Malpractice and Other Civil Liability in Psychedelic Psychiatry.

Psychedelics have the ability to fundamentally alter the consciousness of individuals who take them and thus pose unique legal risks for psychiatrists interested in incorporating them into their practice. Several issues related to malpractice may be relevant, including absence of standards of care, risk of harm, inappropriate treatment, and the doctrine of respondeat superior. In addition to malpractice, psychiatrists should be aware of other potential civil claims, including battery and the intentional or negligent infliction of emotional distress. Before providing psychedelic treatments to patients, psychiatrists should understand and mitigate their risk of malpractice and other civil claims.

Bestiality Law in the United States: Evolving Legislation with Scientific Limitations.

Societies have proscribed bestiality, or sex between humans and nonhuman animals, since the earliest recorded legal codes. In the early American colonies, religious prohibitions against bestiality provided the grounds for punishing those who engaged in such acts. In the 1800's, Henry Bergh imported the animal welfare approach to the United States, which modernized the legislative treatment of animals in the country. Until recently, however, many laws in the U.S. have been outdated and vague and have utilized moralistic terminology. Since the 1960's, a growing body of literature has developed suggesting that individuals who harm animals may also interpersonally offend. This concept, known as the Link, has served as a major motivation for advocates to promote new legislation criminalizing bestiality, to modernize old state statutes, and to expand penalties for individuals convicted of having sex with animals. Unfortunately, data supporting the Link between bestiality and interpersonal violence are limited and of questionable generalizability to the broad public. The Link's weaknesses can assist in guiding further research. This article summarizes the history of bestiality law, the current state of bestiality legislation in the United States, the body of Link-related literature on bestiality and interpersonal violence and other problematic sexual behaviors, and the empirical weaknesses and needs revealed by this legislation.

Animal maltreatment law: Evolving efforts to protect animals and their forensic mental health implications.

Animals have long formed an important part of human communities and served various roles in human activities. Some of the earliest human civilizations developed laws that protected animals for assorted reasons, including their economic value, religious beliefs pertaining to animals, and societal concerns about cleanliness. In the 1800s, Western thinkers began to view animals as having rights of their own and proposed legislation that changed the legal landscape regarding animal maltreatment. In the United States today there are widely varying laws designed to address the various forms of animal maltreatment. Each state's laws are different. Some states have modern statutes designed to identify and punish animal maltreatment, and others are relatively lax in their consideration of what constitutes abuse. The purpose of this article is to review the development of animal maltreatment legislation from ancient civilization to the present day in the United States; to identify current legislative reforms designed to assist in investigating and prosecuting animal abusers; to describe the role that forensic mental health experts may play in evaluating abusers for a variety of related concerns, including violence risk, sexual violence risk, and fitness for guardianship of an animal; and to delineate areas requiring further research to improve the forensic evaluation of animal abusers.

Improving adherence to antiretroviral therapy for youth living with HIV/AIDS: a pilot study using personalized, interactive, daily text message reminders.

BACKGROUND: For youth living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), nonadherence to antiretroviral therapy (ART) can lead to poor health outcomes and significantly decreased life expectancy. OBJECTIVE: To evaluate the feasability, acceptability, and preliminary efficacy of short message service (SMS) or text message reminders to improve adherence to ART for youth living with HIV/AIDS. METHODS: We conducted this prospective pilot study using a pre-post design from 2009 to 2010 at a community-based health center providing clinical services to youth living with HIV/AIDS. Eligibility criteria included HIV-positive serostatus, age 14-29 years, use of a personal cell phone, English-speaking, and being on ART with documented poor adherence. During the 24-week study period, participants received personalized daily SMS reminders and a follow-up message 1 hour later assessing whether they took the medication, and asking participants to respond via text message with the number 1 if they took the medication and 2 if they did not. Outcome measures were feasibility, acceptability, and adherence. Self-reported adherence was determined using the visual analog scale (VAS) and AIDS Clinical Trial Group (ACTG) questionnaire 4-day recall. Viral load and CD4 cell count were followed as biomarkers of adherence and disease progression at 0, 12, and 24 weeks. RESULTS: Participants (N = 25) were mean age 23 (range 14-29) years, 92% (n = 23) male, 60% (n = 15) black, and 84% (n = 21) infected through unprotected sex. Mean VAS scores significantly increased at 12 and 24 weeks in comparison with baseline (week 0: 74.7, week 12: 93.3, P < .001; week 24: 93.1, P < .001). ACTG questionnaire 4-day recall also improved (week 0: 2.33, week 12: 3.24, P = .002; week 24: 3.19, P = .005). There was no significant difference in CD4 cell count or viral load between baseline and 12- or 24-week follow-up, although there was a trend toward improvement of these biomarkers and a small to moderate standardized effect size (range of Cohen d: -0.51 to 0.22). Of 25 participants, 21 (84%) were retained, and 20 of the 21 (95%) participants who completed the study found the intervention helpful to avoid missing doses. CONCLUSIONS: In this pilot study, personalized, interactive, daily SMS reminders were feasible and acceptable, and they significantly improved self-reported adherence. Larger controlled studies are needed to determine the impact of this intervention on ART adherence and other related health outcomes for youth living with HIV/AIDS.