***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: AIMS The main purpose of this first atomoxetine study in Japanese adults with attention-deficit/hyperactivity disorder ( ADHD ) was to investigate the tolerability of an 8-week treatment regimen . METHODS This was an open-label , dose escalation study conducted in 45 Japanese patients aged at least 18 years with DSM-IV-defined ADHD . Patients received atomoxetine orally for 8 weeks . Atomoxetine administration was started at 40 mg/day ( 7 days ) , and subsequently increased to a maximum dose of 120 mg/day . Tolerability was assessed by discontinuation rate due to adverse events . Adverse events , laboratory tests , vital signs and electrocardiograms were collected . In addition , ADHD symptoms were assessed by using the Japanese version of the Conners ' Adult ADHD Rating Scale-Investigator Rated : Screening Version ( CAARS-Inv : SV ) scores . RESULTS Thirty-nine patients completed the study period .  Atomoxetine was well tolerated with a 6.7 % ( 3/45 ) discontinuation rate due to nausea , malaise and anorexia . The most commonly reported adverse events were nausea , nasopharyngitis and headache ; there were no unexpected safety concerns . No deaths or serious adverse events were reported . Mean CAARS-Inv : SV-J total ADHD symptom scores decreased in a time-dependent manner ; the mean change from baseline to endpoint was -15.0 ( P<0.001 ) . CONCLUSIONS This study showed that atomoxetine was well tolerated in these patients and suggested that atomoxetine at a maximum dose of 120 mg/day would be safe in Japanese ADHD patients Objective : To test the hypothesis that atomoxetine does not significantly worsen tic severity relative to placebo in children and adolescents with attention deficit/hyperactivity disorder ( ADHD ) and comorbid tic disorders . Methods : Study subjects were 7 to 17 years old , met Diagnostic and Statistical Manual of Mental Disorders – IV criteria for ADHD , and had concurrent Tourette syndrome or chronic motor tic disorder . Patients were r and omly assigned to double-blind treatment with placebo ( n = 72 ) or atomoxetine ( 0.5 to 1.5 mg/kg/day , n = 76 ) for up to 18 weeks . Results : Atomoxetine treatment was associated with greater reduction of tic severity at endpoint relative to placebo , approaching significance on the Yale Global Tic Severity Scale total score ( –5.5 ± 6.9 vs –3.0 ± 8.7 , p = 0.063 ) and Tic Symptom Self-Report total score ( –4.7 ± 6.5 vs –2.9 ± 5.2 , p = 0.095 ) and achieving significance on the Clinical Global Impressions ( CGI ) tic/neurologic severity scale score ( –0.7 ± 1.2 vs –0.1 ± 1.0 , p =  0.002 ) . Atomoxetine patients also showed greater improvement on the ADHD Rating Scale total score ( –10.9 ± 10.9 vs –4.9 ± 10.3 , p < 0.001 ) and CGI severity of ADHD/psychiatric symptoms scale score ( –0.8 ± 1.1 vs –0.3 ± 1.0 , p = 0.015 ) . Discontinuation rates were not significantly different between treatment groups . Atomoxetine patients had greater increases in heart rate and decreases of body weight , and rates of treatment-emergent decreased appetite and nausea were higher . No other clinical ly relevant treatment differences were seen in any other vital sign , adverse event , or electrocardiographic or laboratory measures . Conclusions : Atomoxetine did not exacerbate tic symptoms . Rather , there was some evidence of reduction in tic severity with a significant reduction of attention deficit/hyperactivity disorder symptoms . Atomoxetine treatment appeared safe and well tolerated Background Compared to existing literature on childhood attention deficit hyperactivity disorder ( ADHD ) , little published adult data are available , particularly outside of the United States . Using General Practitioner ( GP ) question naires from the United Kingdom , this study aim ed to examine a number of issues related to ADHD in adults , across three cohorts of patients , adults who received ADHD drug treatment in childhood/adolescence but stopped prior to adulthood ; adults who received ADHD drug treatment in childhood/adolescence and continued treatment into adulthood and adults who started ADHD drug treatment in adulthood . Methods Patients with a diagnosis of ADHD and prescribed methylpheni date , dexamfetamine or atomoxetine were identified using data from The Health Improvement Network ( THIN ) . Date s when these drugs started and stopped were used to classify patients into the three cohorts . From each cohort , 50 patients were r and omly selected and question naires were sent via THIN to their GPs . GPs returned completed question naires to THIN who forwarded anonymised copies to the research ers . Data sets were analysed using descriptive statistics . Results Overall response rate was 89 % ( 133/150 ) . GPs stated that in 19 cases , the patient did not meet the criteria of that group ; the number of valid question naires returned was 114 ( 76 % ) . The following broad trends were observed : 1 ) GPs were not aware of the reason for treatment cessation in 43 % of cases , 2 ) patient choice was the most common reason for discontinuation ( 56 % ) , 3 ) 7 % of patients who stopped pharmacological treatment subsequently reported experiencing ADHD symptoms , 4 ) 58 % of patients who started pharmacological treatment for ADHD in adulthood received pharmacological treatment for other mental health conditions prior to the ADHD being diagnosed . Conclusion This study presents some key findings relating to ADHD ; GPs were often not aware of the reason for patients stopping ADHD treatment in childhood or adolescence . Patient choice was identified as the most common reason for treatment cessation . For patients who started pharmacological treatment in adulthood , many patients received pharmacological treatment for comorbidities before a diagnosis of ADHD was made This article aims to assess the efficacy and safety of atomoxetine in Korean adults with attention‐deficit hyperactivity disorder ( ADHD ) Although the efficacy and tolerability of ADHD medications have been investigated fairly extensively , there are very few data comparing the different types of medication ( e.g. psychostimulants , non-stimulants ) in terms of medication adherence . The primary research objective of the COMPLY observational study was to evaluate medication adherence ( i.e. compliance ) over 1 year in children and adolescents with ADHD in a routine clinical setting . COMPLY was a prospect i ve 12-month , observational , open-label study that included children and adolescents , aged 6–17 years , with ADHD .  Medication adherence ( i.e. compliance ) was measured using the Pediatric Compliance Self-Rating ( PCSR ) instrument and using items 1–4 of the Medication Adherence Rating Scale ( MARS ) . A total of 504 patients were enrolled . At baseline , 252 patients ( 50.0 % ) were prescribed non-stimulant ( atomoxetine ) medication and 247 patients ( 49.0 % ) were prescribed psychostimulant medication .  Both types of medication were prescribed concomitantly in five patients ( 1.0 % ) . After 12 months , 123 patients ( 48.8 % ) were taking atomoxetine and 176 patients ( 71.3 % ) were taking psychostimulants  . Adherence ( PCSR score ≥5 ) was present in both groups ( atomoxetine : 67.5 % ; psychostimulant : 74.2 % ) throughout the observation period . MARS scores declined over time in both groups ( atomoxetine : from 3.7 to 2.9 ; psychostimulant : from 3.6 to 3.1 ) , indicating a deterioration in adherence . There was no statistically significant difference in terms of medication adherence between the two groups Abstract Objective : To underst and attention – deficit/hyperactivity disorder ( ADHD ) treatment patterns and estimate adherence and persistence in Quebec , Canada . Design : This cross – sectional , retrospective prescription cl aims analysis used a r and om sample of 15 838 patients with ADHD from a Quebec data base ( Régie de l'assurance maladie du Québec [ RAMQ ] ) to assess treatment patterns , adherence ( 1–year medication possession ratio in new users ) , and persistence ( proportion persistent at 3 , 6 , and 12 months after index prescription ) . Results : The mean patient age was 14 years ; 72.6 % were male . During the 5–year study period ( 2004–2009 ) , 416 646 ADHD prescriptions were flled .  Short – acting ( SA ) medications declined from 72.8 % to 26.4 % of all cl aims , while stimulant and nonstimulant long – acting ( LA ) medications increased from 27.2 % to 73.6 % . Approximately half of the patients used both  SA and LA medications ( either concomitantly or subsequently ) , and the others used only SA ( 30 % ) or LA ( 19 % ) drugs . Among patients using both , switching from SA to LA was the most frequent ( 27.9 % ) treatment pattern . More patients on LA methylpheni date s ( 6.4 % ) compared with LA amphetamines ( 1.9 % ; P < 0.01 ) required augmentation with an SA drug . Fewer patients on SA stimulants ( 39.4 % ) were ≥ 80 % adherent compared with LA stimulants ( 63 % ; P < 0.001 ) and LA nonstimulants ( 60.2 % ; P < 0.001 ) . More patients on LA stimulants ( 81.1 % ) were persistent at 12 months compared with LA nonstimulants ( 61.7 % ; P < 0.001 ) and SA stimulants ( 59.6 % ; P < 0.001 ) . Similar trends were observed at all time points measured . Conclusions : Switching from SA to LA medications and treatment augmentation are common in ADHD management , with implication s for patient care and health care re source use . This analysis found poor adherence in ADHD treatment , although adherence and persistence were improved with LA stimulant formulations Adolescence is a particularly high-risk period for non-adherence with post-transplant medical regimens . There remains a lack of research investigating factors related to non-adherence in adolescent LT recipients . The present study empirically assessed the relationship between adherence and HRQOL in adolescent LT recipients . Participants included 25 adolescents ( mean = 15.1 yr , range 12 - 17.9 ) and their parent/guardian(s ) . Adherence was assessed using multiple indices including clinician-conducted interviews , rate of clinic attendance , and s.d . of consecutive tacrolimus blood levels . HRQOL was examined using self-report and parent-proxy report on well-vali date d assessment measures . Results indicated that 76 % of participants were non-adherent on at least one measure of adherence , and HRQOL was significantly lower than normative data for healthy children . Tacrolimus s.d . were significant related to poor HRQOL across domains of physical , school , and social functioning . Non-adherent adolescents reported poorer health perceptions , self-esteem , mental health , family cohesion , and more limitations in social and school activities related to physical , emotional , and behavioral problems . These results suggest that empirically based assessment of HRQOL may help identify those at highest risk for behavior , emotional and school difficulties , as well as non-adherence . The examination of tacrolimus s.d . may also help identify patients who may benefit from intervention to promote adherence and HRQOL . Prospect i ve investigations are necessary to further identify the impact of HRQOL on adherence and long-term health outcomes to further guide clinical intervention Purpose To assess baseline predictors and consequences of medication non-adherence in the treatment of pediatric patients with attention-deficit/hyperactivity disorder ( ADHD ) from Central Europe and East Asia . Patients and methods Data for this post-hoc analysis were taken from a 1-year prospect i ve , observational study that included a total of 1,068 newly-diagnosed pediatric patients with ADHD symptoms from Central Europe and East Asia .  Medication adherence during the week prior to each visit was assessed by treating physicians using a 5-point Likert scale , and then dichotomized into either adherent or non-adherent . Clinical severity was measured by the Clinical Global Impressions-ADHD-Severity ( CGI-ADHD ) scale and the Child Symptom Inventory-4 ( CSI-4 ) Checklist . Health-Related Quality of Life ( HRQoL ) was measured using the Child Health and Illness Profile-Child Edition ( CHIP-CE ) . Regression analyses were used to assess baseline predictors of overall adherence during follow-up , and the impact of time-varying adherence on subsequent outcomes : response ( defined as a decrease of at least 1 point in CGI ) , changes in CGI-ADHD , CSI-4 , and the five dimensions of CHIP-CE . Results Of the 860 patients analyzed , 64.5 % ( 71.6 % in Central Europe and 55.5 % in East Asia ) were rated as adherent and 35.5 % as non-adherent during follow-up . Being from East Asia was found to be a strong predictor of non- 
    Output:
    
The findings from this review indicate that persistence and adherence to atomoxetine treatment were generally high .
Factors found to influence adherence and nonadherence to atomoxetine treatment in ADHD in this review include age , sex , the definition of response used , length of treatment , initial dose of treatment , comorbid conditions , and reimbursement .
Tolerability was cited as an important reason for treatment discontinuation .