Pratap Narayan, MD, a forensic psychiatrist with extensive experience in the criminal justice system joins Lorry in this episode to talk about dealing with psychopathic patients. He currently lives and works in California. Originally from India, Dr. Narayan migrated to the US early in his career and completed fellowships in Forensic Psychiatry and Psychiatric Research.

Psychopath is a common label for persons with a serious antisocial personality disorder that includes lack of conscience or empathy, general disregard for others, and above average intelligence. Prisoners are ten times as likely to have an antisocial personality disorder as the general population. So, correctional nurses need to understand how to recognize and respond to these conditions. Characteristics of those with antisocial personality disorder include:

• superficial charm
• self-centered & self-important
• need for stimulation & prone to boredom
• deceptive behavior & lying
• conning & manipulative
• little remorse or guilt
• shallow emotional response
• callous with a lack of empathy
• living off others or predatory attitude
• poor self-control
• promiscuous sexual behavior
• early behavioral problems
• lack of realistic long-term goals
• impulsive lifestyle
• irresponsible behavior
• blaming others for their actions
• short term relationships

Nurses, in a natural role as care provider, can easily be drawn into the manipulative behaviors of this patient population. Dr. Narayan provides helpful guidance to remain psychologically safe while working in correctional settings. Key points for remaining balanced in the nurse-patient relationship include:

• Watch for warning signs of a risky relationship such as personal questions and inappropriate requests.
• Rely on institutional policies when dealing with every patient.
• Be aware of licensure practice and standards of care. Seek to meet the standards and stay within the boundaries of licensure.

Have you dealt with psychopaths in your correctional nursing practice? Share your experiences in the comments section of this post.