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People with diabetes should be screened regularly for kidney disease buy generic benadryl from india allergy testing bellevue wa. The two key markers for kidney disease are estimated glomerular filtration rate (eGFR) and urine albumin buy benadryl 25mg low cost allergy forecast tucson. Drugs used to lower blood pressure can slow the progression of kidney disease significantly discount benadryl uk allergy medicine urination. Two types of drugs, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), have proven effective in slowing the progression of kidney disease. In people with diabetes, excessive consumption of protein may be harmful. Intensive management of blood glucose has shown great promise for people with diabetes, especially for those in the early stages of CKD. As a result, the number of people with kidney failure caused by diabetes is also growing. Some experts predict that diabetes soon might account for half the cases of kidney failure. In light of the increasing illness and death related to diabetes and kidney failure, patients, researchers, and health care professionals will continue to benefit by addressing the relationship between the two diseases. The NIDDK is a leader in supporting research in this area. Several areas of research supported by the NIDDK hold great potential. Discovery of ways to predict who will develop kidney disease may lead to greater prevention, as people with diabetes who learn they are at risk institute strategies such as intensive management of blood glucose and blood pressure control. Find out about the different treatments for kidney failure. Your kidneys filter wastes from your blood and regulate other functions of your body. When your kidneys fail, you need treatment to replace the work your kidneys normally perform. Developing kidney failure means you have some decisions to make about your treatment. If you choose to receive treatment, your choices include hemodialysis, which requires a machine used to filter your blood outside your body; peritoneal dialysis, which uses the lining of your belly to filter your blood inside the body; and kidney transplantation, in which a new kidney is placed in your body. Your choice of treatment will have a big impact on your day-to-day lifestyle, such as being able to keep a job if you are working. You are the only one who can decide what means most to you. Reading this information is a good way to learn about your options so you can make an informed choice. And, if you find that your choice is not a good fit for your life, you can change treatments. With the help of your health care team, family, and friends, you can lead a full, active life. Healthy kidneys clean your blood by removing excess fluid, minerals, and wastes. They also make hormones that keep your bones strong and your blood healthy. When your kidneys fail, harmful wastes build up in your body, your blood pressure may rise, and your body may retain excess fluid and not make enough red blood cells. When this happens, you need treatment to replace the work of your failed kidneys. Hemodialysis cleans and filters your blood using a machine to temporarily rid your body of harmful wastes, extra salt, and extra water. Hemodialysis helps control blood pressure and helps your body keep the proper balance of important chemicals such as potassium, sodium, calcium, and bicarbonate. Dialysis can replace part of the function of your kidneys. Diet, medications, and fluid limits are often needed as well. Your diet, fluids, and the number of medications you need will depend on which treatment you choose. Hemodialysis uses a special filter called a dialyzer that functions as an artificial kidney to clean your blood. The dialyzer is a canister connected to the hemodialysis machine. During treatment, your blood travels through tubes into the dialyzer, which filters out wastes, extra salt, and extra water. Then the cleaned blood flows through another set of tubes back into your body. The hemodialysis machine monitors blood flow and removes wastes from the dialyzer. During treatment, you can read, write, sleep, talk, or watch TV. Before dialysis, needles are placed into the access to draw out the blood. If your kidney disease has progressed quickly, you may not have time to get a permanent vascular access before you start hemodialysis treatments. You may need to use a catheter?a small, soft tube inserted into a vein in your neck, chest, or leg near the groin?as a temporary access. Some people use a catheter for long-term access as well. Catheters that will be needed for more than about 3 weeks are designed to be placed under the skin to increase comfort and reduce complications. For more information about vascular access, see the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) fact sheet Vascular Access for Hemodialysis. Hemodialysis is most often done in a dialysis center by patient care technicians who are supervised by nurses. Medicare pays for three hemodialysis treatments each week. If you choose in-center treatment, you will have a fixed time slot three times per week on Monday-Wednesday-Friday or Tuesday-Thursday-Saturday. If you do not get the time slot you want at first, you can ask to be put on a waiting list for the time slot you prefer. For a special event, you may be able to trade times with someone else. You will want to think about the dialysis schedule if you work or have children to care for. This treatment is done for a longer period at night, while you sleep at the center. Getting more dialysis means fewer diet and fluid limits, and this treatment leaves your days free for work, child care, hobbies, or other tasks. You can choose to learn how to do your own hemodialysis treatments at home.
Clomipramine (CMI) is presumed to influence obsessive and compulsive behaviors through its effects on serotonergic neuronal transmission benadryl 25mg visa allergy treatment kind of soap & detergent association. Clomipramine is indicated for the treatment of obsessions and compulsions in patients with Obsessive-Compulsive Disorder (OCD) generic benadryl 25 mg without prescription allergy treatment kinesiology. The obsessions or compulsions must cause marked distress order benadryl paypal allergy medicine vegan, be time-consuming, or significantly interfere with social or occupational functioning, in order to meet the DSM-III-R (circa 1989) diagnosis of OCD. The effectiveness of clomipramine for long-term use (i. The physician who elects to use clomipramine for extended periods should periodically re-evaluate the long term usefulness of the drug for the individual patient. Clomipramine is contraindicated in patients with a history of hypersensitivity to clomipramine or other tricyclic antidepressants. Clomipramine HCl should not be given in combination, or within 14 days before or after treatment, with a monoamine oxidase (MAO) inhibitor. Hyperpyretic crisis, seizures, coma, and death have been reported in patients receiving such combinations. Clomipramine is contraindicated during the acute recovery period after a myocardial infarction. Clomipramine is contraindicated in patients with existing liver or kidney damage and should not be administered to patients with a history of blood dyscrasias. Clomipramine is contraindicated in patients with glaucoma, as the condition may be aggravated due to the atropine-like effects of the drug. Seizure was identified as the most significant risk of clomipramine use. Caution should be used in administering clomipramine to patients with a history of seizures or other predisposing factors. Rare reports of fatalities in association with seizures have been reported by foreign post-marketing surveillance, but not in U. In some of these cases, clomipramine had been administered with other epileptogenic agents: in others, the patients involved had possibly predisposing medical conditions. Thus a causal association between clomipramine treatment and these fatalities has not been established. Physicians should discuss with patients the risk of taking clomipramine HCl while engaging in activities in which sudden loss of consciousness could result in serious injury to the patient or others, e. Suicide: Since depression is a commonly associated feature of OCD, the risk of suicide must be considered. Prescriptions for clomipramine HCl should be written for the smallest quantity of capsules consistent with good patient management, in order to reduce the risk of overdose. Cardiovascular: Tricyclic antidepressants, particularly in high doses, have been reported to produce sinus tachycardia, changes in conduction time and arrhythmias. A few instances of unexpected death have been reported in patients with cardiovascular disorders. Myocardial infarction and stroke have also been reported with drugs of this class. Therefore, clomipramine should be administered with extreme caution to patients with a history of cardiovascular disease, especially those who have a history of conduction disorders, those with circulatory lability and elderly patients. It also has a hypotensive action which may be detrimental in these circumstances. In such cases, treatment should be initiated at low doses with progressive increases only if required and tolerated, and the patients should be under close surveillance at all dosage levels. Monitoring of cardiac function and the ECG is indicated in such patients. Psychosis, Confusion, And Other Neuropsychiatric Phenomena: Patients treated with clomipramine have been reported to show a variety of neuropsychiatric signs and symptoms including delusions, hallucinations, psychotic episodes, confusion, and paranoia. Because of the uncontrolled nature of many of the studies, its is impossible to provide a precise estimate of the extent of risk imposed by treatment with clomipramine. As with tricyclic antidepressants to which it is closely related, clomipramine may precipitate an acute psychotic episode in patients with unrecognized schizophrenia. Mania/Hypomania: During premarketing testing of clomipramine in patients with affective disorder, hypomania or mania was precipitated in several patients. Activation of mania or hypomania has also been reported in a small proportion of patients with affective disorder treated with marketed tricyclic antidepressants, which are closely related to clomipramine. Central Nervous System: More than 30 cases of hyperthermia have been recorded by nondomestic post-marketing surveillance systems. Most cases occurred when clomipramine was used in combination with other drugs. When clomipramine and a neuroleptic were used concomitantly, the cases were sometimes considered to be examples of a neuroleptic malignant syndrome. Sexual Dysfunction: The rate of sexual dysfunction in male patients with OCD who were treated with clomipramine in the premarketing experience was markedly increased compared with placebo controls (i. Approximately 85% of males with sexual dysfunction chose to continue treatment. Weight Changes: In controlled studies of OCD, weight gain was reported in 18% of patients receiving clomipramine, compared with 1% of patients receiving placebo. In these studies, 28% of patients receiving clomipramine had a weight gain of at least 7% of their initial body weight, compared with 4% of patients receiving placebo. Several patients had weight gains in excess of 25% of their initial body weight. Conversely, 5% of patients receiving placebo had weight losses of at least 7% of their initial body weight. Surgery: Prior to elective surgery with general anesthetics, therapy with clomipramine HCl should be discontinued for as long as is clinically feasible, and the anesthetist should be advised. Use in Concomitant Illness: As with closely related tricyclic antidepressants, clomipramine should be used with caution in the following:Hyperthyroid patients or patients receiving thyroid medication, because of the possibility of cardiac toxicity;Patients with increased intraocular pressure, a history of narrow-angle glaucoma, or urinary retention, because of the anticholinergic properties of the drug;Patients with tumors of the adrenal medulla (e. Withdrawal Symptoms: A variety of withdrawal symptoms have been reported in association with abrupt discontinuation of clomipramine, including dizziness, nausea, vomiting, headache, malaise, sleep disturbance, hyperthermia, and irritability. In addition, such patients may experience a worsening of psychiatric status. While the withdrawal effects of clomipramine have not been systematically evaluated in controlled trials, they are well known with closely related tricyclic antidepressants, and it is recommended that the dosage be tapered gradually and the patient monitored carefully during discontinuationInformation for Patients:Physicians are advised to discuss the following issues with patients for whom they prescribe clomipramine:The relatively high incidence of sexual dysfunction among malesSince clomipramine HCl may impair the mental and/or physical abilities required for the performance of complex and hazardous tasks and since clomipramine HCl is associated with a risk of seizures, patients should be cautioned about the performance of complex and hazardous tasksPatients should be cautioned about using alcohol, barbiturates, or other CNS depressants concurrently, since clomipramine HCl may exaggerate their response to these drugs;Patients should notify their physician if they become pregnant or intend to become pregnant during therapy;Patients should notify their physician if they are breast-feeding. There are no adequate or well-controlled studies in pregnant women. Withdrawal symptoms, including jitteriness, tremor, and seizures, have been reported in neonates whose mothers had taken clomipramine until delivery. Clomipramine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. The safety and effectiveness in children below the age of 10 have not been established. Therefore, specific recommendations cannot be made for the use of clomipramine in children under the age of 10. No unusual age-related adverse events have been identified in this elderly population, but the data is insufficient to rule out possible age-related differences, particularly in elderly patients who have concomitant systemic illnesses or who are receiving other drugs concomitantly. Patients should be warned that, while taking clomipramine, their responses to alcoholic beverages, other CNS depressants (e.
Patients should be instructed to contact their physician immediately should they develop pruritus cheap 25 mg benadryl allergy forecast richmond va, dark urine buy benadryl 25 mg visa allergy symptoms in dogs, jaundice order benadryl visa allergy testing baltimore, right upper quadrant tenderness, or unexplained "flu-like" symptoms. Patients should be instructed to call their doctor as soon as possible should they notice an increase in aggression or hostility. In the event of capsule content coming in contact with the eye, the affected eye should be flushed immediately with water, and medical advice obtained. Hands and any potentially contaminated surfaces should be washed as soon as possible. Patients should consult a physician if they are taking or plan to take any prescription or over-the-counter medicines, dietary supplements, or herbal remedies. Patients should consult a physician if they are nursing, pregnant, or thinking of becoming pregnant while taking STRATTERA. If patients miss a dose, they should take it as soon as possible, but should not take more than the prescribed total daily amount of STRATTERA in any 24-hour period. Patients should use caution when driving a car or operating hazardous machinery until they are reasonably certain that their performance is not affected by atomoxetine. CYP2D6 metabolism - Poor metabolizers (PMs) of CYP2D6 have a 10-fold higher AUC and a 5-fold higher peak concentration to a given dose of STRATTERA compared with extensive metabolizers (EMs). Laboratory tests are available to identify CYP2D6 PMs. The blood levels in PMs are similar to those attained by taking strong inhibitors of CYP2D6. The higher blood levels in PMs lead to a higher rate of some adverse effects of STRATTERA (see ADVERSE REACTIONS ). Albuterol - STRATTERA should be administered with caution to patients being treated with systemically-administered (oral or intravenous) albuterol (or other beta2 agonists) because the action of albuterol on the cardiovascular system can be potentiated resulting in increases in heart rate and blood pressure. CYP2D6 inhibitors - Atomoxetine is primarily metabolized by the CYP2D6 pathway to 4-hydroxyatomoxetine. In EMs, selective inhibitors of CYP2D6 increase atomoxetine steady-state plasma concentrations to exposures similar to those observed in PMs. Dosage adjustment of STRATTERA may be necessary when coadministered with CYP2D6 inhibitors, e. In EM individuals treated with paroxetine or fluoxetine, the AUC of atomoxetine is approximately 6- to 8-fold and Css,max is about 3- to 4-fold greater than atomoxetine alone. In vitro studies suggest that coadministration of cytochrome P450 inhibitors to PMs will not increase the plasma concentrations of atomoxetine. Pressor agents - Because of possible effects on blood pressure, STRATTERA should be used cautiously with pressor agents. Carcinogenesis, Mutagenesis, Impairment of Fertility Carcinogenesis -Atomoxetine HCl was not carcinogenic in rats and mice when given in the diet for 2 years at time-weighted average doses up to 47 and 458 mg/kg/day, respectively. The highest dose used in rats is approximately 8 and 5 times the maximum human dose in children and adults, respectively, on a mg/m2 basis. Plasma levels (AUC) of atomoxetine at this dose in rats are estimated to be 1. The highest dose used in mice is approximately 39 and 26 times the maximum human dose in children and adults, respectively, on a mg/m2 basis. Mutagenesis - Atomoxetine HCl was negative in a battery of genotoxicity studies that included a reverse point mutation assay (Ames Test), an in vitro mouse lymphoma assay, a chromosomal aberration test in Chinese hamster ovary cells, an unscheduled DNA synthesis test in rat hepatocytes, and an in vivo micronucleus test in mice. However, there was a slight increase in the percentage of Chinese hamster ovary cells with diplochromosomes, suggesting endoreduplication (numerical aberration). The metabolite N-desmethylatomoxetine HCl was negative in the Ames Test, mouse lymphoma assay, and unscheduled DNA synthesis test. Impairment of fertility - Atomoxetine HCl did not impair fertility in rats when given in the diet at doses of up to 57 mg/kg/day, which is approximately 6 times the maximum human dose on a mg/m2 basis. Pregnancy Category C - Pregnant rabbits were treated with up to 100 mg/kg/day of atomoxetine by gavage throughout the period of organogenesis. At this dose, in 1 of 3 studies, a decrease in live fetuses and an increase in early resorptions was observed. Slight increases in the incidences of atypical origin of carotid artery and absent subclavian artery were observed. These findings were observed at doses that caused slight maternal toxicity. The no-effect dose for these findings was 30 mg/kg/day. The 100-mg/kg dose is approximately 23 times the maximum human dose on a mg/m2 basis; plasma levels (AUC) of atomoxetine at this dose in rabbits are estimated to be 3. Rats were treated with up to approximately 50 mg/kg/day of atomoxetine (approximately 6 times the maximum human dose on a mg/m2 basis) in the diet from 2 weeks (females) or 10 weeks (males) prior to mating through the periods of organogenesis and lactation. In 1 of 2 studies, decreases in pup weight and pup survival were observed. The decreased pup survival was also seen at 25 mg/kg (but not at 13 mg/kg). In a study in which rats were treated with atomoxetine in the diet from 2 weeks (females) or 10 weeks (males) prior to mating throughout the period of organogenesis, a decrease in fetal weight (female only) and an increase in the incidence of incomplete ossification of the vertebral arch in fetuses were observed at 40 mg/kg/day (approximately 5 times the maximum human dose on a mg/m2 basis) but not at 20 mg/kg/day. No adverse fetal effects were seen when pregnant rats were treated with up to 150 mg/kg/day (approximately 17 times the maximum human dose on a mg/m2 basis) by gavage throughout the period of organogenesis. No adequate and well-controlled studies have been conducted in pregnant women. STRATTERA should not be used during pregnancy unless the potential benefit justifies the potential risk to the fetus. Parturition in rats was not affected by atomoxetine. The effect of STRATTERA on labor and delivery in humans is unknown. Atomoxetine and/or its metabolites were excreted in the milk of rats. It is not known if atomoxetine is excreted in human milk. Caution should be exercised if STRATTERA is administered to a nursing woman. Anyone considering the use of STRATTERA in a child or adolescent must balance the potential risks with the clinical need (see BOX WARNING and WARNINGS, Suicidal Ideation). The safety and efficacy of STRATTERA in pediatric patients less than 6 years of age have not been established. The efficacy of STRATTERA beyond 9 weeks and safety of STRATTERA beyond 1 year of treatment have not been systematically evaluated. A study was conducted in young rats to evaluate the effects of atomoxetine on growth and neurobehavioral and sexual development. Rats were treated with 1, 10, or 50 mg/kg/day (approximately 0.
The myth that alcoholism is a "psychological problem" is yielding under the weight of evidence that the disease has its roots in biological causes order benadryl pills in toronto allergy medicine used in meth. This news holds significant hope for the estimated 15 order 25 mg benadryl otc allergy latex treatment. Such discoveries may eventually lead to prevention or detection of the disease before its damage becomes irreversible cost of benadryl allergy shots and anxiety. The following characteristics of alcoholism leave little doubt as to the devastating impact of the disease:Alcoholism is a progressive disease that generally first appears between the ages of 20 and 40, although children can become alcoholics. At all ages, two to five times more males than females are heavy drinkers. For both males and females, drinking prevalence is highest and abstention lowest in the 21 to 34 age range. Among those 65 years and older, abstainers exceed drinkers in both sexes. Alcohol dependence is often associated with depression. Depression typically makes its appearance before the drinking. Studies show that, among the general population, those with diagnosable depression are at a somewhat elevated risk for development of alcoholism. Women seem also to be more sensitive to alcohol than men. When differences in weight are factored out, women still seem to get higher blood levels of alcohol from drinking--a fact that may increase their risk. It takes five to 15 years for an adult to become an alcoholic; an adolescent can become an alcoholic, by contrast, in six to 18 months of heavy drinking. Younger alcohol abusers are also more likely to die of alcohol poisoning through hypoglycemia because their livers cannot metabolize the alcohol as efficiently as the adult liver. Generally, abuse occurs in one of three patterns: regular, daily intoxication; drinking large amounts of alcohol at specific times, such as every weekend; and long periods of sobriety interspersed with binges of heavy daily drinking that last for weeks or months. As drinking continues, dependence develops and sobriety brings serious withdrawal symptoms such as delirium tremens (DTs) that include physical trembling, delusions, hallucinations, sweating and high blood pressure. Long-term, heavy drinking can cause dementia, in which the individual loses memory and the ability to think abstractly, to recall names of common objects, to use correct words to describe recognized objects or to follow simple instructions. Physical complications of chronic alcohol dependence include cirrhosis (liver damage), hepatitis, altered brain-cell functioning, nerve damage, gastritis (inflammation of the stomach), premature aging, impotence and infertility, and a variety of reproductive disorders. Some researchers suspect the hormonal imbalances caused by alcohol dependence actually fool the body into shutting off its supply of natural opiates (endorphins). Chronic alcohol dependence also increases the risk and severity of heart disease, pneumonia, tuberculosis and neurological disorders. FAS is the leading preventable cause of mental retardation in children, and studies have shown that 8,000 American babies are born with FAS each year. Researchers are discovering biological markers that could eventually identify many potential alcoholics. Preliminary studies indicate that alcoholics are born with a faulty liver enzyme system that may lead to their addiction, an encouraging twist to the existing knowledge that alcoholics do not metabolize alcohol normally. Still other studies reveal that the majority of alcoholics have abnormal brain waves and memory impairments. This appears to be true of their young children as well, even though the offspring may never have been exposed to alcohol. This makes children of alcoholics important targets for alcohol abuse prevention efforts. For comprehensive information on substance abuse, visit the Addictions Community. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. National Council on Alcoholism and Drug Dependence, Definition of Alcoholism Fact Sheet. NIMH, National Institute on Drug Abuse, Substance Abuse Fact Sheet. If you feel you may be suffering from a mental illness, we urge you in the strongest terms to seek the advice of an experienced mental health professional - a psychologist or psychiatrist. Psychologists hold graduate degrees and practice "talk therapy". Although general practitioners - regular medical doctors - may legally prescribe antidepressants and other medications, most do not have the training or experience to diagnose and treat the more serious mental illnesses. If left untreated, a mental illness can cause permanent damage. For instance, besides the kindling (a process in which the brain becomes increasingly sensitive to stress and eventually begins to show episodes of abnormal activity even in the absence of a stressor) that occurs with untreated manic depression, there is the damage that bad decisions or the inability to maintain relationships can do to your life. If you get severely depressed, there is the danger of suicide. It is much easier to deal with a mental illness before you become desperately ill. Look at it this way: an office visit is much cheaper than a hospital stay. In a case like that, there is the danger that antidepressants may cause one to become manic. A person who is thinking or talking about suicide or homicide should seek help immediately. Having only one or two of the problems listed below is not necessarily cause for alarm. A combination of symptoms, however, is a signal for professional intervention. The child seems overwhelmed and troubled by his or her feelings, unable to cope with them. The child seems constantly preoccupied, worried, anxious, and intense. The child has fears or phobias that are unreasonable or interfere with normal activities. The child is having difficulty mastering school work. Teachers suggest that the child may have a learning disability or other type of school-related problem. The child tries to stimulate himself or herself in various ways. Examples of this kind of behavior include excessive thumb sucking or hair pulling, rocking of the body, head banging to the point of hurting himself, and masturbating often or in public.
There is a major difference between True Self and reflected-self buy genuine benadryl line allergy sore throat. Loving your True Self is a healthy benadryl 25 mg on line allergy medicine every nights, adaptive and functional quality purchase benadryl overnight delivery allergy like symptoms. One depends on the existence and availability of the reflection to produce the emotion of self-love. The absence of a "compass", an "objective and realistic yardstick", by which to judge the authenticity of the reflection. In other words, it is impossible to tell whether the reflection is true to reality - and, if so, to what extent. The popular misconception is that narcissists love themselves. He who loves only impressions is incapable of loving people, himself included. But the narcissist does possess the in-bred desire to love and to be loved. If he cannot love himself - he must love his reflection. Thus, driven by the insatiable urge to love (which we all possess), the narcissist is preoccupied with projecting a loveable image, albeit compatible with his self-image (the way he "sees" himself). The narcissist maintains this projected image and invests resources and energy in it, sometimes depleting him to the point of rendering him vulnerable to external threats. To a narcissist, love is interchangeable with other emotions, such as awe, respect, admiration, attention, or even being feared (collectively known as Narcissistic Supply). Thus, to him, a projected image, which provokes these reactions in others, is both "loveable and loved". The more successful this projected image (or series of successive images) is in generating Narcissistic Supply (NS) - the more the narcissist becomes divorced from his True Self and married to the image. I am not saying that the narcissist does not have a central nucleus of a "self". All I am saying is that he prefers his image - with which he identifies unreservedly - to his True Self. The narcissist, therefore, is not selfish - because his True Self is paralysed and subordinate. The narcissist is not attuned exclusively to his needs. On the contrary: he ignores them because many of them conflict with his ostensible omnipotence and omniscience. He does not put himself first - he puts his self last. He caters to the needs and wishes of everyone around him - because he craves their love and admiration. It is through their reactions that he acquires a sense of distinct self. In many ways he annuls himself - only to re-invent himself through the look of others. He is the person most insensitive to his true needs. The narcissist drains himself of mental energy in this process. This fact, as well as his inability to love human beings in their many dimensions and facets, ultimately transform him into a recluse. His soul is fortified and in the solace of this fortification he guards its territory jealously and fiercely. He protects what he perceives to constitute his independence. His convoluted mind comes up with the most elaborate contraptions in lieu of answers. Why should people indulge the narcissist, divert time and energy, give him attention, love and adulation? He feels that he deserves whatever he succeeds to extract from others and much more. Actually, he feels betrayed, discriminated against and underprivileged because he believes that he is not being treated fairly, that he should get more than he does. There is a discrepancy between his infinite certainty that his is a special status which renders him worthy of recurrent praise and adoration, replete with special benefits and prerogatives - and the actual state of his affairs. To the narcissist, this status of uniqueness is bestowed upon him not by virtue of his achievements, but merely because he exists. Herein lies a paradox, which haunts the narcissist: he derives his sense of uniqueness from the very fact that he exists and he derives his sense of existence from his belief that he is unique. Clinical data show that there is rarely any realistic basis for these grandiose notions of greatness and uniqueness. Some narcissists are high achievers with proven track records. Still, they are ridiculously pompous and inflated personalities, bordering on the farcical and provoking resentment. The narcissist is forced to use other people in order to feel that he exists. It is trough their eyes and through their behaviour that he obtains proof of his uniqueness and grandeur. With time, he comes to regard those around him as mere instruments of gratification, as two-dimensional cartoon figures with negligible lines in the script of his magnificent life. He becomes unscrupulous, never bothered by the constant exploitation of his milieu, indifferent to the consequences of his actions, the damage and the pain that he inflicts on others and even the social condemnation and sanctions that he often has to endure. When a person persists in a dysfunctional, maladaptive or plain useless behaviour despite grave repercussions to himself and to others, we say that his acts are compulsive. The narcissist is compulsive in his pursuit of Narcissistic Supply. This linkage between narcissism and obsessive-compulsive disorders sheds light on the mechanisms of the narcissistic psyche. The narcissist does not suffer from a faulty sense of causation. He is not oblivious to the likely outcomes of his actions and to the price he may have to pay. The narcissist lives in a world of all or nothing, of a constant "to be or not be". Every discussion that he holds, every glance of every passer-by reaffirms his existence or casts it in doubt.
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