This systematic review assesses the current state of clinical and preclinical research on panic disorder (PD) in which the carbon dioxide (CO 2 ) challenge was used as a trigger for panic attacks (PAs). A total of 95 articles published from 1984 to 2012 were selected for inclusion. Some hypotheses for PD evolved greatly due to the reproducibility of PAs in a controlled environment using the safe and noninvasive CO 2 test. The 35% CO 2 protocol was the method chosen by the majority of studies. Results of the test report specific sensitivity to hypercapnia in PD patients of the respiratory PD subtype. The CO 2 challenge helped assess the antipanic effects of medication and nonpharmaceutical approaches such as physical exercise and cognitive behavioral therapy. The test was also used in studies about the genetic component of PD, in which twins and relatives of PD patients were analyzed.

The treatment of a man who attempted suicide after experiencing symptoms of anxiety and aggressiveness associated with the use of androgenic-anabolic steroids (AAS) is described. This report includes 30 days of inpatient treatment and a 6-month follow-up. Regular use of fluoxetine apparently prevented the onset of anxiety, depression, aggressiveness, and suicide ideation, even with the concurrent use of AAS. The urinary concentration of androgens, metabolites of AAS, and fluoxetine were monitored through analysis of urinary samples by the Brazilian Laboratory of Doping Control. Our results are congruent with previous findings describing the risk of suicide prompted by AAS use as well as the efficacy of fluoxetine in the treatment of mood disorders associated with the use of anabolic steroids.

ObjectivesTo estimate the overall prevalence of androgenic-anabolic steroids (AAS) users seeking support from physicians. Secondary objectives are to compare this prevalence in different locations and among subpopulations of AAS users, and to discuss some of the factors that could have influenced the engagement of AAS users with physicians.DesignSystematic review and meta-analysis.Data sourcesMEDLINE, PsycINFO, Web of Science and SciELO were searched in January 2022.Eligibility criteriaQuantitative and qualitative studies reporting the number of AAS users who sought support from physicians, with no restrictions of language or time of publication.Data extraction and synthesisTwo independent reviewers extracted data and assessed the quality of studies, including publication bias. A random-effects meta-analysis was performed to estimate the overall prevalence of AAS users seeking support from physicians, followed by pooled prevalence rates by studies’ location and the subpopulation of AAS users.ResultsWe identified 36 studies published between 1988 and 2021, involving 10 101 AAS users. The estimated overall prevalence of AAS users seeking support from physicians is 37.12% (95% CI 29.71% to 44.52%). Higher prevalence rates were observed in studies from Australia (67.27%; 95% CI 42.29% to 87.25%) and among clients of the needle and syringe exchange programme (54.13%; 95% CI 36.41% to 71.84%). The lowest prevalence was observed among adolescent AAS users (17.27%; 95% CI 4.80% to 29.74%).ConclusionOur findings suggest that about one-third of AAS users seek support from physicians, with remarkable differences between locations and subpopulations of AAS users. Further studies should investigate the factors influencing the engagement of AAS users with physicians.PROSPERO registration numberCRD42020177919.

The use of androgenic-anabolic steroids (AAS) can be associated with psychiatric symptoms such as insomnia, anxiety and increased aggressiveness. Although dosedependent effects have been observed in some controlled studies, this association is not always seen in the ecological use of AAS. This study utilized WADA's steroid profile of suspicious use of AAS, urinary detection of AAS metabolites and measurement of sexual hormones to confirm recent use of AAS in a cohort of 103 bodybuilders (75 males, 28 females). The majority of participants (61.2%) presented symptoms of agitation, insomnia, increased aggressiveness or depression in the last 3 months. About one-third of participants presented scores on the HAM-A anxiety scale equivalent to moderate to severe symptoms of anxiety. A minority of participants (12.6%) presented high to moderate scores on the BPQ aggressiveness scale. The majority of participants (73.8%) presented hyperthymic temperament in the BRIEF-TEMPS scale.There was no significant difference in the presence of psychiatric symptoms between males and females and no association between psychiatric symptoms and estimated weekly doses of AAS. A negative association was observed between scores on the BPQ scale (verbal aggression, anger and total score) and the time of AAS use. We discuss differences of AAS use between male and female bodybuilders and the screening of AAS use in the general population. Our findings highlight the importance of mental health awareness among people using AAS.

Palavras-chaveAnabolizantes, esteroides, transtornos relacionados ao uso de substâncias. Keywords ABSTRACTThe present study reports several case studies about the use of androgenic-anabolic steroids (AAS) by patients under treatment for substance use disorder (SUD). Ten subjects were interviewed, two women and eight men, ranging from 25 to 43 years old. Regarding treatment regime, eight subjects were inpatients and two, outpatients. ASSIST-WHO and MINI-SUD scales and a semi-structured interview were used as research instruments. Seven subjects reported the use of AAS within fewer than twelve months from the interview date. Mental health professionals did not previously question none of the subjects were about the use of AAS. We discuss the efficacy of the chosen instruments to assess AAS use. RESUMOEste artigo apresenta uma série de casos relatando o uso de esteroides androgênicos anabolizantes (EAA) por pacientes em tratamento para transtorno por uso de substâncias (TUS