Anabolic androgenic steroids and violence : a medicolegal and experimental study
Author: Thiblin, Ingemar
Date: 1999-05-28
Location: Rättsmedicinska enhetens föreläsningssal, Karolinska Institutet
Time: 9.00
Department: Institutionen för onkologi-patologi / Department of Oncology-Pathology
Abstract
Non-medical use of anabolic androgenic steroids (AAS) has been linked to
various psychological and behavioural complications in case and survey
reports. Judging from these reports, the symptoms most consistently
associated with AAS use are extreme irritability, increased
aggressiveness and mood swings. There are also a limited number of
reports connecting AAS-associated aggressivity with violent acts
including homicide, while reports of self-injurious behaviour associated
with use of AAS are extremely rare.
With the objective to evaluate the possible role of AAS-related
behavioural changes for outwardly or self-directed violence, violent acts
committed by AAS users and premature death among users of AAS, were
studied by reviewing autopsy and police reports, court records, forensic
psychiatric evaluations and medical records. In a subset of AAS-using
suicide victims further information was gained by means of psychological
autopsy, i.e. semi-structured interviews with survivors. Hypotheses
regarding the effects of AAS on mental processes brought out by
observations in the medicolegal studies were tested in experimental
animal studies.
Different patterns of violence were associated with different phases of
AAS use that in turn were associated with specific patterns of
psychological changes. Mood swings, impulsive aggression with violent
outbursts resulting in violence towards other persons - including
homicide - or damage of property were associated with current use of AAS
in subjects with a history of prolonged AAS use. The same phase of AAS
use was also associated with homicidal death, impulsive suicide and death
from impulsive intake of high amounts of analgesics in combination with
benzodiazepines and/or alcohol without a clear suicidal intent. A mental
state dominated by depressive symptoms, suicide with high suicidal intent
and execution-like homicides in response to perceived humiliation were
associated with AAS abstinence. Hypomania-like symptoms and planned
criminal activity were associated with short-time intake of AAS.
In most but not all cases in which a detailed background history was
obtained, pre-existing psychopathology and/or abuse of other psychotropic
drugs was reported. Acute influence of pharmaceuticals/illicit drugs
and/or alcohol was also prevalent. In eight cases a mixed substance abuse
was established after the use of AAS commenced.
Administration of AAS at low doses resulted in a reduction of vigilance
and fear in rats. High-dose treatment of AAS resulted in alterations in
dopaminergic, serotonergic and cholinergic systems suggestive of
increased neuronal activity in brain areas regulating mood, emotion and
motivation. The observations in the present study indicate that long-term
use of AAS may aggravate pre-existing and possibly may precipitate new
psychiatric symptoms to a degree of severe outwardly directed violence,
completed suicide or lethal mixed substance abuse. The sporadic use of
AAS by criminals suggests that early effects of AAS on mental processes
may involve reduction of anxiety and/or enhancement of antagonism. The
observations of early central stimulatory effects of AAS gain support
from the experimental studies showing a reduction of vigilance and fear
and increased dopaminergic and serotonergic activity in limbic structures
in AAS-treated rats. The observed shift from early hypomania-like
symptoms in early AAS career towards symptoms characterised by impulsive
aggression, mood swings, and depression in later career, together with
the experimentally demonstrated effects on neurotransmission, suggests
that stimulatory effects of AAS may later fatigue central systems
regulating mood, emotion and motivation.
Issue date: 1999-05-07
Publication year: 1999
ISBN: 91-628-3495-9
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