Psychopaths are incapable of feeling empathy and guilt, being responsible for most violent crimes. To date, confinement has been the option of choice to minimize the harm they inflict. However, a deeper understanding of the neurobiology of psychopathy may lead to new insight on possible treatment approaches.

This work aims to review the current knowledge in psychopathy treatment.

A literature search of MEDLINE (2000-present) was conducted using the search terms “psychopathy” + “treatment” and “drug therapy”.

Defects in the amygdala and the prefrontal cortex have been implicated in the pathological basis of psychopathy. The most affected areas are the ventromedial prefrontal cortex (VMPC) and the associated anterior cingulated cortex. Alterations in connectivity between the amygdala and the VMPC with other areas of the brain have been demonstrated and seem to be responsible for the non-empathetic, unemotional, and amoral features of psychopaths. Also, they present an increase in dopamine turnover and metabolism and a serotonin dysregulation.

As not all individuals with the biological substrate for psychopathy become violent, it seems that plasticity in forebrain circuits may allow the development of more prosocial responses, especially in youth. Some authors emphasize the need to address other behaviours that can be responsible for violent actions, namely, impulsive aggression. Some drugs have shown efficacy in controlling impulsive aggression.

Pharmacological approaches to treating psychopathy have been disappointing. A more reasonable goal would be to focus on impulsive aggression, for which treatment effectiveness has been demonstrated. Additional research is needed if we hope to design rational therapeutic strategies for this disorder.

The authors have not supplied their declaration of competing interest.