Outline the clinical characteristics of depression

Outline the clinical characteristics of depression The clinical symptoms of depression are characterised by an all-encompassing sadness, composed of a remarkably broad range of feelings, thoughts, and physical manifestations. These include low self-esteem, suicidal thoughts, pessimism, and feelings of dejection and hopelessness. Most sufferers will experience sleep disturbance and a loss of appetite and libido. All of these symptoms are usually accompanied by overwhelming tiredness, a lack of interest or enjoyment, guilt feelings, crying spells and social withdrawal. Other common features are psychomotor retardation (general slowing down physically), loss or motivation, and feelings of inadequacy and helplessness. There is often a diurnal mood variation (sufferers may feel worse either in the mornings or in the evenings). See table below for a more detailed explanation of the behaviours associated with depression. Affective Physiological Cognitive Behavioural Anger Abdominal pain Ambivalence Aggressiveness Anxiety Anorexia Confusion Agitation Apathy Backache Inability to concentrate Alcoholism Bitterness Chest pain Indecisiveness Altered activity level Denial of feelings Constipation Loss of interest and motivation Drug addiction Dejection Dizziness Self blame Intolerance Guilt Fatigue Self- depreciation Irritability Helplessness Headache Self- destructive thoughts Lack of spontaneity Hopelessness Impotence Pessimism Overdependence Loneliness Indigestion uncertainty Poor personal hygiene Low self-esteem Lassitude Psychomotor retardation Sadness Menstrual changes Tearfulness Sense of personal worthlessness Nausea Underachievement Sexual non responsiveness Withdrawal Sleep disturbances Vomiting Weight changes Give two or more physiological causes of depression The cognitive model Of the causes of depression proposes that people experience symptoms of depression because their thinking is disturbed. Depression is a cognitive problem that is dominated by the persons negative evaluation of themselves, their world and their future. In the course of their development certain experiences sensitize the individual and make them vulnerable to depression. They also acquire a tendency to make extreme, absolute judgments; loss is viewed as irrevocable and indifference as total rejection. The depression prone person is likely to explain an adverse event as a personal shortcoming. `The deserted husband believes she left me because Im unlovable. Instead of considering the other possible alternatives, such as personality incompatibility, the wifes own problems, or her feelings towards him. As he focuses on his personal deficiencies, they expand to the point where they completely dominate his self concept. He can think of himself only in a negative way and is unable to acknowledge his other abilities, achievements, and attributes. This negative set is reinforced when he interprets ambiguous or neutral experiences as additional proof of his deficiencies. Comparisons with other people further lower his self-esteem. And thus every encounter with others becomes a negative experience. His self-criticisms increase as he views himself as deserving of blame. (Beck) In the cognitive model of depression, it is thought that many cases develop through early life experiences, where parents have been excessively critical, the child may internalise the impact rule that being valued only comes from perfect performance. This assumption may become latent or silent during parts of adult life, where any endeavours are met with a reasonable degree of success. Thus, prior to becoming depressed, the person had by unrelenting hard word, managed to live up to the excesses of their conditional belief however, any notable failures activate the latent assumption and the person becomes sensitised to any signs of falling short of their perfectionist standard. A common factor that interferes with the application of the cognitive model apparently disparate presentations of persistent depression is avoidance. In persistent depression avoidance can serve to mask negative thinking patterns or inhibit the effect of negative thoughts on mood. On occasions, negative thinking may be overt or apparent due to such avoidance. Pinpointing such avoidance in persistent depression is often prerequisite to identifying negative thoughts. The behavioural model The behavioural explanation of the causes of depression is based on the view that abnormality is seen as the result of learning from the environment. In other words depression is a response to life experiences and stressors. Disturbances of mood are a specific response to stress. There are two major types of stress that a person may experience. The first is the stress of major life events that are evident to others. The second type of stress may not be obvious at all to others, but it is the minor stress or irritations of daily life. These are the small disappointments, frustrations, criticisms, and arguments that when accumulated over time and in the absence of compensating positive events produce a major and chronic negative impact. It is appropriate, therefore, to examine in more detail some of the sources of life stressors that may produce disturbances of mood. Four such, sources include major life events, roles, coping resources, and physiological changes. Major life events (Hol mes and Rahe) did the pioneering work in this area with the development of social readjustment rating scale. Rank Life event Mean value 1 Death of spouse 100 2 Divorce 73 3 Marital separation 65 4 Jail term 63 5 Death of close family member 63 6 Personal injury or illness 53 7 Marriage 50 8 Fired at work 47 9 Marital reconciliation 45 10 Retirement 45 11 Change in health of family member 44 12 Pregnancy 40 13 Sex difficulties 39 14 Gain of new family member 39 15 Business readjustment 39 16 Change in financial state 38 17 Death of close friend 37 18 Change to different line of work 36 19 Change in number of arguments with spouse 35 20 Mortgage over 10,000 31 21 Foreclosure of mortgage or loan 30 22 Changes in responsibilities at work 29 23 Son or daughter leaving home 29 24 Trouble with in-laws 29 25 Outstanding personal achievement 28 26 Wife begin or stop work 26 27 Begin or end school 26 28 Change in living conditions 25 29 Revision of personal habits 24 30 Trouble with boss 23 31 Change in work hours or conditions 20 32 Change in residence 20 33 Change in school 20 34 Change in recreation 19 35 Change in church activities 19 36 Change in social activities 18 37 Mortgage or loan less than 10,000 17 38 Change in sleeping habits 16 39 Change in number of family get- togethers 15 40 Change in eating habits 15 41 Vacation 12 42 Christmas 12 42 Minor violations of the law 11 The scale ranks important life events and assigns a specific value to each one on the basis of the amount of coping behaviour needed by the individual to deal with the event. As the score of the mean value increases, the likelihood of an illness increases. The behavioural model overcomes the ethical issues raised by the medical model of labelling someone as `ill or abnormal, instead the model concentrates on behaviour and whether it is adaptive of maladaptive. Those who support the psychodynamic model, however, claim the behavioural model focuses only on symptoms and ignores the cause of abnormal behaviour they claim that the symptoms are merely the tip of the iceberg, the outward expression of deeper underlying emotional problems. Coping resources Life stress may also take the form of inadequate coping resources. Personal resources available to individuals include their socioeconomic status (income, occupation, social position, and education), families (nuclear and extended), interpersonal networks, and the secondary organizations provided by the broader social environment. The far-ranging effects of poverty, discrimination, inadequate housing, and social isolation cannot be ignored or taken lightly. Physiological changes Disturbances in mood may also occur as a response to physiological changes produced by drugs or a wide variety of physical illnesses. Drug- induced depressions have been noted to occur following treatments with various antihypertensive drugs and the abuse of addictive substances, such as amphetamines, and barbiturates. Depression may also occur, secondary to a wide variety of medical illnesses, for example viral infections, nutritional deficiencies, endocrine disorders, anaemias, and central nervous system disorders, such as multiple sclerosis, tumours, and cerebral vascular disease. Evaluate psychodynamic therapy in treatment of depression in terms of its strengths and weakness Psychodynamic therapy is a generic term that embraces all those therapies of an analytic nature. Probably the majority of psychodynamicists adhere to work and teaching of Freud. But also in this group you will find therapy based on ideas of various other psychologists including Jung and Adler. In this type of therapy, the therapist keeps his own personality out of the picture. This vital aspect of psychodynamic psychotherapy and it enables the therapist to be like a blank canvas onto which patients can transfer and project deep feelings about themselves, their parents and other significant people in their life. It is then up to the therapist to handle all the feelings and information that emerge, to gradually help patients to deal with all this `baggage. In this way the therapists helps patients gain a better understanding of what their disturbances are and how their mind works. The term psychodynamic refers to a group of explanations that try to account for the dynamics of behaviour i.e. the forces that motivate behaviour. Freuds revolutionary theory was that depression does not have a physical cause, but instead arises from unresolved, unconscious conflicts which form in early childhood. This model is based on Freuds theory of psychosexual development. A child passes through a series of stages (oral, anal, phallic, latency, and genital) if there is a major conflict at any of these stages, the child can spend an unusually long time at that developmental stage (called fixation) if and adult experiences great personal problems, he or she will tend to show regression (going backwards through the stages of psychosexual development) to the stage at which he or she had previously been fixated. The prime goal of therapy is to enable patients to gain access to their repressed ideas and conflicts, and to encourage them to face up to whatever pops out from the unconscious mind. Freud initially used hypnosis as a means of accessing repressed memories but later turned to the analysis of dreams and technique of free association, where a client is encouraged to say the first thing that comes in to his or her mind. The strengths of psychodynamic therapy is that it identifies traumatic childhood experiences as a factor in the development of depression in later life. A weakness of this type of therapy is that the therapist may appear disinterested in the clients current problems. A depressed patient wants to talk about themselves now as opposed to then. Another weakness to the Freudian approach is that it tends to focus too much on sex, and does not emphasise the importance of interpersonal and social factors in causing and maintaining depression. A patient must have the right to approve or disapprove of any treatment programme and a depressed patient may well have fears and doubts about laying their soul to bear to a stranger. Another ethical implication of this type of therapy is that patients may not take any responsibility for their illness depends on unconscious processes over which they have no control. In addition, the idea that adult mental illness is based in childhood experiences implies that parents are at least partially to blame. Is it ethical to cause distress to parents by suggesting that they are responsible for their childs menta l illness? Serious ethical issues are raised by numerous recent cases of false memory syndrome, where patients in therapy have made allegations about childhood physical or sexual abuse which may or may not be true. Freud believed that men and women have their own biologically determined sexual natures, and depression can develop when the natural course of their sexual development is thwarted. This notion is ethically dubious, as it ignores cultural differences in sexual attitudes and behaviour. Outline the clinical characteristics of Schizophrenia Although the popular concept of split personality is still common the reality of Schizophrenia is far more complex. The two most frequently found elements of the illness are delusions and hallucinations. Bizarre delusions are common. The content of these delusions is patently absurd and has no possible basis in fact, such as delusions of being controlled, thought broadcasting or thought insertion. Suffers often report grandiose or religious delusions or beliefs about themselves having physical symptoms which do not in fact exist. They may feel persecuted or irrationally jealous. A particularly distressing symptom consists of auditory hallucinations in which either a voice keeps up a running commentary on the individuals behaviour of thoughts, or two or more voices converse with each other. To the outsider the sufferer may appear incoherent, blinded or even catatonic. There is a marked deterioration from their previous level of functioning in such areas as work, social relations and self care. Below is a list of symptoms from American Psychiatric Association: Diagnostic and statistical manual of mental disorders, third edition, Washington, D.C, APA, 1980. Social isolation or withdrawal Marked impairment in role functioning as wage earner, student, or homemaker Marked peculiar behaviour (e.g., collecting garbage, talking to self in public, or hoarding food) Marked impairment in personal hygiene and grooming Blunted, flat, or inappropriate affect Digressive, vague, over elaborate, circumstantial, or metaphorical speech Odd or bizarre ideation, or magical thinking, e.g., superstitousness, clairvoyance, telepathy, sixth sense, others can feel my feelings, overvalued ideas, ideas of reference Unusual perceptual experiences, e.g., recurrent illusions, sensing the presence of a force or person not actually present. Give two or more psychological (psychodynamic/behavioural/cognitive) expiations of Schizophrenia Psychodynamic Psychoanalytical theory states that Schizophrenic behaviour results when the ego can no longer withstand the pressures emanating from the id and from external reality. The ego of the psychotic person struggles to cope with stress because of serious deficiencies in the relationship between the person as a child and his mother. When the person is anxious and stressed he employs ego defence mechanisms in an unhealthy way in an effort to control unacceptable impulses and thoughts. Take for example a man or woman with paranoid delusions. So much psychic energy is invested in holding down these terrible thoughts and impulses that there is little energy left to deal with normal daily living. The person withdraws from usual activities and has difficulty maintaining basic physiological needs such as nutrition and hygiene. If stress and anxiety gets even worse, ego functioning may deteriorate further, and the person will be flooded with frightening thoughts and impulses. As ego identity disint egrates communication is confused and garbled, and the person is alone in their own world. According to Freud, schizophrenia is a form of regression, back to the oral stage of development; the oral stage is the first stage of psychosexual development. A baby is born a bundle of id, is self indulgent and concerned only with a satisfaction of their needs. There is a need gratify these impulses but their experiences in the real world result in conflict, people with schizophrenia are overwhelmed by anxiety because their egos are not strong enough to cope with id impulses in schizophrenia, this can lead to self indulgent symptoms such as delusions, such as hearing voices which may have an ultimate authority. It has been suggested that schizophrenia has a psychosomatic cause the origin is solely in the mind. At best it could only be a partial explanation of some symptoms, e.g. delusions. In reality Freud is denying the experience of patients with schizophrenia, it is unscientific and extremely difficult to test. Concepts such as repression are difficult to observe and measure, although this difficulty does not invalidate the theory. The theory is based on unrepresentative samples, case studies, from which it is difficult to generalise. The theory fails to account for gender differences the onset for males is around 20 years, and for females 30 years. Nor does the theory explain why, prior to diagnosis, their behaviour has appeared normal. Furthermore, it also excludes considerations of the environment. A concise explanation of Schizophrenia was given by O.A. Will in his 1961 study of Human relatedness and the schizophrenic reaction. The expression of complicated patterns of behaviour adopted by the organism in an effort to deal with a gross inadequacy in relating to other humans. The Behavioural explanation Schizophrenia can evolve as the results of various experiences that influence the growth of the individual. In most instances a series of life events predisposes the individual to difficulty with interpersonal relationships. The family is the unit within which the first experiences with closeness to others take place. Lack of maternal stimulation or attention deprives the infant of a sense of security and there is failure to establish basic trust. This can lead to a suspicious attitude toward others that may continue throughout life. The quality of mothering attention is also important. A child may be adequately fed and receive impeccable physical care but without any communication of maternal caring. A child who is treated like an object may well become an adult who treats others like objects. Family communication patterns may also be stressors leading to disruptions in relationships. Patients with a medical diagnosis of schizophrenia are frequently members of families with identifiably disturbed communication patterns. Relationship problems frequently become manifest in the symptomatic behaviour of one family member. This deviant behaviour develops when the family is subjected to intolerable levels of stress. A family member who actscrazy may serve the function of keeping the family system intact. For example, if there is a family rule that hostility is never expressed directly between family members, and the parents are involved in a conflict which they may not confront, tension will build up within the family system. One of the children may respond to this tension by acting crazy and performing destructive acts in the home. Evaluate cognitive behavioural therapies in the treatment od schizophrenia in terms of its strengths and weakness Cognitive behavioural therapy is a kind of psychotherapy which aims to change the way that people think about their problem and thus alters the effects of the problem itself. One specific example is stress inoculation training, which is a technique to reduce stress through the use of stress management techniques, and self statements that aim to restructure the way the person thinks. A second example is increasing hardiness, which is building up in the patient a cluster of traits possessed by those people best able to cope with stress. The main strength of C.B.T in the treatment of schizophrenia is that it gives more power, choice, and responsibility for their treatment to a group of patients who have traditionally had things done to them, for example in the form of medication, social skills training and even ECT. There is no doubt that distorted and irrational beliefs and this treatment targets abnormal thinking. The purely cognitive approach grew out of dissatisfaction with the behavioural model and its emphasis on purely external factors. It emphasised internal mental influences and the power of the individual to shape their own thinking. Recently the two approaches have been integrated, so CBT treatment deals with maladaptive behaviours as well as distorted thoughts and beliefs. The weakness of this therapy is that it can be seen as rather limited genetic factors are ignored, and not much attention is paid to the role of social and interpersonal factors or of individuals life experiences in producing schizophrenia. Discuss the ethics of cognitive behavioural therapy Because the cognitive approach to therapy concentrates on the concept that mentally ill people have distorted thoughts and beliefs, it follows that sufferers of schizophrenia may feel that their illness is their own fault. This raises some ethical issues. Patients will be even more stressed if they have to take responsibility for their illness. It is unfair to blame patients for being ill, because their families may be mainly responsible, since it may be that maladaptive experiences in adulthood are based in childhood experiences, over which the sufferer has no control. It is even more striking to understand that the negative thoughts and beliefs of patients could be rational, and reflect the awful circumstances of the way they live in other words, if the patient feels blame they are unlikely to contemplate change. Outline the characteristics of one eating disorder (Bruch .H. The golden cage: the enigma of anorexia nervosa 1978) Perception is also an important aspect of the behaviour of young people with anorexia nervosa. These people perceive that they are fat and literally starve themselves to achieve their goal of being thin. However, because of the distortion in body image that they experience, the goal is unattainable. Even when emaciated to the point that their appearance is skeletal, they will maintain that they are fat and persist in their attempt to lose weight. Bruch describes the typical anorexic process as `beginning with a diet. Initially, the dieter experiences a sense of deprivation and difficulty in maintain the restrictions. However, she then enters a stage of pride in her accomplishment and this perpetuates the behaviour. At the same time, biological effects of starvation cause distortions in perception of body sensations. There is a heightening of sensory experience and a feeling that has been compared to intoxication. As the condition progresses, the patient begins to feel special and different because of her superhuman effort and extraordinary accomplishment. These results in her alienation and isolation from others who fail to understand her behaviour and its meaning to her. She is then becomes increasingly absorbed in her own world and her behaviour assumes even greater importance to her. Anorexia nervosa is really a misnomer. Anorexia means lack of appetite. People with anorexia nervosa do experience hunger, and it is the victory over hunger that provides their reward. Anorexics are often fascinated with food and cooking, becoming students of nutrition. They may compulsively loiter in places where food is sold or served and watch other people eat. Their life becomes centred on food and the avoidance of eating. Anorexics go to extremes to avoid weight gain. They will induce vomiting, take diuretics and laxatives, and exercise strenuously. Many other physical changes are common in anorexic women, including amenorrhea (periods stopping), lanugo (extra body hair especially facial), and bradycardia (heart problems). Another eating disorder that is similar in some respects to anorexia nervosa is bulimia. The bulimic person experiences episodes of binge eating, frequently followed by vomiting. Binge eating is compulsive intake of food that is stopped only when the person vomits, experiences pain runs out of food, or is interrupted. It is differentiated from anorexia nervosa by the fact that severe weight loss is not generally seen and the individual is well aware that their behaviour is abnormal. Bulimics are usually able to maintain a more normal weight by alternating binging and vomiting or by eating very little between binges. Give two or more psychological explanations of eating disorders Psychodynamic Eating disorders usually begin in adolescent girls (90% of sufferers are female). This may suggest that this coincides with the onset of sexual development and sexual fears. Psychodynamic theorists have suggested that an adolescent girl may be terrified by their own feelings of sexual desire, or a fear of becoming pregnant, or even (and this may seem farfetched but is based on ignorance of the facts of life) of a fear of becoming pregnant by oral sex. If eating is mentally links in adolescent to getting pregnant, then starving herself will prevent pregnancy. It also stops menstruation so ovulation stops so no pregnancy. Another psychodynamic explanation of eating disorders is that some adolescent girls are afraid of growing up and have an unconscious desire to remain pre-pubescent. If they lose a lot of weight their bodies will not develop normally and they can hang on to the belief that they are still children. Finally, some patients who present with eating disorders were victims of sexual abuse as children. Consequently they hate their bodies and may even self-harm. There is a theory, supported by Minuchin, Roseman, and Baker (1978) that eating disorders may be firmly rooted in family dynamics. The term enmeshment is used to describe a family where there is no space for the personal independence of the child family members all seem to do everything together. Adolescence should be a time when the child develops their independence. If they cannot do this the anorexic adolescent may rebel by refusing to eat. Families which are enmeshed like this find it difficult to sort out conflicts (Minuchin et al.1978). In the theory of psychodynamics such families create anxiety. This is where ego-defences come in; parents unable to cope with their anxiety put the blame (unconsciously) on the anorexic child herself. Parental conflicts are common in families of both anorexics and bulimics (Kalusy, Crisp, and Harding 1977). This research came to the conclusion that families with an anorexic child tend to be ambitious, to deny or ignore conflicts, and blames othe r people for their problems. Behavioural The psychological theory of classical conditioning teaches us a great deal about the development of anorexia. These sufferers associate eating with anxiety they associate losing weight with avoiding bad thoughts and feelings (Leitenberg, Agras, and Thompson (1968)). The other relevant psychological theory is operant conditioning. The anorexic gets pleasure from gaining attention. It is also rewarding or re-enforcing because slim people are considered more attractive than fat ones. Similarly, there is a behavioural explanation of bulimia. When a bulimic binges it causes them anxiety, so when they vomit they revise the situation and their anxiety is reduced. This reduction in anxiety makes the person feel better, so the cycle of bingeing followed by vomiting is maintained. (Rosen and Leitenberg 1985). Discuss the ethics of behavioural therapies The term is used when considering moral behaviour among professionals, such as behavioural therapists. Certain things may be less acceptable than others, but if the ultimate end is for the good of the patient, then we may feel than an undesirable behaviour is acceptable. A psychiatric ward full of patients with eating orders can be one of the most depressing places on earth. Behavioural therapy usually involves giving patients targets and rewards regarding their consumption of food and drink. Patients with eating disorders can be distressed, stubborn, and frightened; the behavioural programmes developed for their recovery are often unwelcome and in themselves cause anxiety. There are major ethical issues occurring on a daily basis can staff force people to eat against their will? What of the rights of these individuals to be treated in a caring and respectful way? I doubt that loss of privileges constitute a caring and respectful way of helping a disturbed patient who refuses to eat. The issues of informed consent and the protection of patients from harm are huge points of conflict in the therapeutic treatment of people with eating disorders.

Economic Country Analysis For Poland Economics Essay

Economic Country Analysis For Poland Economics Essay 1. Introduction: Today with a GDP of 2,7% (2010 figure projected by European Commission) Poland is one of the fastest growing European economies. The country suffered relatively little from the recent financial crisis in the world markets due to a large internal demand for consumer goods from the growing middle class and low level of household debt compared to its western peers. In addition there has been almost no exposure to sub-prime mortgage product, the country did however suffer from lower demand for its export products. (European Commission, 2009) The Polish state went through a major transformation since it abolished communism in 1989. It joined NATO in 1999, and the European Union in May 2004. With a population of 38.1 million it is the 6th most populated country in the EU. Polands capital is Warsaw and it has a population of around 2 million inhabitants. Poland has an area of 312,678 sq km and is geographically located in the heart of Europe between Germany and Russia. Polands strategic geographic position has been a source of conflicts and for many centuries, currently its attracting foreign direct investment as it is the EUs gateway to the east. (GUS, 2010) Despite steady economic development Poland still has a large development gap to close compared with countries such as Germany or Britain. Currently the GNI per capita is $11,880 (World Bank, 2008). It is expected to join the Euro zone in 2012-2014. Countrys main export products are: foodstuffs, machinery, transportation equipment and chemicals. Polands political situation is stable with a liberal pro reforms government in office. One last thing to keep in mind is that the Catholic Church plays an important role and despite the fact that it is formally separated from the state it does have a large impact on the social policy. The aim of this report is to look at Polands economy from a broad international investors perspective and give some recommendations whether it is a good destination for investment. 2. Factual description Political and social situation The political stage in Poland has been shocked by the crash of the government plane in April 2010 where countrys residing president, Lech Kaczynski, and many prominent politicians have died. Despite the tremendous scale of the tragedy the markets have been largely intact indicating investors confidence in the Polish economy. The political system can be described as a mix of parliamentary and presidential with a somewhat dominant position of the legislative branch. President Kaczynskis death forced a new presidential election where Bronislaw Komorowski, previous speaker of the parliament and a prominent politician of Civic-Platform, came out victorious in the second round having defeated ex-Presidents twin brother and leader of the parliamentary opposition Jaroslaw Kaczynski. Mr Komorowski is closely connected with the center Civic Platform-led government which suggests that the Prime Minister, Donald Tusk, will be more capable of introducing new reforms. Because Poland has traditional had a largely fragmented multiparty system, the current government is a coalition between the above mentioned Civic Platform and PSL. The international investors should welcome recent changes in the political environment both the legislative and executive branch of the government are largely open to friendly political and economic relations with both the EU and its biggest neighbour Russia. Poland is the only EU country to start its recovery without having fallen into recession, and we expect a continued gradual strengthening of growth in 2010-2011. (Eastern European outlook, 2009) Economic structure and growth According to the European Commission, in 2010 Poland will be the fastest developing country in the EU. Strong economic performance should continue throughout 2011 when Poland is expected to remain amongst the fastest growing economies in Europe (Business news, 2010). Nowadays polish economy is well diversified. The traditionally dominant agricultural sector currently contributes 5% of GDP while, it is a large beneficent of the CAP policy and requires major improvements in its production efficiency. The industrial sector of the economy makes up 30% of the GDP. The sector is mainly concentrated around food processing industries, the automotive industry (the biggest brands Deawoo and Fiat) and labor-intensive processes such as textiles and clothing industry. Polands highly educated work force and relatively low labor prices have attracted investment from many international companies. Especially German firms with labor-intensive processes have moved to Poland to benefit from lower wages . Increasing wages are expected to incentivize these firms to move on to other low-wage countries. While this may sound like bad news, the good news is that Poland is now seen as a destination for knowledge intensive businesses with higher profit margins. With one of the largest internal markets in the EU, Poland is a heavyweight both within the region and the Community. Poland has a relatively closed economy, with a relatively well balanced import and export structure slight dominance of imports. Polands GDP growth is expected to reach 2.7% in 2010 and 3.3% in 2011. (such prognoses for Polands economy were presented on May 5th, 2010 by the European Commission) In 2008 unemployment fell to 9.8% (a historic low), but climbed back to 11% in 2009, and remains above the EU average. Inflation for 2008 reached 4.3%, more than the upper limit of the National Bank of Polands target range (3%), but fell to 3.4% in 2009 due to global economic slowdown. If Poland wants to sustain its rapid economic development and attract both development of regional business and foreign investment it needs to address several issues: simplify laws and lower the time required to form new businesses, streamline its rigid labour code, improve the efficiency of its commercial court system. Furthermore, the state has to address the issues of growing spending on the health care and pension systems. These areas cripple the budget and Poland has a budget deficit little beyond 3% of GDP. One of the reasons the state faces these issues is negative population growth and aging society a problem Europe is largely familiar with. (Theodora, 2010) Country Forecast Overview (3 Year) Key Indicators 2009 2010 2011 Real GDP Growth (%) 1.70 3.10 3.40 Consumer Price Inflation (av;%) 3.45 2.50 2.30 Budget Balance (% of GDP) -1.77 -3.00 -2.80 Current-Account Balance (% of GDP) -1.67 -3.00 -3.40 Exchange Rate US$:Euro (av) 3.12 3.12 3.14 Exchange Rate US$:Euro(year-end) 2.85 3.13 3.10 Source: Country Forecast Poland May 2010 Country Forecast Overview (3 Year) Key Indicators 2009 2010 2011 Real GDP Growth (%) 1.70 3.10 3.40 Consumer Price Inflation (av;%) 3.45 2.50 2.30 Budget Balance (% of GDP) -1.77 -3.00 -2.80 Current-Account Balance (% of GDP) -1.67 -3.00 -3.40 Exchange Rate US$:Euro (av) 3.12 3.12 3.14 Exchange Rate US$:Euro(year-end) 2.85 3.13 3.10 Source: Country Forecast Poland May 2010 Year GDP in Billions of USD PPP % GDP Growth 2005 518.00 3.65 2006 567.48 6.27 2007 623.43 6.86 2008 668.58 5.00 2009 688.69 1.70 Source: EIU Country Data 2009 2008 GDP (purchasing power parity) $686.2 billion $678.8 billion GDP per capita (PPP): $17,800 $17,600 Labor force: 16.99 million Unemployment rate: 11% 9.8% Investment (gross fixed): 20.7% of GDP Public debt: 47.5% of GDP 45.2% of GDP Inflation rate (consumer prices): 3.4% 4.2% GDP composition by sector (2009): agriculture: 4.6% industry: 28.1% services: 67.3% Labor force by occupation (2005): agriculture: 17.4% industry: 29.2% services: 53.4% Export / import structure Polands geographical position between the developed Western states and the emerging markets of Eastern Europe (Russia, Ukraine and perhaps Belorussia in the future) makes it a strategic location for exporting industries trying to access high demand consumer markets (Lopez, 2009). Polish main agricultural products are: potatoes, fruits, vegetables, wheat; poultry, eggs, pork. Major industrial sectors are: machine building, iron and steel, coal mining, chemicals, shipbuilding, food processing, glass blowing, beverages, textiles. Polands exports in 2009 (est.) equaled $134.7 billion down from $178.4 billion in 2008. The export structure by products is as follows: machinery and transport equipment 37.8%, intermediate manufactured goods 23.7%, miscellaneous manufactured goods 17.1%, food and live animals 7.6%. The export structure by destination is: Germany 24.9%, France 6.2%, Italy 6%, UK 5.7%, Czech Republic 5.6%, Russia 5.3% (2008) Polands imports in 2009 reached $141.7 billion (est.), significantly below the $204.4 billion for 2008. The imports structure by products is as follows: machinery and transport equipment 38%, intermediate manufactured goods 21%, chemicals 14.8%, minerals, fuels, lubricants, and related materials 9.1%. The imports structure by trading partner is: Germany 28.3%, Russia 9.9%, Italy 6.2%, Netherlands 5.4%, France 4.8%, China 4.5%, Czech Republic 4% (2008) (Source: CIA WorldFactbook, 2010 ) Budget (2009): revenues: $83.68 billion expenditures: $93.47 billion Fiscal policy The direction of fiscal and monetary policies is largely influenced by the European Union and Polands ambition to join the Euro-zone. Adopting of the single currency requires the state to reform the public finance and curb the inflation and budget deficit in line with guidelines of the ERM II. The government had a deadline in mind to join the Euro-zone in 2012 however due to the global financial crisis it has been rumored that the date may be pushed back to 2013-2014. Before this happens Polands constitution needs to be amended and the budget balance has to be brought back to 3% of GDP. (Europa Press releases, 2009) Fight with the fiscal deficit is made difficult by the fact that currently around 66% of the spending is fixed with major portion of the funding going to social security/pension schemes and wages in the public sector. Over the next two years the fiscal deficit is projected to oscillate around 3-4%. On the positive side the government has proposed a tightening of its budget in July 2010 and hopes to benefit from the expected rise in the economic cycle. What may worry potential investors is that the upcoming parliamentary elections will incentivize the government to postpone and budget cuts until it secures a second turn. Another issue is the public debt level. This is especially a hot topic due to the situation in Greece. Polands public debt level has stabilized over past 5 years due to strong economic growth, in 2008 it has slightly exceeded 45% of the GDP and by the end of 2010 should be just below 50% of GDP. While this is still an acceptable level as Maastricht treaty has set the limit at 60%, it should be kept in mind that going beyond 50,55,60% will trigger more strict targets for fiscal restraint. (The Market Oracle, 2009) Monetary policy The main goal behind the monetary policy in Poland is to contain the inflation within the 2.5% +/- 1% target band. The National Bank of Poland has lowered the policy rate from a high of 6% in October 2008 to 3.5% in June 2009 in an attempt to stimulate the economy (Reintje Maasdam, 2009). The gradual appreciation of the Zloty (since March 2010) aids monetary loosening. However, as inflation remains stubbornly high, the NBP is reluctant to cut rates further. Moreover, if the interest-rate differential with the euro zone and Switzerland is narrowed too much, this could push the zloty down again. 2009 and in 2010, the slowing economy will curb wage growth with a disinflationary effect, while the strengthening zloty will also help to keep inflation in check. Inflation is expected to be around 2.5% in 2010. The zloty responded strongly to the risk aversion to Eastern Europe. 3. Analysis of factors influencing the business environment Thanks to largely limited exposure to subprime mortgages, consistent fiscal and monetary policy, large internal market and low level of household debt, Poland was more immune to the turbulence on the world markets than other members of the European Community. Poland was the only state in the EU in 2009 to report a positive economic growth of 1,8% GDP. source: Data from Central Statistical Office  as of  31.05.2010  and Eurostat as of 12.05.2010.   Poland currently is the main recipient of EU cohesion funds, with EU transfers set to reach an annual average of 3.3% of GDP in the coming years (Katarzyna Szulc, 2008). This should allow for major investment in infrastructure including railway, highways and new airports, which will in turn help attract large inward FDI flow. This is all good news for the investors, especially if we keep in mind that there are major investments made due to the preparations for 2012 Euro Cup. Postponing of the adoption of the euro has been seen as a major issue until recently, but now with the events in Greece many people find the polish zloty comforting. Poland has a generally well educated population which allows it to be competitive in more knowledge intensive industries but needs to improve the ease of doing business. It is currently constrained by large bureaucracy and outdated laws governing new business formulation and taxation. Perhaps the legislators need not look as far as Singapore for success stories and benchmarks for best practices but can turn to their Baltic colleagues. Poland Compared to global good practice economy as well as selected economies: Source: The International Bank for Reconstruction and Development / The World Bank Washington, D.C.Doing Business 2010, Poland, 2009 Poland has been successively reducing the gap separating it from the 15 old EU countries. In 2000, Polands GDP per capita was USD 4.473 and in 2009 it rose more than four times to reach USD 18.072. Our country has also recorded a stable increase in consumer expenditure at an average annual rate of 5 percent. source: World Economic Outlook Database, October 2009 4. Recommendations and issues for discussion Poland will most likely remain a good destination for investment over the next couple years. While it may perhaps not yield returns as high as less developed countries such as Kazakhstan it is characterized by a much lower risk profile and transparent legal and political systems. Poland is currently a major recipient of EU funding which helps improve the infrastructure and lower the gap between rural and urban areas. Furthermore the Euro 2012 requires an enormous rise of the hospitality and transportation sectors. The even should help promote Poland around the world and lead to an influx of tourists. Poland also benefits from a rising middle class which is a source of high demand for consumer goods. In addition as there will be further growth in the real estate sector as the ratio between the number of dwellings and inhabitants is below EU average. These trends should be strengthened by the planned reductions in the personal income tax.

Perraults Puss in Boots :: Perrault Puss Boots Essays

Perrault's "Puss in Boots" Perrault's "Puss in Boots" is the charming tale of a boy who is delivered into good fortune through the clever cunning of his cat, and this story carries with it a basic plot, structure and theme commonly found in works of this genre. In fairy tales, one of the basic characteristics of a story line is its general involvement with some type of initial difficulty, usually made known to the reader in the introduction. As a result, the main character or characters of the story are compelled to seek a final resolution to the situation (Bruti). Perrault follows this formula, and begins his tale by presenting the dilemma of a young boy who must make his way in the world following the death of his father, his only inheritance being that of a cat. Having outlined the challenge facing the main character, the story proceeds to the next part of the story, the opening. It is at this point in the story where the main character is often given something, such as an object, or advice from another character to assist him or her in the completion of their transformation (Morris). In most instances, the support given acts as a catalyst and spurs the hero or heroine into action. In "Puss in Boots", the cat plays the role of an assistant to the orphaned boy, but with one slight inversion to the traditional story line. In this case, the cat not only offers words of consolation and advice to the boy, he also initiates the action leading up to the final resolution and transformation of the hero. Normally, a more common version of this theme would have the Miller's son carry out the plan of action, not his advisor. Traditionally in most fairy tales, the action occurring within the story moves along at a very quick pace, and it provides the basis for conflict and suspense. This is accomplished through the "use of repetition both in expressions and events" (Bruti). Generally the plot is based on a cycle of three recurrences, with each event acting as an episode or sub-story within the general story, and this pattern of three is often repeated one or more times throughout the story depending on the complexity of the tale (Morris). Following in the path of tradition, Perrault's tale also employs the use of repetition, with events occurring in patterns of three.

Scott McNealy: Chairman And CEO Of SUN Microsystems :: essays research papers

Scott McNealy, Chairman and CEO, co-founded Sun Microsystems in 1982. Since the founding of Sun, the company has become one of the world leaders in computing network solutions. Thru McNealy’s participative, charismatic and transformational leadership styles, Sun is sure to continue its hold in the industry. A charismatic leader is one who has a compelling vision or sense of purpose, and ability to communicate that vision in clear terms that followers can understand. They also demonstrate a consistency and focus in pursuit of the vision, and an understanding of his or her own strengths. Through McNealy’s writings he conveys his vision of what technology should be and were it should go in the future. His willingness to take on controversial issues in the industry, head on, shows his belief and focus on his visions. McNealy states, â€Å"Without choice, there is no competition. Without competition, there is no innovation. And without innovation, you are left with very little† in support of the U.S. Anti-trust Laws. The company’s mission statement is also an example of the clearly defined vision of where McNealy wants Sun to go in the future. One who has a participative leadership style actively seeks input from followers for many of the activities in organization. As bright a star that McNealy is one must realize that he couldn’t have done this all himself. The fast-paced, ever evolving computing industry requires more than just one individual’s input on an organizations direction. The book defines a transformational leader as one who inspires followers to transcend self-interests for the good of the organization and who is capable of having a profound and extraordinary affect on followers. McNealy has proven himself to be this type of leader. Not only has he had a

Violent Females and Restorative Justice Essay -- Violence, Women

2. Introduction As of the early 20th century, there has been a rise in violent crime committed by women. This is due to a change in gender roles that result in women having a lack of informal control, giving women the mindset that they are more assertive (Kruttschnitt, et. al, 2008). It has been found that women as a whole are less likely to reoffend after attending a restorative justice conference (Hayes, 2005). Due to the female violent offenders only being a minority offender group (Bonta, et.al, 1995), there are gaps in research in terms of the effectiveness of restorative justice on their recidivism rates (Latimer et.al, 2005). This research proposal will aim to address the gaps in this research by outlining the theoretical framework that backs the ideology that restorative justice may potentially be more beneficial and have a more positive outcome for females than males. Firstly this paper will discuss the current literature, outlining the effectiveness of restorative justice, the research su rrounding the rise in female violent offenders, and the potential success of the two variables in reducing future recidivism. And finally, a research question and hypotheses will be outlined in order to potentially influence future policy change. 3. Literature Review Restorative Justice conferencing has been seen to be successful in reducing recidivism. This method of justice involves the offender(s), victim(s) and/or stakeholders of an offence to meet in a professionally mediated environment to discuss the offence and negotiate an outcome (Tuddenham, 2001). The term â€Å"Restorative Justice† is referred to as practices that are aimed at making the offender aware of the material and psychological damage or harm that has been caused t... .... (2001). Evaluating Restorative Justice. Probation Journal, 48(4), 296. doi:10.1177/026455050104800411 Umbreit, M. S. (1995). Holding Juvenile Offenders Accountable: A Restorative Justice Perspective. Juvenile and Family Court Journal, 46(2), 31. doi:10.1111/j.1755- 6988.1995.tb00815.x Umbreit, M. S., & Armour, M. P. (2011). Restorative Justice and Dialogue: Impact, Opportunities, and Challenges in the Global Community. Journal of Law and Policy, 36(65), 65-89. Verrecchia, P. J. (2009). Female Delinquents and Restorative Justice. Women & Criminal Justice, 19(1), 80. doi:10.1080/08974450802586992 Walgrave, L. (2011). Investigating the Potentials of Restorative Justice Practice.Washington University Journal of Law & Policy, 36(1), 91. Wortley, R. (2011). Development. In Psychological criminology: An integrative approach (pp. 36). New York, USA: Routledge.

Exegesis Paper on Luke 12:49-53

â€Å"I came to bring fire to the earth, and how I wish it were already kindled! 50 I have a baptism with which to be baptized, and what stress I am under until it is completed! 51 Do you think that I have come to bring peace to the earth? No, I tell you, but rather division. 52 For now on five in one house there will be divided, three against two and two against three; 53 They will be divided: father against son and son against father, mother against daughter and daughter against mother, mother-in-law against her daughter-in-law and daughter-in-law against mother-in-law. (Luke 12:49-53) â€Å"I came to bring fire to the earth, and how I wish it were already kindled (v49)! † As I read these words from this passage again, I can almost hear the urgency and emotion that was in Jesus’ voice when he spoke them. â€Å"I came to bring fire to the earth, and how I wish it were already kindled (v49)! † This is Jesus describing his mission, his purpose for entering into our world: to cast fire on the earth. Yet it had not happened yet, for with great longing in his voice, he tells his disciples, â€Å"how I wish it were already kindled (v49)! But whatever do these strange words mean? What is this fire about which Christ speaks of? How or when did he cast this fire to the earth, if he ever did? There are occasions in the Bible when fire did fall from heaven. Fire and brimstone fell from heaven upon Sodom and Gomorrah (Genesis 19:24-25) and destroyed those towns and all its inhabitants. One of the ten plagues against Egypt was fire and hail from heaven (Exodus 9:3). The prophet Elijah called down fire from heaven that incinerated soldiers sent from wi cked King Ahaziah (2 Kings 1:9-17). Lightning is sometimes described as fire from heaven in the Bible (Psalm 27:9; Psalm 144:5-6). All of these fires from God, however, were destructive fires. And it is the destructive and consuming force of fire that we usually think of when we think of fire. Does it sound like Jesus to be longing and wishing for destruction? No, the fire that Jesus came to cast on the earth is none of those fires. It is not a destructive fire. It is the fire of the Holy Spirit. The Scriptures sometimes associates the Holy Spirit with fire. In the book of Revelation, the Holy Spirit is pictured as â€Å"seven lamp stands with burning flames† (Revelation 4:5). John the Baptist prophesied concerning Jesus, â€Å"I baptize you with water, but he who is more powerful than I is coming; I am not worthy to untie the thong of his sandals. He will baptize you with the Holy Spirit and fire† (Luke 3:16). But do we have any Biblical evidence that Jesus ever sent the Holy Spirit from heaven in the form of fire? Yes we do and it happened on the Day of Pentecost as recorded in Acts 2. 1â€Å"When the day of Pentecost had come, they were all together in one place. And suddenly from heaven there came a sound like the rush of a violent wind, and it filled the entire house where they were sitting. 3Divided tongues, as of fire, appeared to them, and a tongue rested on each of them. 4 All of them filled with the Holy Spirit and began to speak in other languages as the Spirit gave them ability (Acts 2:1-4). †Later, when Peter stood up and preached a sermon before thousands of curious onlookers, he explained to them what the tongues of fire meant, 32 â€Å"This Jesus God raised up, and of that all of us are witnesses. 3Being therefore exalted at the right hand of God, and having received from the Father the promise of the Holy Spirit, he has poured out this that you both see and hear (Acts 2:32-33). The resurrected Jesus, ascended to the right hand of God had poured forth the Holy Spirit from heaven; he had cast the fire of the Holy Spirit to the earth. When the fire of the Spirit fell upon the apostles they were transformed; they were filled with boldness, they praised the mighty works of God in many languages, and they spoke the Word of God to the gathered people. The fire was kindled! 3000 were baptized and converted on that one day. And that kindled fire spread throughout Jerusalem, Judea, Samaria, and to the ends of the earth (Acts 1:8). But when Jesus spoke the words of our text, the day of Pentecost was still in the distant future. Our Lord knew that before the great day of casting fire upon the earth could come, something of monumental significance had to happen first. Our Lord put it this way, â€Å"I have a baptism with which to be baptized, and what stress I am under until it is completed (v51)! †One thing is sure. Jesus was not referring to his baptism in the Jordan by John the Baptist; that baptism had already happened. No, he was referring to another kind of baptism, a baptism that filled Jesus with distress as he thought about it; a baptism that he desperately wanted to be completed. He was talking about the baptism of his death and resurrection. For truly baptism is a death and resurrection. Listen to Paul in Romans 6 describe what happens when a Christian is baptized: 3â€Å"Do you not know that all of us who have been baptized into Christ Jesus were baptized into his death? Therefore we have been buried with him by baptism into death, so that, just as Christ was raised from the dead by the glory of the Father, so we too might walk in newness of life (Romans 6:3-4). † Paul is not merely saying that baptism pictures a death and resurrection. He is saying that those who are baptized truly die with Christ, are buried with Christ, and rise again with Christ. Their sinful nature is put to death and they arise as new creations. Jesus was our ultimate sacrifice who paid the ultimate price for our sins, but it wasn’t enough for Jesus to just die on the cross. He also had to be buried and resurrect from the dead. Through the acts of his death, burial, and resurrection, Jesus bought our salvation. He purchased salvation with his own blood and made it available to all who obey him. Jesus made the ultimate sacrifice for our sins by dying on the cross. He went to the cross perfect and sinless. He did not deserve death. He was the only person that could make atonement for our sins. In order to make atonement, the sacrifice had to be without blemish and without sin. This is why we cannot atone for our own sins. We are born into sin. Jesus was not born into sin because God was his father. We have to identify with his death by dying to sin. We die to sin, put off the old man, by repenting of our sins and turning away from sin. We can’t kill the sinful nature. What we put to death is the control the sinful nature has over us. 12 â€Å"Therefore, do not let sin exercise dominion in your mortal bodies, to make you obey their passions. 13 No longer present your members to sin as instruments of wickedness, but present yourselves to God as those who have been brought from death to life, and present your members to God as instruments of righteousness. 4 For sin will have no dominion over you, since you are not under law, but under grace (Romans 6:12-14). † Christians are not under the control of sin. We must live an overcoming life and not allow sin to work in our lives. â€Å"When then are we to say? Should we continue in sin, in order that grace may abound? 2 By no means! How can we who died to sin go on living in it? (Romans 6:1-2). †When Jesus died on the cross, He, who had no sin, paid the death penalty for our sins. Through baptism we are united, or joined with Christ in paying the death penalty for sin. We are baptized into His death, into the death penalty for sin. We, who are unable to return from death because we have sin, are joined to Christ and since Christ is sinless and was victorious over death, we, now being united with Him through baptism, are made victorious being united with Christ in His resurrection. Now if God allows us to participate in the death, burial, and resurrection of Jesus Christ, an event which occurred 2000 years ago, through baptism, it can truly be said we are saved through faith and God’s grace! Baptism can be likened to the Israelites coming up out of the land of slavery, passing through the Red Sea and entering the Promised Land. Baptism can be likened to passing through the flood of Noah. Baptism is about leaving our old sinful, worldly ways behind and taking upon our shoulders the yoke of Christ. It is about lifestyle change and dying to ourselves and doing God’s will instead of ours. Our reason and purpose for living changes after baptism. Afterward is a new way of life. Baptism is about heart, faith, total commitment, surrender, self-denial, death, resurrection, repentance, and seeking God’s mercy through Jesus Christ and the work He did on that cross on that day of infamy 2000 years ago. That is what Jesus meant by his baptism: His death and resurrection which atoned for the sins of the whole world, by which God offers forgiveness and eternal life to all who believe and are baptized, â€Å"he is the atoning sacrifice for our sins, and not for ours only but also for the sins of the whole world, 1 John 2:2). But once Jesus underwent his â€Å"baptism,† then he could, and did, cast fire on the earth, that is, gave the Spirit to his church. From that day until this the fire of the Spirit has fallen on the Church, and through it, has set the unbelieving world ablaze; this raging fire has spread, bringing not destruction, but salvation to an uncountable number. There is great debate as to what this â€Å"fire† is that Jesus wants to pour upon the earth, but it is more than likely that Jesus is speaking about the coming of the kingdom of God and of the terrible judgment that faces humanity in that day. The coming day of the kingdom is not prefigured by â€Å"peace† on earth, but rather by â€Å"fire†. There is ultimately the fire of the great judicial inquest, but in the meantime, the Day of Judgment is prefigured in the fire of Jesus â€Å"baptism†, (v50), and in the fire of â€Å"division†, (v51). Jesus knows well enough now that the coming kingdom of God is realized through tribulation, and for Jesus, this means suffering and death. Jesus must himself face the wrath of God and so he sets his eyes turned toward Calvary and with determination, presses onward toward the end. Jesus' â€Å"baptism† (the word is being used figuratively here) is his suffering and death on the cross, his atoning sacrifice for sin on behalf of those who have put their trust in him for salvation. In verse 51. Jesus aligns himself with the Old Testament prophets when he reminds his listeners that the coming day of the Lord is not a day of peace, but rather, is a day of judgment, a day of apocalyptic tribulation, a day when the saved are separated from those doomed to destruction. In the present moment, this coming day is prefigured in social division, (v52-53). We know that Jesus makes much of the sign of â€Å"love†, the love of the brotherhood, but what we have here is another sign of the kingdom, the sign of division. Jesus now explains what he means by â€Å"division† and then, in (v53), supports his words by quoting Micah 7:6. â€Å"Division† was one of the commonly expected signs of the coming messianic kingdom, and so now, with the coming of Jesus the messiah, families can expect that household members will â€Å"turn against one another†. Some members of the family will stand with Jesus and others will stand against him. His coming would inevitably mean division;in other words, it did. That was one of the great reasons why the Romans hated Christianity because it tore families in two. Over and over again a man had to decide whether he loved better his friends and kin or Christ. The essence of Christianity is that loyalty to Christ has to take precedence over the dearest loyalty to Christ has to take precedence over the dearest loyalty of this earth. In other words a man must be prepared to count all things but loss for the excellence of Jesus Christ. In this Luke passage, we see Jesus pressing on toward Jerusalem and the cross, or as he calls it, his baptism. For Jesus, the cross was ever before his eyes. How different from Jewish idea of God’s King! Jesus came, not with avenging armies and flying banners, but to give his life a ransom for many. In his death, Jesus' draws us close to the â€Å"fire† of the great judicial inquest. For the present, â€Å"division† prefigures that terrible day, a division realized through the preaching of the gospel. Some accept the Spirit-inspired message, but many reject it. None-the-less, through the proclamation of the gospel the kingdom of God finds its consummation.

Characterization of Having Anorexia Nervosa

Anorexia nervosa is a psycho logic illness that is characterized by marked weight loss, an intense fear of gaining weight, a distorted body image, and amenorrhea (Johnson 1996). It primarily affects adolescent girls and occurs in approximately 0.2 to 1.3 percent of the general population (Johnson 1996). There are numerous complications of anorexia nervosa, involving nearly every organ system, however most complications may be reversed when a healthy nutritional state is restored (Johnson 1996). Treatment involves nutritional and psychological rehabilitation, and may be administered on an inpatient or outpatient basis (Johnson 1996). By the age of eighteen, more than 50 percent of females perceive themselves as too fat, despite having a normal weight, therefore it is not surprising that the prevalence and incidence rates of anorexia nervosa (and bulimia) tend to be higher in certain populations, such as college sororities (Johnson 1996). In this type of environment, there is a high priority placed on thinness and dieting is a common practice (Johnson 1996). This condition generally begins in adolescence to early adulthood, with onset at a mean of 17 years of age, however it has been reported in grade-school children and middle-aged persons (Johnson 1996). Anorexia nervosa seldom occurs in developing countries, and is most common in industrialized societies, such as Great Britain, Sweden, Canada, and the United States, where food is easily obtained and a high priority is placed on slenderness (Johnson 1996). Patients with anorexia maintain a body weight less than 85 percent of normal either through weight loss or by refusal to make expected weight gains during times of normal growth (Johnson 1996). Criteria for anorexia nervosa as defined in the Diagnostic and Statistical Manual of Mental Disorders, DSM-IV include: A.Refusal to maintain body weight at or above a minimally normal weight for age and height. B.Intense fear of gaining weight or becoming fat. C.Disturbance in the way in which one' body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight. D.In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration (Johnson 1996). During the current episode of anorexia nervosa, the individual has regularly engaged in binge-eating or purging behavior, i.e., self-induced vomiting or the misuse of laxatives, diuretics or enemas (Johnson 1996). Individuals with anorexia nervosa have a disturbed perception of their own weight and body- shape (Johnson 1996). Some individuals perceive themselves as overweight even though they are emaciated, while other perceive only certain parts of their body as fat (Johnson 1996). Although anorexia nervosa typically develops during adolescence, late-onset disease may emerge in adulthood after successful pregnancies and child rearing (Tinker 1989). When a patient's weight falls below 70 percent of ideal body weight, hospitalization and use of a nasogastric tube and hyperalimentation may be necessary (Tinker 1989). Many adults who have anorexia nervosa resist an impatient psychiatric admission, however they can be managed on an outpatient basis by a team consisting of the family physician, a psychotherapist and a nutritionist (Tinker 1989). With careful attention to fundamental concepts of care, interventional skills and positive attitudes toward patient care and recovery, most patients with eating disorders can be expected to do well, however the expectation that every patient will develop entirely ‘normal' behaviors and interpersonal relationships may be unrealistic (Tinker 1989). Julie K. O'Toole, M.D. reported to a conference sponsored by the North Pacific Pediatric Society, that despite common perceptions among medical professionals and the general public, anorexia nervosa is not a psychosocial disease, but is a brain disorder and should be seen as such (Finn 2005). O'Toole claims she has treated children who were home-schooled on farms with no television and no access to fashion magazines, however she does admit that the images of thinness in the media do make it more difficult to achieve remission (Finn 2005). Moreover, several formal epidemiologic studies have failed to find any link between anorexia and social class, and that the disease has been seen in non-Westernized Arabic girls, as well as Asians (Finn 2005). Thus, according to O'Toole, by rejecting the purely psychoanalytic paradigm allows the patient to receive the same compassion and understanding as do victims of other medical diseases (Finn 2005). The most common physical examination findings are lanugo, bradycardia, and hypotension, osteopenia and osteoporosis (Harris 1991). Medical complications include pain and retarded emptying of the stomach, excessively dry skin, intolerance to cold weather, constipation, and edema (Harris 1991). Other complications include decreases in heart size and the development of abnormal blood flow dynamics through the heart chambers and valves (Harris 1991). Laboratory abnormalities can include anemia, leukopenia, thrombocytopenia, hypoalbuminemia, and disturbances of thyroid function (Harris 1991). Some studies have found that undernourishment may result in a significant stunting of growth in male adolescents, but has only a marginal effect in female adolescents (Stein 2003). Other investigators note advanced skeletal maturation during growth retardation, resulting in permanent foreshortening, in a female patient but not in male patients (Stein 2003). A recent study found that anorexia nervosa patients who were discharged while underweight had a worse outcome and higher rate of re-hospitalization than those who had achieved a stable weight (Maloney 1997). A weekly joint care conference on the medical ward is critical for successful management, and for outpatient treatment, the clinician sets the target weight as that weight necessary to regain menses and stop bone demineralization (Maloney 1997).