Shikata Ga Nai
Querétaro
Joined May 2011
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Se trataba sencillamente de que con mi música podría sobrellevar todo lo demás. Mi música era el pegamento que me mantenía entero. #Eltemordeunhombresabio con #música es mejor ☺️
Fercillo retweeted
2026 is the year of orexin agonists: the ‘GLP1s of the brain’.
Takeda’s oveporexton became the first to be FDA-approved this year, for narcolepsy.
Orexin agonists could transform sleep medicine just like GLP1s transformed obesity -- and they're already expanding into more indications: sleep disorders beyond narcolepsy, fatigue, depression and even ADHD.
You can see that in the pipeline of emerging drugs -- and 8 companies already have clinical-stage orexin agonists.
Every breakthrough in medicine in 2026... so far.
23 newly-approved (entirely novel) drugs, first-in-class cancer drugs, unprecedented efficacy in autoimmunity, bariatric surgery-level weight loss with a drug, and 'GLP1s of the brain'...
Read it here: breakingground.substack.com/…
Fercillo retweeted
The nine-step ADHD diagnostic model is what the Academy ADHD curriculum ( 24 hrs) is based on. 🚨
Here is how it’s used 👇
In clinical practice at the end of this process, we do not necessarily arrive at a split between “ADHD” and “an alternative diagnosis”.
We often have a collection of differential diagnoses and coexisting conditions, with varying degrees of probability, organised into a working hierarchy through our formulation.
Hence the importance of implementing a diagnostic process
1/ Diagnostic Hierarchy
2/ Diagnostic Formulation
3/ DSM / ICD construct
That formulation guides what we target first, why, and what remains to be clarified.
Difficulties involving cognition, activity regulation, reward sensitivity and sleep are transdiagnostic.
Their presence alone does not tell us which condition is driving the presentation.
We need to examine their phenomenology, developmental course, context and relationship to one another, while systematically evaluating other explanations.
The distinction between ADHD and alternative or coexisting conditions may become clearer only later, as additional history, exclusion of other contributors and longitudinal observation refine our understanding.
More about the curriculum below 👇
An interactive graphic in a new Clinical Practice article summarizes the assessment and treatment of adult attention deficit–hyperactivity disorder. Topics include pathophysiological mechanisms, clinical features, coexisting conditions, and management strategies. Explore the graphic and read the full article: nej.md/4s25aNL
ALT An illustrated flowchart from the Clinical Practice article “Adult Attention Deficit–Hyperactivity Disorder” that shows the assessment pathway for adult ADHD. It includes steps such as clinical interview, assessment of symptoms, and DSM-5-TR criteria evaluation. Two possible outcomes are shown: ADHD diagnosis or alternative/associated condition. The NEJM identity sits at the bottom. Illustrations of people are featured around the chart.
Fercillo retweeted
“Doctor, ¿cómo debería sentirme cuando tomo mi medicamento para el TDAH? ¿Cómo sé si está funcionando?”
Es una pregunta frecuente en consulta. Y tiene sentido: si toda tu vida has tenido dificultades para mantener la atención, ¿cómo sabes lo que es concentrarte bien?
Lo primero que debemos entender es que no existe una sensación específica que indique que el medicamento está funcionando.
No necesariamente sentirás una claridad mental extraordinaria, tranquilidad absoluta o un cambio radical.
Lo que buscamos es que las cosas que antes te costaban trabajo ahora sean más fáciles de hacer.
Por ejemplo, comenzar una actividad, mantener la atención por más tiempo, terminar lo que empezaste o retomar una tarea después de distraerte. También cometer menos errores por descuido o controlar mejor tus impulsos.
Es decir, no evaluamos solamente cómo te sientes, sino cómo estás funcionando en tu vida cotidiana.
Otro punto importante es que notar cierta mejoría no siempre significa que ya encontramos la dosis adecuada.
Cada persona responde de manera diferente. Por eso ajustamos gradualmente el tratamiento, buscando el mayor beneficio posible con efectos secundarios tolerables.
Sentirte eufórico, demasiado acelerado, irritable o emocionalmente apagado tampoco significa que el medicamento funcione mejor. Son señales que debemos revisar.
La evidencia muestra que aproximadamente el 70% de los niños y adolescentes responde a un primer tratamiento estimulante, y más del 90% puede responder a alguno de los dos grupos cuando se prueban tanto metilfenidato como anfetaminas.
También hay diferencias en el tiempo de respuesta. Los estimulantes pueden mostrar beneficios desde el primer día, mientras que medicamentos como la atomoxetina necesitan varias semanas para alcanzar su efecto completo.
Finalmente, una buena respuesta no significa concentrarte perfectamente todo el tiempo, dejar de distraerte o convertirte en otra persona.
Distraerse y cambiar el foco de atención es parte del funcionamiento normal del cerebro humano. Dependiendo del contexto, incluso puede ser necesario y saludable.
El objetivo del tratamiento no es eliminar las distracciones, sino conseguir que los síntomas del TDAH interfieran menos con tu vida, sin dejar de sentirte tú mismo.
Referencias: Wolraich et al., Pediatrics (2019); Farhat et al., Molecular Psychiatry (2022); Faraone et al., Nature Reviews Disease Primers (2024).
Fercillo retweeted
An interactive graphic in a new Clinical Practice article summarizes the assessment and treatment of adult attention deficit–hyperactivity disorder. Topics include pathophysiological mechanisms, clinical features, coexisting conditions, and management strategies. Explore the graphic and read the full article: nej.md/4s25aNL
ALT An illustrated flowchart from the Clinical Practice article “Adult Attention Deficit–Hyperactivity Disorder” that shows the assessment pathway for adult ADHD. It includes steps such as clinical interview, assessment of symptoms, and DSM-5-TR criteria evaluation. Two possible outcomes are shown: ADHD diagnosis or alternative/associated condition. The NEJM identity sits at the bottom. Illustrations of people are featured around the chart.
Fercillo retweeted
Could obesity be quietly aging our brains and increasing our risk of dementia? Obesity refers to excess body fat that can negatively affect health, including brain health. Cali McEntee, Eva Feldman and colleagues describe in a new review in Nature Reviews Neurology how obesity may affect memory, thinking and the biological pathways involved in dementia.
Key points:
- Midlife obesity is associated w/ cognitive decline and an increased risk of dementia, even when weight decreases later in life.
- Obesity may affect the hippocampus and prefrontal cortex, brain regions essential for memory, attention and decision-making, through inflammation, insulin resistance and vascular dysfunction.
- Exercise, healthier nutrition, weight-loss surgery and newer weight-management medications offer potential opportunities to improve metabolic health and possibly protect cognition, although more definitive trials are needed.
My take: What resonates w/ me is that obesity is not simply a number on a scale. It is a biological condition that can influence how our brains function and age. The brain and body are not separate universes. Inflammation, blood vessel health, insulin signaling and metabolism all matter. Perhaps most importantly, the timing of obesity matters. Carrying excess weight in midlife may have consequences that are not completely reversed by losing weight decades later.
Here are 5 points that resonated w/ me:
1- Midlife may represent an important window of opportunity for protecting long-term brain health.
2- Where fat accumulates may matter as much as how much we weigh, particularly when it collects around the abdomen.
3- Obesity can create a vicious cycle in which inflammation disrupts the brain circuits controlling appetite, potentially promoting further weight gain.
4- Exercise, nutrition and appropriate medical treatment should be viewed as investments in brain health, not simply strategies for changing appearance or body weight.
5- We still need randomized trials to establish whether treating obesity actually prevents dementia, but the opportunity to improve metabolic and vascular health is already in front of us.
nature.com/articles/s41582-0…
Fercillo retweeted
A new Clinical Practice article summarizes the assessment and treatment of adult attention deficit–hyperactivity disorder, with an emphasis on common psychiatric and medical coexisting conditions and combined pharmacologic and psychosocial care.
Read “Adult Attention Deficit–Hyperactivity Disorder” by Jan K. Buitelaar, MD, PhD, and Jeffrey H. Newcorn, MD: nej.md/4s25aNL
ALT An illustrated diagram from the Clinical Practice article “Adult Attention Deficit–Hyperactivity Disorder” that shows the neurobiologic mechanisms of attention deficit–hyperactivity disorder (ADHD). It includes four overlapping circles labeled "Brain Structure," "Genetics," "Neurochemistry," and "Environmental Factors," each listing contributing elements. Additional text provides points on behavioral and cognitive features. The NEJM identity sits at the bottom.
Fercillo retweeted
Psi Mammoliti x Pictoline 🧠🫂
"Respira hondo", "relájate" o "no es para tanto" salen del cariño, pero a quien vive ansiedad le pueden sumar presión y culpa.
Guarda este post o compártelo a esa persona que necesite leerlo hoy.
#SaludMental #sociedad #pictoline
Fercillo retweeted
Cuando vuelves a hacer algo que amabas y, sin darte cuenta, recuperas esa parte de ti que tanto extrañabas:
