Interpersonal violence and suicide are major health concerns, leading to premature death, extensive human suffering and staggering monetary costs. Although violent behaviour has multiple causes, it is well known that acute substance intake and abuse increase the risks of both interpersonal and self-directed violence. This association is quite well established for alcohol, while a more ambiguous literature exists for other common drugs of abuse. For example, anabolic androgenic steroids (AAS), synthetic analogues to the “male” sex hormone testosterone are suggested to elicit violent and aggressive behaviour. Two studies (I and III) in the present thesis addressed the association between AAS use and being suspected or convicted of a violent crime among remand prisoners and in a general population sample, respectively. Further, using the case-crossover design to control for confounders stable within individuals, I also investigated the triggering (short-term risk) effect of alcohol and drugs such as benzodiazepines and AAS, on violent crime (Study II). Finally, a fourth study (IV) based on a large national forensic sample of suicide completers (n=18,894) examined the risk of using a violent, more lethal, suicide method, when under acute influence of alcohol, central stimulants or cannabis. The results of this thesis suggested that AAS use in itself is not a proximal risk factor for violent crime; the observed risk is probably due to the co-occurrence of abuse of other substances. Alcohol is a strong triggering risk factor for violent crime, constant across males and females as well as individuals with or without behavioral and psychiatric vulnerability. Intake of high doses of benzodiazepines is associated with an increased risk for violent crime. Cannabis use is associated with an increased risk of using the lethal suicide method of jumping from a height. I conclude that mapping substance abuse patterns may inform violence risk assessment and treatment planning.

Orientador: Edson Luis Maistro / Banca: Mario Sergio Montovani / Banca: Luis Fernando Barbisan / Resumo: Os anabolizantes esteróides têm sido amplamente utilizados por profissionais e atletas de elite para melhorar sua aparência e habilidades atléticas. Além disso, eles apresentam um importante papel quimioterapêutico no tratamento de vários tipos de distúrbios metabólicos, homeostáticos e sexuais, em ambos os sexos. Tendo em vista que muitas drogas esteróides têm apresentado diferentes resultados considerando efeitos genotóxicos e mutagênicos, o objetivo desse trabalho foi avaliar o potencial genotóxico do hormônio nandrolona (deca-durabolin®) in vivo em células da medula óssea e do sangue periférico de camundongos, usando o teste do micronúcleo e o ensaio do cometa, respectivamente. Os animas receberam injeção intradérmica de 3 concentrações do hormônio esteróide (1.0, 2.5 e 5.0 mg/kg peso corporal). As células foram coletadas 24 h após o tratamento hormonal para o teste do micronúcleo (avaliação da clastogenicidade) e o teste do cometa (avaliação da genotoxicidade). O teste do micronúcleo evidenciou que as duas maiores doses testadas da nandrolona induziram aumentos estatisticamente significativos de células micronucleadas e o teste do cometa não evidenciou aumento significativo de danos no DNA nos linfócitos do sangue periférico. Sob estas condições experimentais, conclui-se que o hormônio esteróide nandrolona apresentou efeito clastogênico e/ou aneugênico e, por outro lado, não foram observados efeitos genotóxicos quando o mesmo foi administrado intradermicamente em camundongos / Abstract: Anabolic androgenic steroids have been widely used by professional and elite athletes to improve their appearance and athletic abilities. Besides, they have an important place in the chemotherapeutic treatment of various types of metabolic, homeostatic, and sexual disorders in both sexes. Since many steroidal drugs have been found to be different results considering genotoxic and mutagenic effects, the aim of this study was to evaluate the genotoxic potential of nandrolone (deca-durabolin®) in vivo in bone marrow and peripheral blood cells of mice, using micronucleus and comet assays, respectively. The animals received intradermal injection of the 3 concentrations of the steroid (1.0, 2.5 and 5.0 mg/kg body weight). The cells were collected 24 h after the hormone-treatment for the micronucleus (clastogenicity endpoint) and comet assays (genotoxicity endpoint). Micronucleus test showed that the two higher tested-doses of the nandrolone induced statistically significant increase of the micronucleated cells and comet assay no evidenced significant increase in the DNA damage of the lymphocytes from peripheral blood. Under our experimental conditions, the nandrolone steroid hormone showed clastogenic and/or aneugenic effects and, on the other hand, no genotoxic effects when administered intradermally to mice / Mestre

Denna studie gjordes för att undersöka anabola androgena steroider (AAS). Problemformuleringarna som ställdes syftade till att identifiera tillgängligheten hos öppenvårdsenheter enligt behandlare samt att undersöka hur behandlare arbetar med dessa klienter. Community Readiness Model, transteoretisk förändringsprocess samt transformativt lärande har använts som teoretiska utgångspunkter i syfte att uppnå förståelse för så väl det organisatoriska lärandet samt för individens förändringsprocess. En kvalitativ studie har gjorts genom semistrukturerade intervjuer med behandlare, aktiva inom öppenvården. Intervjumaterialet har kodats samt analyserats och ställts emot tidigare forskning för att slutsatser kring syfte och problemformuleringar. Faktorer som kunskapsbrist samt låg motivation har identifierats som bidragande orsaker till missbruksvårdens svårtillgänglighet. Man har sett ett behov av samverkan och kunskapsspridning som faktorer som skulle kunna öka tillgängligheten. Studien visar att vårdens motivation till förändring och arbete med denna problematik är lika viktig som klientens.

<p>Supratherapeutic doses of anabolic androgenic steroids (AASs) are administered, not only as performance-enhancing drugs in the world of sports, but also in order to modify behaviour. AAS abusers are at risk of developing serious physical and psychological side effects such as dependence and aggressive behaviour. The aim of this thesis was to investigate the impact of supratherapeutic doses of nandrolone decanoate after subchronic administration on dopamine and serotonin pathways involved in drug dependence and aggression, in the male rat brain.</p><p>Adult male Sprague-Dawley rats received intramuscular injections of nandrolone decanoate (3 or 15 mg/kg) or vehicle once daily for 14 days. Nandrolone decanoate pre-exposure abolished the effect of amphetamine on the 3,4-dihydroxyphenylacetic acid (DOPAC) tissue level in the hypothalamus and on the DOPAC/dopamine ratio in the hypothalamus and the hippocampus. A significant decrease of the basal extracellular DOPAC and homovanillic acid (HVA) levels could be detected in the nucleus accumbens, which remained low during the first hour following the amphetamine challenge. Nandrolone decanoate significantly reduced the activity of both monoamine oxidase A and B (MAO-A and -B) in the caudate putamen and amygdala. The gene transcript levels of MAO-B, and the dopamine D1 and D4 receptors were altered in limbic regions. No changes in transcriptional levels could be detected among the serotonin receptor genes examined. However, the density of the serotonin transporter protein was elevated in a range of aggression-related brain regions.</p><p>Taken together, subchronic administration of nandrolone decanoate causes dopaminergic and serotonergic dysregulations in distinct brain regions. These areas of the brain are involved in the development of drug dependence and expression of impulsive and aggressive behaviours. These results may contribute to explain some of the behavioural changes often reported in AAS abusers, such as polydrug use and impaired impulse control.</p>

Os esteróides anabólicos-androgênicos (EAA) se caracterizam como um grupo de compostos naturais e sintéticos formados a partir da testosterona e seus derivados e foram desenvolvidos com finalidade terapêutica. No entanto, a partir da década de 90 o seu uso tem sido considerado um problema de saúde pública; e o seu consumo aumentado entre atletas profissionais e amadores que usam a medicação até 100 vezes acima da dose recomendada. Os efeitos adversos mais comuns relacionados ao uso dos EAA são alterações hepáticas, endócrinas, músculo-esqueléticas, cardiovasculares, imunológicas, reprodutivas, psicológicas, efeitos virilizantes e feminilizantes; e efeitos tóxicos. Apesar de diversos efeitos deletérios, os EAA em dose e freqüência adequada podem ter efeitos benéficos no reparo de feridas, revertendo os efeitos de corticosteróides. O objetivo deste trabalho foi avaliar os efeitos de doses suprafisiológicas (10mg/semana, por 60 dias) do EAA decanoato de nandrolona em 32 ratos (Rattus norvegicus), sendo divididos igualmente para o grupo experimental e controle (8 fêmeas e 8 machos para cada grupo) através da macroscopia, microscopia e morfometria. Os resultadosmostraram que os animais do grupo controle ganharam mais peso ao final do tratamento do que os animais tratados. Os ovários e testículos apresentaram atrofiaenquanto a hipertrofia foi observada nos úteros e próstatas, com diferença de peso significativa estatisticamente em todos os órgãos entre o grupo experimental e controle. Nos testículos, a contagem do número de células de Sertoli não apresentou diferença estatística, assim como no percentual de fibras colágenas entre o grupo experimental e controle. A média da altura das células epiteliais nas próstatas dos animais tratados apresentou-se maior que as do controle. Os ovários das ratas medicadas apresentaram diminuição de corpos lúteos e folículos atrésicos. Os resultados encontrados indicam que as altas doses do EAA decanoato de nandrolona causam alterações macroscópicas e morfológicas nos sistemas reprodutores de machos e fêmeas, podendo ser irreversíveis. O efeito benéfico do uso de EAA na síntese de colágeno não foi observado nos fragmentos de gengiva analisados. / The anabolic-androgenic steroids (AAS) are characterized as a group of natural and synthetic compounds formed from testosterone and derivatives, and have been developed for therapeutic purposes. However, after the 1990s, their utilization has been considered a public health problem and the intake increased among professional and amateur athletes, who ingest up to 100 times the recommended dose of the drug. The most common adverse effects related to utilization of AAS are hepatic, endocrine, muscle-skeletal, cardiovascular, immunological, reproductive and psychological alterations; masculinizing and feminizing effects; and toxic effects. Despite the several harmful effects, utilization of AAS at adequate dose and frequency may have beneficial effects on wound repair, reverting the effects of corticosteroids. This study evaluated the effects of supraphysiological doses (10mg/week, for 60 days) of the AAS nandrolone decanoate in 32 rats (Rattus norvegicus), equally divided into experimental and control groups (8 females and 8 males for each group), by macroscopic, microscopic and morphometric analyses. The results revealed that animals in the control group gained more weight at treatment completion than treated animals. The ovaries and testicles presented atrophy, and hypertrophy of uterus and prostates was observed, with statistically significant difference in weight in all organs between the experimental and control groups. In the testicles, counting of the number of Sertoli cells and the percentage of collagen fibers did not present statistically significant difference between the experimental and control groups. The mean height of epithelial cells in the prostates of treated animals was greater in treated animals than in the control group. The ovaries of treated rats exhibited reduction in corpora lutea and atresic follicles. The results indicated that high doses of AAS nandrolone decanoate caused macroscopic and morphological alterations in the reproductive systems of males and females, which may be irreversible. The beneficial effect of utilization of AAS on the collagen synthesis was not observed on gingival fragments analyzed

Os esteróides anabólicos-androgênicos (EAA) se caracterizam como um grupo de compostos naturais e sintéticos formados a partir da testosterona e seus derivados e foram desenvolvidos com finalidade terapêutica. No entanto, a partir da década de 90 o seu uso tem sido considerado um problema de saúde pública; e o seu consumo aumentado entre atletas profissionais e amadores que usam a medicação até 100 vezes acima da dose recomendada. Os efeitos adversos mais comuns relacionados ao uso dos EAA são alterações hepáticas, endócrinas, músculo-esqueléticas, cardiovasculares, imunológicas, reprodutivas, psicológicas, efeitos virilizantes e feminilizantes; e efeitos tóxicos. Apesar de diversos efeitos deletérios, os EAA em dose e freqüência adequada podem ter efeitos benéficos no reparo de feridas, revertendo os efeitos de corticosteróides. O objetivo deste trabalho foi avaliar os efeitos de doses suprafisiológicas (10mg/semana, por 60 dias) do EAA decanoato de nandrolona em 32 ratos (Rattus norvegicus), sendo divididos igualmente para o grupo experimental e controle (8 fêmeas e 8 machos para cada grupo) através da macroscopia, microscopia e morfometria. Os resultadosmostraram que os animais do grupo controle ganharam mais peso ao final do tratamento do que os animais tratados. Os ovários e testículos apresentaram atrofiaenquanto a hipertrofia foi observada nos úteros e próstatas, com diferença de peso significativa estatisticamente em todos os órgãos entre o grupo experimental e controle. Nos testículos, a contagem do número de células de Sertoli não apresentou diferença estatística, assim como no percentual de fibras colágenas entre o grupo experimental e controle. A média da altura das células epiteliais nas próstatas dos animais tratados apresentou-se maior que as do controle. Os ovários das ratas medicadas apresentaram diminuição de corpos lúteos e folículos atrésicos. Os resultados encontrados indicam que as altas doses do EAA decanoato de nandrolona causam alterações macroscópicas e morfológicas nos sistemas reprodutores de machos e fêmeas, podendo ser irreversíveis. O efeito benéfico do uso de EAA na síntese de colágeno não foi observado nos fragmentos de gengiva analisados. / The anabolic-androgenic steroids (AAS) are characterized as a group of natural and synthetic compounds formed from testosterone and derivatives, and have been developed for therapeutic purposes. However, after the 1990s, their utilization has been considered a public health problem and the intake increased among professional and amateur athletes, who ingest up to 100 times the recommended dose of the drug. The most common adverse effects related to utilization of AAS are hepatic, endocrine, muscle-skeletal, cardiovascular, immunological, reproductive and psychological alterations; masculinizing and feminizing effects; and toxic effects. Despite the several harmful effects, utilization of AAS at adequate dose and frequency may have beneficial effects on wound repair, reverting the effects of corticosteroids. This study evaluated the effects of supraphysiological doses (10mg/week, for 60 days) of the AAS nandrolone decanoate in 32 rats (Rattus norvegicus), equally divided into experimental and control groups (8 females and 8 males for each group), by macroscopic, microscopic and morphometric analyses. The results revealed that animals in the control group gained more weight at treatment completion than treated animals. The ovaries and testicles presented atrophy, and hypertrophy of uterus and prostates was observed, with statistically significant difference in weight in all organs between the experimental and control groups. In the testicles, counting of the number of Sertoli cells and the percentage of collagen fibers did not present statistically significant difference between the experimental and control groups. The mean height of epithelial cells in the prostates of treated animals was greater in treated animals than in the control group. The ovaries of treated rats exhibited reduction in corpora lutea and atresic follicles. The results indicated that high doses of AAS nandrolone decanoate caused macroscopic and morphological alterations in the reproductive systems of males and females, which may be irreversible. The beneficial effect of utilization of AAS on the collagen synthesis was not observed on gingival fragments analyzed

<p>Stem cells have the capacity for both self renewal, and to form all cell types in the body. Interestingly, so called neural stem cells (NSCs) are found in the adult human brain, which is of significance both out of a developmental perspective and from a clinical point of view. At the present moment, the regulation of neural stem cell (NSC) proliferation and fate determination is not completely understood.</p><p>The overall aim of this thesis was to study the mechanisms that regulate NSC proliferation and fate determination <i>in vitro</i> and <i>in vivo</i>. In particular, the roles of the female sex hormone estrogen and the testosterone analogue nandrolone, as well as the melanocortin α-melanocyte stimulating hormone (α-MSH), were analyzed in this context. Also, the breast cancer susceptibility gene one (BRCA-1), was studied in the brain with emphasis on regions containing NSCs.</p><p>Our findings show that estrogen and nandrolone have similar effects on NSCs; both decreased NSC proliferation and increased neurogenesis. Estrogen's ability to reduce proliferation was due to increased levels of p21, an inhibitor of cyclin dependent kinases. In contrast, no change in p21 was observed in the case of nandrolone, indicating differential regulation. Adult rats subjected to nandrolone injections had 30% reduced NSC proliferation in the dentate gyrus, indicating profound effects on NSCs <i>in vivo</i>.</p><p>The melanocortin α-MSH acted as a mitogen by increasing levels of cyclinD1 and retinoblastoma protein; as a result NSC proliferation was doubled.</p><p>Finally, BRCA-1 is expressed while NSCs proliferate, but is drastically down regulated upon differentiation, indicating that BRCA-1 could be used as a possible NSC marker.</p><p>In summary, in this thesis estrogen and nandrolone were identified as NSC regulators which decrease proliferation and positively influence neurogenesis. Also, we have identified the hormone α-MSH as a NSC mitogen, and BRCA-1 as a possible NSC marker.</p>

Stem cells have the capacity for both self renewal, and to form all cell types in the body. Interestingly, so called neural stem cells (NSCs) are found in the adult human brain, which is of significance both out of a developmental perspective and from a clinical point of view. At the present moment, the regulation of neural stem cell (NSC) proliferation and fate determination is not completely understood. The overall aim of this thesis was to study the mechanisms that regulate NSC proliferation and fate determination in vitro and in vivo. In particular, the roles of the female sex hormone estrogen and the testosterone analogue nandrolone, as well as the melanocortin α-melanocyte stimulating hormone (α-MSH), were analyzed in this context. Also, the breast cancer susceptibility gene one (BRCA-1), was studied in the brain with emphasis on regions containing NSCs. Our findings show that estrogen and nandrolone have similar effects on NSCs; both decreased NSC proliferation and increased neurogenesis. Estrogen's ability to reduce proliferation was due to increased levels of p21, an inhibitor of cyclin dependent kinases. In contrast, no change in p21 was observed in the case of nandrolone, indicating differential regulation. Adult rats subjected to nandrolone injections had 30% reduced NSC proliferation in the dentate gyrus, indicating profound effects on NSCs in vivo. The melanocortin α-MSH acted as a mitogen by increasing levels of cyclinD1 and retinoblastoma protein; as a result NSC proliferation was doubled. Finally, BRCA-1 is expressed while NSCs proliferate, but is drastically down regulated upon differentiation, indicating that BRCA-1 could be used as a possible NSC marker. In summary, in this thesis estrogen and nandrolone were identified as NSC regulators which decrease proliferation and positively influence neurogenesis. Also, we have identified the hormone α-MSH as a NSC mitogen, and BRCA-1 as a possible NSC marker.

Supratherapeutic doses of anabolic androgenic steroids (AASs) are administered, not only as performance-enhancing drugs in the world of sports, but also in order to modify behaviour. AAS abusers are at risk of developing serious physical and psychological side effects such as dependence and aggressive behaviour. The aim of this thesis was to investigate the impact of supratherapeutic doses of nandrolone decanoate after subchronic administration on dopamine and serotonin pathways involved in drug dependence and aggression, in the male rat brain. Adult male Sprague-Dawley rats received intramuscular injections of nandrolone decanoate (3 or 15 mg/kg) or vehicle once daily for 14 days. Nandrolone decanoate pre-exposure abolished the effect of amphetamine on the 3,4-dihydroxyphenylacetic acid (DOPAC) tissue level in the hypothalamus and on the DOPAC/dopamine ratio in the hypothalamus and the hippocampus. A significant decrease of the basal extracellular DOPAC and homovanillic acid (HVA) levels could be detected in the nucleus accumbens, which remained low during the first hour following the amphetamine challenge. Nandrolone decanoate significantly reduced the activity of both monoamine oxidase A and B (MAO-A and -B) in the caudate putamen and amygdala. The gene transcript levels of MAO-B, and the dopamine D1 and D4 receptors were altered in limbic regions. No changes in transcriptional levels could be detected among the serotonin receptor genes examined. However, the density of the serotonin transporter protein was elevated in a range of aggression-related brain regions. Taken together, subchronic administration of nandrolone decanoate causes dopaminergic and serotonergic dysregulations in distinct brain regions. These areas of the brain are involved in the development of drug dependence and expression of impulsive and aggressive behaviours. These results may contribute to explain some of the behavioural changes often reported in AAS abusers, such as polydrug use and impaired impulse control.

This is a study about gym training young men (age 18-20) and their attitude against anabolic androgenic steroids, AAS. In our study we examine if the muscular ideal in our society have any effect on young men and the young men’s attitude against their body and their training. We want to find out what attitude gym training young men have against AAS, and also what has had the influence to this attitude.          The study contains six qualitative performed interviews with young men who are training at the gym, which are based on relevant information about their training habits, nutritional supplement, influence, the muscular ideal, the gym culture and medias effect on young men when it comes to body ideals.            The young men’s attitudes is connected and compared to prior research about gym-training young men and what affects them to have a certain attitude against AAS, body and training. In our study we also use a theory by Giddens about social interaction and the late modern society we live in.           The conclusions of the result and analysis is that young men who trains at the gym for the purpose of getting bigger and in relation to the training takes nutritional supplements, have a more liberal attitude against AAS compared to those young men who doesn’t. Media, friends, equals at the gym and the gym culture are all factors that affect young men in their positive attitude in opposition to AAS.