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?

Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that is characterized by symptoms of inattention, hyperactivity, and impulsivity. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is widely used by clinicians and researchers for diagnosing psychiatric disorders, including ADHD.

According to the DSM-5 criteria, the diagnosis of ADHD requires the presence of the following symptoms: persistent patterns of inattention and/or hyperactivity-impulsivity that interfere with functioning or development. These symptoms must be present in more than one setting (e.g., at home, school, work) and must be present before the age of 12. The symptoms should also be observed for at least six months and be inconsistent with the individual’s developmental level.

In terms of inattention, the DSM-5 lists symptoms such as difficulty paying attention to details, making careless mistakes, trouble sustaining attention in tasks, difficulty listening, difficulty organizing tasks, and often being forgetful. Hyperactivity symptoms include fidgeting or squirming, leaving one’s seat in situations where sitting is expected, excessive running or climbing, difficulty playing or engaging in activities quietly, talking excessively, and blurting out answers before the questions have been completed. Impulsivity symptoms include difficulty awaiting turn, frequently interrupting or intruding on others, and blurting out answers impulsively.

The neurobiology of ADHD is complex and not fully understood. However, several lines of evidence suggest that both genetic and environmental factors contribute to the etiology of the disorder. Studies have shown that there is a genetic component to ADHD, with heritability estimates ranging from 60-90%. Several genes have been associated with ADHD, including those involved in the dopaminergic and noradrenergic systems. These neurotransmitter systems are thought to play a role in regulating attention and impulse control.

In addition to genetic factors, environmental factors such as prenatal exposure to tobacco smoke, maternal alcohol use during pregnancy, and low birth weight have been implicated in the development of ADHD. Other potential risk factors include lead exposure, prenatal exposure to certain infections, and early exposure to trauma or adversity.

Atomoxetine is a nonstimulant drug that is commonly used in the treatment of ADHD. It works by inhibiting the reuptake of norepinephrine, a neurotransmitter involved in regulating attention and impulsivity. This helps to increase the levels of norepinephrine in the brain and improve symptoms of ADHD.

Some of the side effects of atomoxetine include nausea, decreased appetite, dizziness, dry mouth, constipation, and insomnia. It is important for patients and healthcare providers to monitor for any changes in mood, behavior, or suicidal thoughts, as atomoxetine has been associated with an increased risk of suicidal ideation in some individuals. Other less common side effects may include liver function abnormalities and allergic reactions.

When considering the use of atomoxetine for the treatment of ADHD, several factors should be taken into consideration. First, a thorough evaluation of the patient’s medical history, including any history of heart problems, should be conducted. Atomoxetine should not be used in patients with certain heart conditions or in those who have recently taken a monoamine oxidase inhibitor (MAOI). Additionally, patients should be monitored for any signs of liver dysfunction, as treatment with atomoxetine has been associated with rare cases of hepatic injury.

It is also important to note that atomoxetine may take several weeks to reach its full effect. Therefore, patience is necessary during the titration period. The dosage is typically started low and gradually increased based on the individual’s response and tolerability.

In conclusion, the DSM-5 criteria outline the key symptoms required for the diagnosis of ADHD. The neurobiology of ADHD is multifactorial, with both genetic and environmental factors playing a role in its development. Atomoxetine is a nonstimulant medication used in the treatment of ADHD. It works by increasing the levels of norepinephrine in the brain. While generally well-tolerated, atomoxetine has potential side effects and should be used with caution in certain patient populations. Regular monitoring of patients taking atomoxetine is important to assess for any changes in mood, behavior, or physical health.