Introduction

Drug therapy of antisocial behavior has yielded limited and inconsistent benefits in the past, but recent advances in diagnosis, neurophysiology, and neuropharmacology now offer considerable promise. Antisocial behavior syndromes are developmentally complex and composed of heterogeneous symptoms. Knowledge of the underlying neurophysiological and neurochemical processes has been limited, so that drug treatment for one target symptom has often led to a worsening of other parts of the clinical picture. Clinical drug trials have been carried out mainly with highly heterogeneous patient populations, so that results have usually been difficult to interpret and to replicate. Recent advances that will be described here make it possible now to specify drug-responsive target symptoms and more homogeneous clinical subgroups and to approach drug choice with rational guidance from knowledge of how to match the neuropharmacological properties of drugs with what is known about the neurochemical and neurophysiological basis of the target symptoms.

Despite optimism about recent advances, two points must be emphasized. First, antisocial behavior is developmentally complex with many different genetic and environmental determinants (1–6), so drugs are always merely an adjunct in a comprehensive treatment program. Second, all available treatment recommendations must be considered preliminary and tentative until long-term, double-blind, controlled trials are conducted that take into account available knowledge. Nevertheless, the recommended diagnostic and treatment procedures should both help clinicians refine their treatment strategy and stimulate further research in this important and challenging area.