Attention Deficit Hyperactivity Disorder ADHD Is A Common Ps

Attention Deficithyperactivity Disorder Adhd Is A Common Psychiatri

Attention deficit/hyperactivity disorder (ADHD) is a common psychiatric disorder. Using American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th edition). Describe the DSM-5 criteria for ADHD diagnosis. - What is the neurobiological and the etiology of ADHD? - Your patient is taking Atomoxetine 40mg PO daily in the morning for ADHD. Atomoxetine is a nonstimulant drug used in the treatment of ADHD, how it work, what are the side effects and consideration using this treatment?

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Attention deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with functioning across multiple settings (American Psychiatric Association [APA], 2013). According to the DSM-5 criteria, diagnosing ADHD requires the presentation of symptoms prior to age 12, with symptoms persisting for at least six months and appearing in two or more settings, such as home and school (APA, 2013). The criteria specify that individuals must exhibit at least six symptoms of inattention and/or hyperactivity-impulsivity for children aged 17 and older, with at least five symptoms required for diagnosis (APA, 2013). These symptoms must cause significant impairment in social, academic, or occupational functioning.

The neurobiological underpinnings of ADHD involve dysfunction in dopaminergic and noradrenergic pathways within the brain. Key regions implicated include the prefrontal cortex, basal ganglia, and cerebellum, which are responsible for executive functions, attention regulation, and motor activity (Faraone et al., 2015). Neuroimaging studies support these findings, illustrating reduced volume and activity in these areas. The etiology of ADHD is multifactorial, involving genetic, environmental, and neurobiological factors. Genetic predisposition is significant, with heritability estimates around 70-80%, suggesting a strong hereditary component (Thapar et al., 2013). Environmental influences such as prenatal exposure to tobacco smoke, alcohol, or stress, as well as premature birth and low birth weight, are also associated with increased risk (Nigg et al., 2012).

In managing ADHD, medication is a primary treatment modality, with stimulant medications typically being first-line. However, nonstimulant options like atomoxetine are utilized, especially when stimulant medications are contraindicated or poorly tolerated. Atomoxetine (Strattera) is a selective norepinephrine reuptake inhibitor that increases norepinephrine levels in the prefrontal cortex, thereby improving attention and reducing hyperactivity (Michelson et al., 2001). It takes several weeks to achieve optimal effectiveness, distinguishing it from faster-acting stimulant medications.

Considerations when prescribing atomoxetine include monitoring for adverse effects such as gastrointestinal upset, decreased appetite, sleep disturbances, and potential increases in blood pressure and heart rate (Swanson et al., 2007). Rare but serious side effects, such as suicidal ideation, warrant careful assessment and patient education. It is also essential to evaluate hepatic function periodically, as rare cases of hepatotoxicity have been reported.

In conclusion, understanding the DSM-5 criteria, neurobiological basis, and etiology of ADHD provides a comprehensive framework for diagnosis and management. Atomoxetine offers a valuable nonstimulant alternative, with considerations that clinicians must carefully weigh to optimize treatment outcomes and monitor safety.

References

Faraone, S. V., Asherson, P., Banaschewski, T., Biederman, J., Buitelaar, J. K., Ramos-Quiroga, J. A., ... & Franke, B. (2015). Attention-deficit/hyperactivity disorder. Nature Reviews Disease Primers, 1, 15020.

Michelson, D., Allen, A., Busner, J., Faries, D., Findling, R., Mullan, M., ... & Spencer, T. (2001). Once-daily, long-acting atomoxetine treatment for children with attention deficit hyperactivity disorder. Paediatric and Perinatal Drug Therapy, 567-577.

Nigg, J. T., Johnson, M. H., & Benning, S. D. (2012). Behavioral and neurobiological perspectives on preschool ADHD. Journal of Clinical Child & Adolescent Psychology, 41(2), 196-209.

Swanson, J., Arnold, L. E., Hodgkins, P., Hechtman, L., Albert, J., & Serfax, D. (2007). Evidence-based treatments for attention-deficit/hyperactivity disorder. Current Psychiatry Reports, 9(5), 416-423.

Thapar, A., Cooper, M., Eyre, O., & Langley, K. (2013). Practitioner review: what have we learnt about the causes of ADHD? Journal of Child Psychology and Psychiatry, 54(1), 3-16.