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Sub-anesthetic ketamine infusions may benefit a range of psychiatric conditions, including alcohol and cocaine use disorders. Currently, there are no effective pharmacological treatments for cannabis use disorder.The objective of this uncontrolled proof of concept trial was to test the feasibility, tolerability, and potential therapeutic effects of integrating ketamine infusions with a behavioral platform of motivational enhancement therapy and mindfulness-based relapse prevention in treating cannabis use disorder (CUD).Eight cannabis-dependent individuals (four female, four male) receiving motivational enhancement therapy and mindfulness-based relapse prevention behavioral treatments completed this single-blind outpatient 6-week study. Participants received either one or two infusions of ketamine (0.71 mg/kg [infusion 1]; 1.41 mg/kg [infusion 2] for non-responders) during the study. Participants self-reported cannabis use (Timeline Follow-Back) and underwent an assessment of confidence in abstaining from using cannabis (Drug-Taking Confidence Questionnaire) at predetermined time points throughout the study.Ketamine infusions were well-tolerated and there were no adverse events. Frequency of cannabis use decreased significantly from baseline (B = 5.1, s.e = 0.7) to the week following the first infusion (B = 0.8, s.e = 0.412), and remained reduced at the end of the study (B = 0.5, s.e = 0.3). Participants' confidence in their ability to abstain from cannabis in potentially triggering situations increased significantly from baseline to the end of study.These findings suggest that combining ketamine with behavioral therapy is feasible,tolerable, and potentially helpful, in treating cannabis-dependent individuals.

In violent crime cases, aggravating factors in United States criminal codes, such as “heinous,” “atrocious,” or “depraved,” are used to distinguish elements of the crime warranting more severe sentencing. These aggravating terms are vaguely defined and applied arbitrarily in violent cases. This paper details the development of a 25 item Depravity Standard to operationalize an evidence-based approach to distinguishing the worst of violent crimes. The items were applied to 393 detailed case files drawn from several American jurisdictions to develop and refine the item definitions, determine interrater reliability, and mine for the frequency of each item’s occurrence. This information was combined with 1,590 participant responses ranking the relative depravity of each item to develop a straightforward scoring system for measuring depravity in violent cases. The Depravity Standard guide can seamlessly be applied to identify the worst violent crimes, and provide support for those cases that may deserve leniency or early-release.

BACKGROUND AND AIMS Stimulant drug users have a greater prevalence of risky driving behaviour. This study aimed to assess how far this association remains after adjusting for aggressiveness. DESIGN Cross-sectional interview study assessing associations between measures of risky driving behaviours as outcomes, measures of stimulant drug use as predictors and a measure of aggressiveness as a covariate. SETTING United States. PARTICIPANTS Data were drawn from wave 3 (2012-13) of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC-III) (n = 36 309 aged ≥ 18 years). MEASUREMENTS Stimulant drug use, past-year DSM-5 stimulant use disorder, aggression and measures of risky driving were assessed using face-to-face interviews conducted using the Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS-5) and the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). FINDINGS Overall, 2714 (8.3%) respondents indicated life-time stimulant use, and 112 (0.3%) met criteria for past-year DSM-5 stimulant use disorder. More than 10% of ongoing stimulant users and one-third of respondents with DSM-5 stimulant use disorder reported stimulant-specific driving under the influence of drugs (DUID) in the past-year (both P

The relationship between amphetamine use and aggressive or violent behaviour is unclear. This review examined laboratory data collected in humans, who were administered an acute dose of amphetamine or methamphetamine, in order to investigate the link between amphetamines and aggression. It is registered with PROSPERO (CRD42019127711). Included in the analysis are data from twenty-eight studies. Behavioural and/or subjective measures of aggression were assessed in one thousand and sixty-nine research participants, with limited amphetamine-use histories, following a single amphetamine dose (0-35 mg). The available published evidence indicates that neither amphetamine nor methamphetamine acutely increased aggression as assessed by traditional laboratory measures. Future research should assess supratherapeutic amphetamine doses as well as include a broader range of multiple aggression measures, facilitating simultaneous assessment of the various components that comprise this complex, multifaceted construct.

Fifteen cases of Fetal Abduction by Maternal Evisceration (FAMAE) reported to the National Center for Missing and Exploited Children during 1987-2011 outline the findings from a review of the forensic psychiatric considerations and legal course of each of the cases. Most offenders confessed to law enforcement within a short time of being placed under arrest in statements reflecting a continued effort to manage impressions and minimize culpability. Psychiatric assessment is invariably central to the legal disposition of FAMAE cases, as the defendant's goal is to diminish the perception of culpability/criminal responsibility and mitigate sentencing. Of those sentenced in the United States, nine defendants received life without parole, two received the death penalty (one executed), and one received a minimum of 30 years. Two abductors committed suicide and were not sentenced. Proffered diagnoses at trial included psychogenic amnesia, pseudocyesis, dissociative disorder, and delusional disorder; however, these rarely stood up to court scrutiny. Psychiatric experts showed the greatest variance in diagnosis over what to call the feigned pregnancy. In addition to delusional disorder and dissociative disorder, pseudocyesis, factitious disorder/pregnancy, pseudopregnancy, schizophrenia, and PTSD were among the various diagnoses proposed. A differential diagnosis for many FAMAE offenders may also include borderline personality disorder. Future research accounting for those women claiming false pregnancy who do not become homicidal will clarify whether FAMAE is the extreme endpoint of a fertility identity disorder.

Purpose Criminal law distinguishes aggravating factors such as “heinous,” “atrocious,” “cruel” (HAC) or “depraved” as features of a crime that warrant more severe sentencing. This review examines whether these aggravators are fairly applied, and how they can be refined to best serve justice. Methods and results Current HAC statutes, and appellate state and Supreme Court cases, were comprehensively reviewed to determine how these statutes are interpreted and applied. The review revealed discrepancies in definitions across states, and descriptions that were often vague and would potentially lead to inconsistent application. These shortcomings highlight a need for evidence-based definitions that guide inexperienced jurors, provide judges and juries with a fair and consistent process for making such decisions, are easily applied to a range of case fact-patterns, and are informed by elements of depraved crime that society deems relevant. Conclusions HAC aggravators, despite efforts to refine them in response to court rulings, do not prevent impressionistic conclusions affected by bias. These aggravators remain vulnerable to arbitrary application. A Depravity Standard informed by a reference point of felony cases and public input would assist the trier of fact to assess depravity in crime in accordance with societal standards, and improve the fairness of sentencing.

Purpose The Depravity Standard is an evidence-based guide developed to operationalize an approach to distinguish the worst of crimes in a consistent manner that minimizes bias. This phase of the research was designed to validate the Depravity Standard items and develop a scoring mechanism. Methods and results Inter-rater reliability was performed by two groups of trained raters, with each of the 25 Depravity Standard items finding high agreement. To distinguish the relative severity of each item as they may occur in a murder case, an online public survey was devised. U.S. participants (n = 1273) rated each item on a scale of 1–100 (100 = most depraved). The items were then applied to 770 case files of adjudicated murder convictions to establish content validity. 582 cases were retained for further analysis, and merged with survey data to establish a percentile scoring system. Conclusions The Depravity Standard is validated for application to murder cases to inform the presence or absence of the 25 items of depravity. It enables assessment of relative depravity of a perpetrator's intent, victim choice, actions, and attitudes. Application of the Depravity Standard relies on evidence, minimizes bias and prejudice, and promotes fairness in sentencing and release decisions.

Purpose Aggravating factors in United States criminal codes, such as “heinous,” “atrocious,” “cruel,” “vile,” or “depraved,” distinguish elements of a crime that warrant more severe sentencing. These terms remain vaguely defined and arbitrarily applied. The Depravity Standard research was designed to develop a measure of societal standards for what elements make a crime depraved. Methods and results Thematic analysis of over 100 appellate court decisions deliberating depravity in crime was performed. Additional input drew from 91 professionals and students in forensic disciplines. 26 items reflecting depravity emerged for further study. Next, a survey of U.S. participants (n = 25,096) was conducted to gauge public consensus for depravity in these items. All items received majority support for being somewhat or especially depraved (69.5%–99.1% agreement). A final set of items was then applied to 770 murder cases to refine the definitions and qualifying and disqualifying examples for each item. Conclusions Case data from 770 murder cases informed the development of a Depravity Standard of 25 items with detailed examples of the intent, actions, victim choice, and attitudes, distinct to what society endorses as the worst of crimes. The items draw content validity from validation studies using actual cases provided by U.S. jurisdictions.

Objective Fetal abduction by maternal evisceration (FAMAE) cases are statistically rare but warrant closer scrutiny as planned homicides. This study reports lessons regarding abductor modus operandi, motivation, intent, planning, and the dynamics in the attack to inform public safety. Methods The fifteen FAMAE cases reported to the National Center for Missing and Exploited Children from 1987 to 2011 were reviewed. Court documents for the cases were retrieved, and investigators and attorneys were called to verify information where necessary. Results All abductors were female, between 19 and 40 years of age. Seven stages of the structure of the crime were identified: targeting and making contact with a pregnant woman, securing weapons, determining the location, subduing the mother, securing the newborn, disposing of the victim mother’s body, and informing others that they birthed a child. Conclusion The case histories analyzed demonstrate how FAMAE perpetrators target an unsuspecting pregnant woman, and entrap and murder her in the service of fetal kidnapping. Awareness of FAMAE promotes public safety from those who would do anything to claim they have borne a child.