Q. I have an individual who has the diagnosis of Antisocial Personality Disorder, Narcissistic with Borderline features. The prevailing thought from the psychiatrist is that medications are of NO value. The person they said needs behavior modification with a cost response to behavior. (Symptoms - drinking urine, semen, public masturbation, and rather nasty behavior while riding the bus around the Developmental Center) Oh yes to complicate matters the individual is dually diagnosed Developmental Disabilities with psychiatric features. Any suggestions?

A. Talk about narcissism. How anyone could deny any patient an extra chance to get better is beyond me. If medications are used, the individual now has two chances to improve: medications and therapy. There is not a single reason to eliminate trying medications. The absolute worst that could happen is they will not work, and you will be no better off than currently. If the individuals behaviors are chemically driven, which is logical, denying medications guarantees that your interventions psychotherapeutically will be less adequate than they could otherwise be.