Hyperactive Disorder (ADHD): A Diagnostic Analysis

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According to the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) by the American Psychiatric Association, attention deficit hyperactivity disorder (ADHD) is “characterized by a pattern of behavior, present in multiple settings (e.g., school and home), that can result in performance issues in social, educational, or work settings” (American Psychiatric Publishing, 2013). ADHD is further divided into two subcategories including primarily inattentive and primarily hyperactive and impulsive. While the exact physiology of ADHD is unknown, the current research indicates that there is impairment of a variety of executive functions that are regulated in the prefrontal cortex of the brain. It is generally understood that…show more content…
Norepinephrine is a neurotransmitter released from noradrenergic neurons. It is one neurotransmitter responsible for the fight-or-flight response that activates the sympathetic nervous system. Strattera does not stimulate production of norepinephrine, rather it prevents reuptake of norepinephrine and allows the neurons to maintain the epinephrine that is already being produced. Strattera selectively blocks the norepinephrine reuptake transporter located on the presynaptic neuron. Norepinephrine transporters also nonselectively take up dopamine due to its similar affinities for both norepinephrine and dopamine which may allow dopamine to diffuse transsynaptically to norepinephrine transporters. There are many norepinephrine transporters in the prefrontal cortex of the brain, but few dopamine transporters. Strattera significantly increases the norepinephrine and dopamine concentrations in the prefrontal cortex of the brain, but does not increase the concentrations of either of these neurotransmitters in dopamine transporter-rich areas such as the nucleus accumbens and striatum. In spite of this knowledge of the mechanism of action of Strattera, it is not understood how this mechanism specifically produces the therapeutic effect on the symptoms of ADHD (Eli Lilly and Company,…show more content…
As with any drug, efficacy and side-effects are dependent on drug metabolism. Strattera is primarily metabolized by the cytochrome P450 system through the liver. Genetically, individuals can have different activity of this enzyme. Based on this individuals can potentially be classified as “poor metabolizers” or “extensive metabolizers.” Due to slow metabolism of the drug, poor metabolizers can have drug levels estimated at about five times higher than average metabolizers leading to increased incidence of adverse side-effects and intolerability. Extensive metabolizers are more likely to not respond to therapeutic doses due to rapid metabolism of the
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