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