Pre-clinical and post-clinical process of committing to e-psychiatric treatment-an evaluation of patient perspective with emphasis on designing cost-effective longitudinal treatment.

BACKGROUND: e-Health is a branch of medicine, specializing in providing cost-effective care, using computer-based technologies. This study evaluates the patient-centered perspective on the process of committing to e-based therapies, emphasizing pre-clinical contemplation stage and post-clinical commitment to treatment stage. METHODS: We set up an online focus group. Participants (15 M, 15 F) were recruited through postings on health sites promoting e-health solutions. Each participant received login information and was asked to participate in a two-hour, moderated and recorded conversation with the principal investigator about the use of e-health solutions. RESULTS: The results stratify data into two stages of acquisition and processing information about e-health solutions: pre-clinical and clinical. In the pre-clinical stage, most patients are health information seekers, meaning that they seek to learn about e-psychiatric solutions as much as possible, comparing different treatment modalities. To accomplish this, they research health sites, discussion forums, and read review notes to evaluate the best course of action; Patients prioritize finding an easy and affordable solution that offers access to the qualified provider without the hassle of attending treatment in person. In clinical stage, patients devote time to understanding their interaction with the provider-they look whether the doctor is flexible in offering blended therapeutic approach; they will often tell the physician that they are concerned with cost of treatment, and believe that e-health solutions give them access to a dedicated provider when needed, which lowers the overhead cost of treatment. Once the patient is comfortable with his treatment planning, they establish commitment toward extended psychiatric care. CONCLUSIONS: This study evaluated how patients decide on what providers to access when seeking e-psychiatric health solutions. We show that the cost of treatment and the provider's commitment to cost-effective, flexible e-health follow-ups predicts the patient's success of remaining in treatment long-term.

Contemporary understanding of zoophilia - A multinational survey study.

INTRODUCTION: People with paraphilias have sexual interests that are unusual, including inanimate objects, places, or individuals (children, corpses). This study explores zoophiles (=PSA, people who have sex with animals) recruited from the Internet. METHOD: We administered a survey of own design via the Internet on popular discussion forums targeting the communities of PSA. All responses were quantified as the percentage of agreeing with one of the possible answer choices, plus the interpretation of qualitative data that may have been supplied in additional space. RESULTS: Survey questions were thematically categorized into four groups - worldview, personal space, sex life, and online space. PSA are remarkably self-aware of their sexuality and recognize that their behavior is illegal (even though they perceive it as an expression of love); they often relate their struggles with finding social acceptance to homosexuality, believing that one way of de-stigmatizing them would be to remove zoophilia from the list of disorders listed in the DSM. Concerning sex life, PSA believe that the quality of sex with animals is much higher than with humans, and physical features, such as the presence of a fur, can be sexually arousing to PSA, especially when seeing animals in public. PSA utilize the Internet to network and connect with other PSA; these Internet-based friendships usually do not extend beyond online conversations, given that PSA tend to be mistrustful of other zoophiles particularly in the area of personal safety. CONCLUSIONS: One of the most essential basis of zoophilia is relationship seeking behavior as well as interest in forming a long-term relationship with an animal partner.

Digital Ethnography of Zoophilia - A Multinational Mixed-Methods Study.

This study investigates people who have sex with animals (PSA) by describing their living situation, sexual activity, beliefs, and attitudes toward stigmatization. These data are highly applicable to the work of psychiatric and forensic professionals investigating paraphilias. We apply mixed-methods approach, using qualitative and quantitative analyses. The findings come from anonymous forum postings of 953 participants; of which 345 agreed to complete a survey upon advertising the study. We identify several themes, describing concerns of zoosexuals chatting within online communities: living situation; sex life; social acceptability; getting help. First, we provide data on how PSA justify their relationships with animal sex partners - with particular emphasis on sex practices and physical features most attractive to them. Second, we elaborate on the stigma associated with being a zoosexual, including the coping mechanism for dealing with social ostracism. Third, we elaborate, in detail, on why PSA find animals sexually appealing. Lastly, we present evidence that online discussion spaces serve as the platform for help-seeking behavior for individuals with paraphilias. This study presents the largest analyses of zoophiles in modern history, using mixed-methods approach, uncovering their daily activities, sexual preferences, and help-seeking behavior.

Lethal asphyxiation due to sadomasochistic sex training - How some sex partners avoid criminal responsibility even though their actions lead to someone's death.

INTRODUCTION: Erotic asphyxiation is a sexual phenomenon in which one partner reduces the other person's brain oxygen level through strangulation. This study analyzes deaths caused by sexually-motivated strangulation to cases of homicidal choking - summarizing criminal penalties for defendants, depending on the presence of drugs, or alcohol intoxication. METHODS: The mode of analysis involves three sources of data. First, a retrospective chart review of our clinics' two recent cases. Second, a meta-analysis of these materials in relationship to forensic reports obtained from prosecutor's office. Third, we examine the prevalence of death due to strangulation in erotic and non-erotic cases using central court database. Lastly, we provide the summary of interviews involving the country's only forensic unit, which investigates criminal cases involving voluntary and involuntary strangulation. RESULTS: In total, we analyzed 15 cases of sexual asphyxiation - 2 of our own; 5 reported in prosecutor's archives; 8 control cases ruled as a non-sexual homicide. The two of our clinical cases describe two victims of voluntary erotic asphyxiation, involving complex sexual environment in which a sexual partner accidentally strangulated the other one during sex. The first case describes a 30 years-old female, who required all of her past sexual partners to choke her with hands in order to reach orgasm. The second case is that of a 41 years-old homosexual male, who was still a novice to kinky play and succumbed to death as a result of being tied with a set of ropes around his neck and body. By combining findings from the analysis of our clinic's cases with 5 files obtained from prosecutor's office - we are able to compare results of these cases to controls (involving homicidal suffocation using the plastic bag). In our cases, the defendants who avoid serving prison time for strangulating in course of erotic play typically exhibit these characteristics - at the time of the killing, they were not under influence of drugs; the deceased had documented (based on witness interview, review of personal items, or medical documentation) long-standing paraphilic disorder. In controls, the likelihood of being convicted of voluntary manslaughter was lower for people who acted under the influence of drugs but higher for those under the influence of alcohol. CONCLUSIONS: These findings show that documented presence of paraphilic tendencies in the deceased might serve as grounds for not sentencing their sex partners for prison time if they acted to satisfy someone else's kinky needs.

Physicians working under the influence of alcohol: An analysis of past disciplinary proceedings and their outcomes.

INTRODUCTION: The intoxicated person may cause harm to others, often requiring expert evaluation for the determination of guilt. The primary aim of this study was to determine the mechanisms of mistakes that led 17 doctors accused of working under the influence of alcohol to face malpractice. We also wanted to clarify what were the legal, professional, and financial consequences - depending on specific patient outcomes. METHOD: We based analysis on the review and meta-analysis of the past forensic evaluation reports of institution-run forensics programs. Furthermore, we apply thematic analysis using combination of grounded theory and Pierre Bourdieu's theoretical framework. RESULTS: During the 2010-2016 timeframe, the regional forensic service opinionated on 17 physicians (3F, 14M) subjected to disciplinary action due to providing treatment under the influence of alcohol. In total, there were 157 patients potentially affected by malpractice - out of those, four were harmed; only one qualified for compensation. In the remaining 153 patients - only 11 persons reported having had awareness about the doctors' intoxication and apparent inability to perform the job, yet they agreed to receive care. Overall, in over 90% of patients, the physician did not harm anyone to a degree threatening patient's life. The supporting staff did not report experiencing distress either. The results of a blood test for the presence of alcohol were available for only four cases. Therefore, it was impossible to analyze the correlation between intoxication level and performance in providing care. All in all, in our analysis - less than 10% of 157 patients' care were compromised by provider's intoxication, either due to a mistake in diagnosis, medical procedure, or lacking communication skills. CONCLUSION: For physicians, working under the influence of alcohol is an uncommon phenomenon, but when it occurs - patients are at risk for receiving poor treatment. Presented analysis indicates that patients - just as much as supporting staff - frequently agree to receive supervision and care from a drunk doctor, despite possible harm. Therefore, it is evident that patients as much as supporting staff fear retaliation, leading to underreporting of these cases.

Similar mechanisms of traumatic rectal injuries in patients who had anal sex with animals to those who were butt-fisted by human sexual partner.

Sexual pleasure comes in various forms of physical play, for many it involves stimulation of the vagina, while the anus for others; some enjoy both. A recent report by Cappelletti et al.1 shows a meta-analysis of cases describing anal trauma due to sexual fisting in human partners. This clinical article reports four cases of males diagnosed with zoophilia, and who received anal sex from animals, resulting in injuries. Surgical and psychiatric evaluations are summarized. Unusual etiology of sexual activity with animals caused peri-anal trauma in men who engaged in anal sex with dogs and farm animals. Injuries to patients who receive anal sex from animals are mechanistically similar to fisting-induced rectal damage. Among zoophiles, the mode of harm occurs through blood-engorged, interlocked penis that causes tissue lacerations upon retraction from an anus. In people experimenting with fisting, repetitive stretching within anal canal and of external sphincter causes the internal injuries. The mode of physical stimulation explains the extent of injuries in fisters vs. zoophiles: in fisting, the pressure applied by hand is controllable proximally around and within anal sphincter, while penetration by the animal penis is unpredictable and occurs within the proximal anal canal. Forensically, the findings presented in this article describe a significant mechanism of injury in fisters versus passive zoophiles. These descriptions may aid in clinically differentiating pleasurable and pathological rectal stimulation.