Toward an integrative approach to mental health: Clinical and ethical challenges in ADHD treatment through the lens of ‘Top-Down’ and ‘Bottom-Up’ models, and psychosocial and lifestyle factors

Abstract

Psychiatry represents a vital clinical discipline. Nevertheless, two notable limitations exist within its diagnostic processes. Firstly, psychiatric disorder definitions are established through consensus rather than derived from measurable biological markers. Secondly, these definitions have at times been overly influenced by the behavioral effects of pharmacological agents. To foster optimal psychological development across the lifespan, this guideline seeks to identify psychosocial and academic difficulties at an early stage. Although this objective is commendable, many nations face a significant rise in prescriptions for psychotropic medications, as observed in cases like attention deficit hyperactivity disorder. Such trends prompt important ethical and clinical considerations regarding how best to evaluate and treat individuals who require medical or therapeutic support to maintain or regain psychological and social autonomy. Given that psychiatric disorder definitions are grounded in consensus, they must remain open to ongoing revision as scientific knowledge advances. This paper will illustrate these issues using attention deficit hyperactivity disorder, and after will address both TOP-DOWN and BOTTOM-UP approaches in psychiatry to examine the key axes for rigorous symptom evaluation and evidence-based therapeutic intervention according to current neurophysiological understanding.