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Because of the widespread opinion in the population that the use of androgenic-anabolic steroids (AAS) induce aggressiveness and violent behaviour, in 2002 the Norwegian Ministry of Justice considered suggesting to the Parliament that such use should be made illegal. However, experts disagreed upon whether any such connexion was proven. The Ministry therefore commissioned a systematic review of the scientific evidence from a group of medical doctors with experience in forensic medicine, substance abuse, anti-doping work and health technology assessment. Search strategy and study selection The bibliographic databases Medline, Embase, PsycLit, Toxline and the databases of INAHTA and the Cochrane collaboration were searched with a combination of terms signifying aggression, violence, criminal behaviour and androgenic-anabolic steroids (Appendix 1). Animal studies and case reports were excluded. Only studies published in English, German or Scandinavian languages were considered. The search was last performed in August 2003. All studies considered possibly relevant were retrieved and read independently by two group members. The studies finally included were read and discussed by all group members. Results The literature search identified 1677 articles, 146 of these (listed in Appendix 2) were retrieved in full text. All of these were registered in Medline or Embase, or both. 25 studies fulfilled the inclusion criteria, primary data from some of these studies were reported in more than one article. There were six randomized placebo-controlled studies (13-19), four other controlled studies (20-24) and fifteen observational studies (25-39). Among the latter seven were studies of the general population (25-31), three were of body-builders (32-34), two of unselected criminals from prison populations (35-36), two were of criminal users of AAS (37-38) and one of dead presumed users of AAS (39). Details of the included studies are found in the evidence tables in Appendix 4. Main conclusions1. There is good evidence that low doping doses influence the level of aggressiveness only slightly or not at all.2. There is no evidence that moderate doping doses (75-200mg AAS daily orally or 50-100mg daily as injection) increase aggressiveness.3. No studies have been done with different AAS concurrently or as repeatedly over long periods of time. The doses used in the experimental studies are far lower than doses used as doping. Accordingly, there is no evidence based on experiments of the effect of such regimens or doses.4. In the experimental studies using the highest doses there is some evidence that high doses of AAS in some individuals may trigger mania or hypomania, mental states that may include increased aggressiveness.5. In the population studies there is a clear association between the use of AAS, aggressiveness and violence (both as perpetrator and as victim). It is not clear whether there is any causal connection. In the subcultures with much use of AAS there is also more use of alcohol and illicit drugs, more high-risk behaviour and more acceptance of violent behaviour.6. There exist some case series and a number of case reports describing persons who have used AAS and performed violent acts. However, these publications are purely descriptive and do not give good evidence on causality. Summing up There is insufficient scientific evidence to decide whether there is a causal link between the use of AAS, aggressiveness and violent behaviour. On the other hand, the scientific evidence cannot disprove that such a causal link exists, especially after use of high doses of AAS by susceptible individuals.

Dangerous behavior. --- Violence.

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POLICE --- SEIZURES --- EPILEPSY --- BEHAVIOR, ADDICTIVE --- DANGEROUS BEHAVIOR --- DIAGNOSIS --- POLICE --- SEIZURES --- EPILEPSY --- BEHAVIOR, ADDICTIVE --- DANGEROUS BEHAVIOR --- DIAGNOSIS

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Violence, dangerosité et maladie mentale sont souvent associées dans l'imaginaire collectif, d'autant que nous sommes très régulièrement confrontés à des faits-divers criminels particulièrement horribles dont certains commis par des malades mentaux.Cette dangerosité a toujours fait l'objet de réflexions tant de la part des psychiatres que de la part des pouvoirs publics comme en témoignent les différentes définitions du concept, son évolution au cours du temps, et les législations successives qui ont organisé les soins.Actuellement, nous assistons à des positions plus sécuritaires et inquiétantes, probablement liées en partie à l'accroissement de l'incertitude, des crises économiques et du sentiment de menace, tant en France qu'à l'étranger. La psychiatrie, pour garder sa vocation soignante et accompagnante auprès du patient souffrant de trouble psychique, doit être compétente dans l'évaluation, et la prise en charge de l'état dangereux. Ce rapport rappelle les principales études épidémiologiques concernant le lien entre violence et trouble mental, et aborde la violence en fonction de la clinique. Il fait le point sur les principaux facteurs de risque de dangerosité, et les outils d'évaluation du risque de violence. Enfin, il expose le cadre thérapeutique et les perspectives de soins des états réputés dangereux

Dangerous Behavior. --- Mental Disorders. --- Violence. --- Dangerously mentally ill. --- Malades mentaux dangereux --- Mental Disorders --- Violence --- Insanity Defense --- Crisis Intervention --- --Maladie mentale --- --Mental Disorders --- --Dangerous Behavior. --- Maladie mentale

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SUBSTANCE DEPENDENCE --- DANGEROUS BEHAVIOR --- ACQUIRED IMMUNODEFICIENCY SYNDROME --- BEHAVIOR THERAPY --- SEX BEHAVIOR --- SYRINGES --- NEEDLE SHARING --- PEER GROUP --- PREVENTION AND CONTROL --- SUBSTANCE DEPENDENCE --- DANGEROUS BEHAVIOR --- ACQUIRED IMMUNODEFICIENCY SYNDROME --- BEHAVIOR THERAPY --- SEX BEHAVIOR --- SYRINGES --- NEEDLE SHARING --- PEER GROUP --- PREVENTION AND CONTROL

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How responsible are mentally disordered offenders for their crimes? How should those offenders deemed mentally unwell be dealt with? Aimed specifically at understanding the social context of the serious criminal offender who is deemed to be mentally abnormal, the third edition of 'Offenders, Deviants or Patients?' takes into account major changes in the law, attitudes towards responsibility and liability for crime, the updating of research findings concerning mental disorders and criminality and our procedures for managing offender-patients through the criminal justice and mental health-care systems. Illustrated by up-to-date case examples, Herschel Prins examines the relationship between abnormality and criminal behavior, the extent to which this relationship is used or misused in the criminal courts and the various facilities that are currently available for the management/incarceration of offenders/patients. Unique in its multidisciplinary approach 'Offenders, Deviant or Patients?' will be invaluable to all those who come into contact with serious offenders, as well as to those studing crime and criminal behavior.

Criminal Psychology --- Prisoners --- Crime --- Dangerous Behavior --- Forensic Psychiatry --- Mental Disorders --- Mental Health Services --- methods --- psychology --- prevention & control --- rehabilitation --- organization & administration --- Prevention & control --- Methods --- Rehabilitation --- Organization & administration --- Psychology