), can lead to pseudopsychopathy. We are talking about an organic personality disorder whose name comes from the similarities that it can show with a psychopathy or an antisocial disorder. Do you want to know more about this clinical picture? Keep reading.

• Related article: "Psychopathy: what happens in the psychopath's mind?"

The importance of the frontal lobe

In the human brain we know that there are different lobes, each with different functions. The frontal lobe is in charge of executive functions, of planning and decision making. The prefrontal lobe is another even more specific area of ​​the frontal lobe, and it is divided into three more areas: dorsolateral, medial, and orbitofrontal.

Prefrontal lesions cause alterations in executive functions, on the work memory and in prospective memory, and can lead to pseudopsychopathy.

On the other hand, depending on the injured area, different symptoms and syndromes appear:

Dorsolateral area

His injury involves the appearance of the dysexecutive syndrome. This consists, broadly speaking, of a robotic behavior of the subject.

Medial zone

When damaged, pseudo-depression can appear. It implies the deficit of certain functions.

Orbitofrontal zone

It is associated with pseudopsychopathy. It involves the excess of certain psychological functions. We will now see in more detail what this clinical picture consists of.

Pseudopsychopathy: What Causes It?

Pseudopsychopathy can be caused by various causes:

• Head injury (TBI) with extensive medial basal injuries.
• Lesion in the orbitofrontal zone of the prefrontal lobe.
• Dementia.

Symptoms

The symptoms of pseudopsychopathy are: personality and emotional alterations, disinhibition, impulsivity, irritability, echopraxia, euphoria, hyperkinesia, impaired social judgment, death (for example, unmotivated smile), lack of emotional control, social inadequacy, obsessions, lack of responsibility, distractibility, infantilism and hyper-reactivity. In addition, criminal and addictive behaviors may appear.

In other words, pseudopsychopathy is a syndrome "of excess" and especially disinhibition, as if the rational part of the subject was annulled, and he did not have filters as to "what behaviors are appropriate at the social level."

When dementia is the cause of pseudopsychopathy, there are also two other patterns that cause two other alterations, as we will see below.

Personality alterations in patients with dementia

There are three fundamental patterns of personality alteration in patients with dementia. They are as follows.

Passive pattern - apathetic

The patient appears "inert", he shows absolute indifference to his surroundings. He is not interested in anything in the environment and shows a total absence of initiative.

Disinhibited pattern - pseudopsychopathy:

The patient is unpleasant, uninhibited, and rude. He messes with others, does not follow social norms and neglects his hygiene.

This pattern appears even in people who were previously highly polite and kind.

Celotypic pattern - paranoid ("distrustful"):

The patient becomes suspicious and paranoid. He begins to believe that his partner is unfaithful to him, that his family wants to deceive him, that everyone is against him, that they hide things from him, etc.

Treatment

To treat pseudopsychopathy, there are several alternatives. Individual and family psychotherapy, as well as a cognitive-behavioral approach together with pharmacological treatment, may be recommended options for this type of patient.

The goal with psychotherapy will be offer a climate of trust for the patient, and a space where he can express his concerns and raise his difficulties. Working the therapeutic alliance will be of vital importance.

At the pharmacological level, neuroleptics, mood stabilizers, and anticonvulsants. The results have been variable.

We must bear in mind that being patients with low self-criticism, it is likely that they acquire a certain dependence on drugs. For this reason, it is important to work on adherence to pharmacological treatment and the correct administration of the recommended dose.

Bibliographic references:

• Junqué, C. (1999). Neuropsychological sequelae of head injuries. Journal of Neurology, 28 (4), 423-429.
• Rosenweig, M., Breedlove, S., Watson, N. (2005). Psychobiology: An Introduction to Behavioral, Cognitive, and Clinical Neuroscience. Barcelona: Ariel.
• Olivera, J. (2011). Dementia and personality: a round trip. Psychiatric Information, 204 (2), 77-198.
• Quiroga, F. (2013). Common psychiatric disorders in neurological diseases. Colombian Neurological Guidelines of the Colombian Neurology Association.