‘Nige­ri­ans with do-you-know-who-i-am at­ti­tude could have per­son­al­ity dis­or­der’

The Punch - - HEALTH -

mal­adap­tive be­hav­iours can be iden­ti­fied and en­cour­aged to seek help to ad­dress these is­sues.

It is very rare for some­one to present to a doc­tor to com­plain of symp­toms of NPD. NPD is of­ten di­ag­nosed dur­ing as­sess­ment or treat­ment of other men­tal health dis­or­ders. It is of­ten as­so­ci­ated with poor re­sponse to treat­ment of anx­i­ety and de­pres­sion and per­sis­tent poor in­ter­per­sonal re­la­tion dif­fi­cul­ties.

There are no lab­o­ra­tory or imag­ing tests used in mak­ing the di­ag­no­sis. NPD is di­ag­nosed us­ing a struc­tured clin­i­cal in­ter­view, in­clud­ing a de­tailed per­sonal his­tory and men­tal state ex­am­i­na­tion. Per­son­al­ity in­ven­to­ries such as per­son­al­ity di­ag­nos­tic ques­tion­naire – 4; mil­lon clin­i­cal mul­ti­ax­ial in­ven­tory III; and in­ter­na­tional per­son­al­ity dis­or­der ex­am­i­na­tion, can be used for fur­ther psy­cho­log­i­cal eval­u­a­tion in mak­ing the di­ag­no­sis.

Peo­ple with nar­cis­sis­tic per­son­al­ity dis­or­der may have a higher risk of sub­stance mis­use and ad­dic­tions be­hav­iour, de­pres­sion and anx­i­ety dis­or­ders, low self-es­teem and fear of not be­ing good enough. They may also have a higher risk of feel­ings of shame, help­less­ness, anger at them­selves, im­pul­sive be­hav­iour, and sui­cide (with lethal means).

Long-term, con­sis­tent out­pa­tient care is the ap­proach of choice in the treat­ment of nar­cis­sis­tic per­son­al­ity dis­or­der. This usu­ally in­volves a com­bi­na­tion of psy­chother­apy and med­i­ca­tion man­age­ment. Psy­cho­dy­namic psy­chother­apy aimed at and ad­dress­ing the pa­tients’ sense of self, mal­adap­tive in­ter­per­sonal re­la­tion­ship dif­fi­cul­ties and global func­tion­ing, has been shown to be ben­e­fi­cial in NPD treat­ment.

Other psy­chother­a­pies, in­clud­ing in­ter­per­sonal ther­apy, cog­ni­tive be­havioural ther­apy and short-term ob­jec­tive-fo­cused psy­chother­apy are also used to treat NPD. Med­i­ca­tions are not used specif­i­cally to treat NPD but are of­ten used to treat con­comi­tant anx­i­ety, de­pres­sion, im­pul­siv­ity or other mood dis­tur­bances ac­cord­ingly.

This rep­re­sents an at­tempt to ed­u­cate peo­ple about some of the com­mon med­i­ca­tions in use in our coun­try. This would be the third such episode in our se­ries which has seen us talk about Parac­eta­mol and Am­lodip­ine. Met­formin, mar­keted un­der the trade name Glu­cophage, is a medicine that doc­tors very com­monly pre­scribe for the peo­ple who have Type 2 di­a­betes. This used to be known as the ma­tu­rity (adult) on­set di­a­betes. The chem­i­cal com­po­si­tion is a white to off-white crys­talline com­pound that is freely sol­u­ble in wa­ter and bears no re­la­tion­ship to any other agent that works to re­duce the blood lev­els of glu­cose. Chem­i­cally, it is known as a biguanide. It works to im­prove the glu­cose tol­er­ance of an in­di­vid­ual with type 2 di­a­betes. It there­fore low­ers the basal glu­cose level which is what the body is found to have at rest, when no food has been eaten, as well as the level reached af­ter a meal has been eaten.

It is of par­tic­u­lar use­ful­ness in treat­ing di­a­betic peo­ple who are over­weight. It is taken only by mouth and is not as­so­ci­ated with weight gain. It is gen­er­ally well tol­er­ated and has been in use for the treat­ment of di­a­betes for more than six decades. It is on the World Health Or­ga­ni­za­tion’s list of es­sen­tial drugs, which is a list of the most ef­fec­tive and safe medicines needed in a health sys­tem. It is the most widely used med­i­ca­tion for di­a­betes taken by mouth but was not even avail­able in the United States un­til 1995. By 2016, how­ever, it be­came the fourth most pre­scribed medicine in that coun­try with more than 81 mil­lion pre­scrip­tions. Met­formin is there­fore a first-line med­i­ca­tion that most peo­ple with type 2 di­a­betes are of­ten placed on. It is used to­day by hun­dreds of thou­sands if not sev­eral mil­lions of peo­ple around our coun­try on a daily ba­sis.

Met­formin acts by re­duc­ing the amount of sugar which the liver re­leases and also by in­creas­ing the sen­si­tiv­ity of the tis­sues in ev­ery part of the body to in­sulin. By do­ing so, it is able to re­duce the daily re­quire­ment of the tis­sues for glu­cose to such a level that con­trol can ac­tu­ally be ob­tained. When this level is at­tained, the pa­tient can ex­pect to live a nor­mal life pro­vided they will abide by the ba­sic rules of ob­tain­ing op­ti­mal con­trol of the blood sugar level. This can be reached by strictly ad­her­ing to the ad­vice of the man­ag­ing doc­tors and ju­di­cious use of the pre­scribed med­i­ca­tions in the man­ner in which they are pre­scribed and for the du­ra­tion of us­age bear­ing in mind that any vari­a­tions will need a care­ful cal­i­bra­tion of their en­ergy in­take ver­i­fied by their doc­tors. It is not an easy path to fol­low but it can be done.

It is also use­ful in the treat­ment of in­fer­til­ity as a sec­ond line agent in those women who suf­fer from the poly­cys­tic ovary syn­drome. Be­sides that, it does help to re­duce weight. It is also known to re­duce the rate of de­vel­op­ing ad­verse car­dio­vas­cu­lar events in peo­ple who are us­ing it. Glu­cophage is an im­por­tant med­i­ca­tion in that it can also be used alone when act­ing as an ad­junct to a strict diet and ex­er­cise in man­ag­ing type 2 di­a­betes. It can be used in pa­tients as young as 10 years. The dosage is in­di­vid­u­al­ized and should not ex­ceed 2,550mg in adults or 2000mg in chil­dren aged be­tween 10 and 16 years of age. There is no fixed dose there­fore. Be­tween nor­mal non­di­a­betic pa­tients who are us­ing Glu­cophage for other pur­poses, and those who have di­a­betes, there is no dif­fer­ence in their uri­nary ex­cre­tion of Glu­cophage.

It is also ex­creted vir­tu­ally un­changed with no ev­i­dence that any break­down of the drug oc­curs in ei­ther the gall­blad­der or the kid­ney. It there­fore has a very good safety pro­file. It should be given in di­vided doses prefer­ably, mean­ing that the us­age should be two times or three times a day rather than one sin­gu­lar large dose. It

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