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Psychotherapy: This is the primary treatment. Long-term, intensive psychotherapy is necessary to address the underlying cognitive distortions and behavioral patterns. Modalities like Dialectical Behavior Therapy (DBT) could be useful for emotional regulation skills, while schema-focused therapy or intensive psychodynamic therapy would be required to address the core deficits in empathy and moral reasoning.
Summary: The patient presents with severe symptoms requiring urgent and intensive intervention. The recommended immediate course of action involves stabilization through targeted pharmacotherapy (likely a mood stabilizer) to manage aggression and impulsivity, in conjunction with initiating long-term, structured psychotherapy. The primary goal is to enhance safety for both the individual and the community while attempting to build foundational skills in emotional regulation and empathy.