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A 13-year-old boy with a diagnosis of attention deficit hyperactivity disorder (ADHD) comes to the clinic with his mother for a review. He was started on atomoxetine 6 weeks prior to this visit for hyperactive/impulsive symptoms and poor concentration. The boy was admitted to the hospital 1 week ago for changed behaviour, disorientation, irrelevant speech and self-harming behaviour. He was reported to be very aggressive and hostile towards other children and adults.
Investigation for organic causes was undertaken and no clear explanation was found. The patient was discharged on day 3 upon improvement of symptoms. Although the diagnosis of ADHD had been made some time ago, stimulant medications were not used because of the risk of abuse and drug diversion. His mother ascribes this hospitalisation to a side effect of atomoxetine as he had not shown such behaviour before starting on treatment and there is no recent history of head injury, illness or change in family dynamics. She asks your opinion about increased aggression and hostility related to atomoxetine.
Structured clinical question
In a school age child with ADHD [patient] can atomoxetine [intervention] cause increased aggression and hostility [outcome]?
Search strategy
Search terms: keywords "ADHD", "Atomoxetine"; textwords "Aggression", "Hostility".
Primary search
EMBASE 1996-July week 2 2007 and Medline 1996-July week 2 2007.
Secondary search
The Cochrane Library.
Search outcome
In Embase the keywords "atomoxetine" (all subheadings) and "attention deficit hyperactivity disorder" (all subheadings) were exploded and combined with "and". The references retrieved were combined with the truncated textwords "Agressi$" or "hostil$". The results were exploded, combined with "Evidence Based Medicine". The textwords were combined with "OR" with the keyword. In Medline the exploded MeSH term "attention deficit hyperactivity disorder" with all subheadings was used. The results were combined with the textwords "Atomoxetine" or "Strattera" using "AND". The results were combined with the publication types meta-analysis or randomised clinical trials.
The search was carried out on 13 July 2007 and a total of eight articles were obtained in Embase combining the above searches. After searching abstracts, one relevant article was retrieved ( table 1 ). The other seven articles did not study aggression or hostility in association with atomoxetine. Medline did not identify any study. The search of a secondary database in...