Essay on personality disorder

Essay Sample on Psychopathy This paper discusses the role of Psychopathy Checklist Revised in providing an insight to the level of psychopathy in an individual. It first dissects the meaning of psychopathy and dissects what it entails. Upon giving a broad discussion of a comprehensive meaning of psychopathy, the piece goes ahead to give the link between psychopathy and crime. It settles on the life of Paul Kenneth Bernardo, an example of a psychopath whose life defines psychopathy at its best. The Canadian serial killer sent a wave of terror across the country through his cruel rapes, sexual assaults and murders. The serial killer worked together with his wife, Karla Homolka to terrorize the country, more so in the township of Scarborough. It gives the scale reading of Psychopathy Checklist Revised of Bernardo and concludes that as much as PCL-R gives exciting and sometimes believable insights on the level of psychopathy of an individual, it does not give a true picture of what a criminal is able to do with the few traits of psychopathy portrayed. Psychologists have described psychopathy as either personality disorder or an aspect of personality that is characterized by endurance of antisocial and dissocial behavior. Psychopaths have limited capacity to be remorseful or show empathy. They also exhibit fearless dominance and poor behavioral controls. According to Diagnostic and Statistical Manual of Mental Disorder, psychopaths have the essential feature of antisocial personality disorder. They have a pervasive pattern of disregarding and violating the rights of other people (Association of American Psychologists, 2012). This behavior begins from childhood and sometimes adulthood, and progresses into a constant conduct in adulthood. The pattern has been referred to by other stakeholders in the field of psychology as Dissocial Personality Disorder or sociopath. Researchers have linked several factors to the frequency of occurrence of psychopaths. There is the concept of childhood and adolescent precursors that may have influence on how a person views life and other people’s feelings (Fredrich, 2011). Conduct disorder diagnoses one with symptoms similar to ASPD. Onset of psychopathy at childhood is said to be as a result of neurological deficit in the child’s interaction with the environment. It is a life-course-persistent behavior that makes a child a psychopath and instills the mindset of criminality in a child at an early stage. Environment in which a child grows also determines his level of psychopathy (Kirk, 2007). Research by Fellington on a sample of male London residents revealed that children with convicted mothers or fathers or both, low involvement with the boy form the father, low family income, physical neglect of the boy and those coming from disrupted families had higher chances of being psychopaths.. According t o research, other factors that lead to the personality disorder include harsh discipline, poor supervision, large family size depressed mother, young mother, delinquent sibling, poor housing and low social class in general. Psychopathy Checklist-Revised (PCL-R) provides a tool for discerning the degree of psychopathy in an individual. The psychological assessment tool is used to scale the psychopathy levels. For this assessment, the PCL-R used includes a 12-item inventory of recorded behaviors and perceived personality traits intended to be completed based on semi structured interviews of the person whose level of psychopathy is in question. The inventory could also get its character traits from official records in the event that the interviewed is not cooperative (Longstaff, 2010). The Psychopathy Checklist-Revised comprises a manual, a scoring form, a rating booklet and interview guides. The test is specifically meant to be undertaken by a suitably qualified and experienced health professional under licensed and scientifically controlled and standardized conditions. This is because the results of this test often mean a lot to the tested person’s future (McLeod, 2012). The Psychopathy Checklist-Revised is used to indicate a categorical diagnosis or a dimensional score of psychopathy for legal, research or clinical purposes. A mental health professional rates the level of an individual psychopathy using a list of 12 items. Each of the 12 items on the PCL-R is measured against a 3-point scale in accordance with specific criteria through semi structured interview and file information. Value 0 is applied to those traits and items that do not apply to the patient or person under study (Psychology, Theories of Art, and Cultural Naratives, 2000). If the trait somewhat applies, it is assigned the value 1. If it fully exhibits itself on the person being studied, the testing professional assigns the value 2 to the trait. Other than examining the criminal and lifestyle behavior of the person, PCL-R also tests glib and superficial charm, need for stimulation, cunning and manipulation, callousness, lack of remorse, pathological lying and grandiosity. Additional ly, the framework gives information on the tested individual’s poor behavioral controls, irresponsibility, denial, impulsiveness and failure to take responsibility for his actions. The results of the test are useful in determining future criminal prospects of the tested and possibility of rehabilitation. The PCL-R used in this assessment has two categories.Categories 1 and 2 provide a summary of the 12 character traits evaluated via factor analysis. The previous versions of PCL-R listed 2 factors named chronically unstable factors and antisocial and socially deviant lifestyles. There is little likelihood of rehabilitation of conversion of people diagnosed as psychopaths under the PCL-R criteria (Jan, Mitho, Bhatti, Ghulam, 2012). Psychopathy Checklist Revised factors, items and facets are divided into factor 1, factor 2 and other factors. Factor 1 outlines the interpersonal traits of the person being tested. These include the glib/ superficial charm, pathological lying, manipulation or conning and grandiose of self-worth (Gus, 2012). It also outlines traits considered affective. These are lack of remorse and guilt, callous or lack of empathy, emotional shallowness and failure for one to accept responsibility for his or her actions and be held accountable. Factor 2 lays out lifestyle traits including impulsivity of the individual, his or her irresponsibility, and lack of realistic, long-term goals, parasitic lifestyle and proneness to boredom that calls for frequent need for stimulation. Facet four presents traits that portray an individual’s degree of socialism or antisocial pointers. They include criminal versatility, revocation of conditional release, and early display of behavioral problems, juvenil e delinquency and poor behavioral controls (Gee, 1995). In the view of a research conducted by Minnesota Multiphase Personality Inventory, psychopathy has an immense relationship with criminality. In an analysis of simple correlation, PCL-R score of averagely 22.1 has been prevalent in North American prisoner samples. Prisoners who score higher in the PCL-R scale have worse criminal records. They are frequent offenders and have done more callous crimes than those with lower PCL-R score (Kietzman, Hermkens, McCarthy, Sylvester, 2009). The study also found out that high scores of psychopathy according to the scale had correlations with repeated imprisonment, discipline infractions, detention in high security facilities and substance abuse. As a measure of PCL-R scale within institutional settings, psychopathy has moderate to medium effects on meta-analysis on institutional misbehavior, post release violent crimes and other post release crimes. Other studies not pegged on PCL-R reveal similar outcomes as those postulated by psychopathy rating on criminality of individuals. Although the PCL-R scheme is good at predicting offenses, especially concerned with violence, it is poor at predicting sexually related crimes (Kirk, 2007). There is little correlation between psychopathy and sexual crimes. However, the higher the rating of one’s psychopathy an individual exhibits on the PCL-R scale, the higher his chances of involving in violent crimes. As traits of psychopaths dictate, they have no remorse or empathy to their victim’s feelings. Research on the brain functioning of a psychopath has shown that the psychopaths only do not see the pain in their victims. They lack the capacity to place themselves in the victim’s shoes. Their lifestyles of proneness to boredom that calls for frequent stimulation of what they perform makes them economically unproductive and hence opt to engage in illegal acquisition of resources to survive (Gee, 1995). This is made worse by their irresponsibility, lack of long term and realistic goals for their lives and impulsivity. If they do not get anywhere to live comfortable, parasitic lives, phsychopaths become criminals to keep alive. Their lack of socially-acceptable behavior puts them at risky position and often finds themselves labeled as criminals by those who cannot condone their behaviors. Paul Kenneth Bernardo is an example of a psychopath whose life defines psychopathy at its best. The Canadian serial killer sent a wave of terror across the country for his cruel rapes, sexual assaults and murders. The serial killer worked together with his wife, Karla Homolka to terrorize the country, especially in the township of Scarborough (Gee, 1995). Psychopathy of Paul Kenneth Bernardo most probably began at childhood. Kenneth, his father was abusive to his mother and his children. Paul Kenneth Bernardo’s father conducted embarrassing things that may have had a negative impact on the young boy. The father fondled a girl in 1975 and was charged in the federal courts for child molestation. He raped Paul Kenneth Bernardo’s sister, all these sinking into the young Bernardo’s memory and making him a cruel creature. His mother detached herself from family life and lived in solitude in the family house basement. Such a stressful life of Paul Kenneth Bernardo caused complex trauma, and he grew up to be one of the worst psychopaths of his time. In a book, Lethal Marriage, the author, Nick Pron reports that the young Bernardo was always happy (Fredrich, 2011). He was a young boy who smiled a lot. The author reports that Bernardo had cute dimples that made his face smiley all the time. At school, he was the perfect child every parent wished to have. This must have been a defensive mechanism and lack of empathy the young Bernardo had developed against problems that had gone out of hand back at home. Unlike his siblings who were totally shaken by the family turmoil they had, Bernardo was calm. Using the PCL-R scale below, Bernardo’s psychopathy level is found to be 25 Factor 1 (Affective/Interpersonal Symptoms Item 1: Glib and Superficial†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 0 1 2 Presentation is shallow and difficult to believe 0 Display of emotions do not appear genuine 0 Attempts to portray self in a positive light 2 Tell unlikely stories; has convincing explanations for behavior 0 Uses technical language and jargon, often inappropriately 0 Conversation and interpersonal behaviour are engaging 1 Item 2: Egocentric and Grandiose†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 0 1 2 View of abilities and self worth are inflated 1 Self-assured and opinionated 0 Exaggerates status and reputation 0 Considers circumstances to be result of bad luck 0 Sees self as the victim of the system 0 Displays little concern for the future 1 Item 3: Lack of Remorse/Guilt†¦..†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 0 1 2 Appears to have no capacity for guilt/no conscience 1 Verbalizes remorse in an insincere manner 1 Displays little emotion to actions 2 Does not appreciate impact on others 2 Concerned more with own suffering than with that of others 2 Item 4: Lack of Empathy†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 0 1 2 Cold and callous 2 Indifferent to the feelings of others 2 Unable to appreciate the emotional consequences of others 2 Item 5: Deceitful and Manipulative†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 0 1 2 Manipulates without concern for the rights of others 0 Distorts the truth 0 Deceives with self-assurance and with no apparent anxiety 0 A fraud artist or con man 0 Enjoys deceiving others 0 Item 6: Shallow Emotions†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦..†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 0 1 2 Expressed emotions are shallow and labile (change spontaneously) 0 Verbal and non-verbal expressions of emotion are inconsistent 0 Factor 2 (Behavioral/Social Deviance Symptoms Item 7: Impulsive†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 0 1 2 Does things on the â€Å"spur of the moment† (including crimes); spends little time considering the consequences of actions 0 Frequently changes jobs, schools, or relationships A drifter; lives a nomadic lifestyle with frequent changes of residence 0 Item 8: Poor Behavioral Controls..†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 0 1 2 Easily angered or frustrated, especially when drinking 0 Often verbally abusive (swears, makes threats) 0 Often physically abusive (breaks or throws objects; pushes, slaps, or punches people) Abuse may be sudden and unprovoked 1 Outbursts are often short-lived 0 Item 9: Need for Excitement†¦.†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 0 1 2 Easily bored; has difficulty doing things that require sustained attention 0 Likes to do things that are exciting, risky, and dangerous 0 Item 10: Lack of Responsibility†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 0 1 2 Behavior frequently causes hardship to others or puts them at risk 1 Unreliable as a spouse or parent; lacks commitment to relationships, fails to care adequate for children; etc. 0 Job performance is inadequate; is frequently late, absent, etc., 0 Untrustworthy with money; has been in trouble for defaulting on loans, not paying bills, not paying child support 0 Item 11: Early Behavior Problems.†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 0 1 2 Conduct problems at home and at school as an adolescent 0 In trouble with the law as a youth/minor 1 Antisocial activities were varied and frequent 0 Item 12: Adult Anti-social Behavior†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 0 1 2 Disregards rules and regulations; has had legal problems as an adult 0 Has been charged with or convicted of criminal offences 1 Antisocial activities are varied and frequent 0 Bernardo’s psychopathy displayed itself in callousness and lack of empathy. Although the man married only once, and was not reported to have other short-term marriages, he had a craving for sex that psychologists have a problem explaining its cause. He conducted a series of rapes and attempted rapes from May 4th 1987 to May 26th 1990 without being caught (American Life and Society Organization, 2009). He inflicted as much, brutal pain as he could on his victims. He stabbed, killed and inflicted all sorts of pain including biting the victims before escaping. He was not sensitive to anyone’s feelings, and this began from the moment her mother revealed to him his real biological father at an age of 16 ((AMCIS), Americas Conference on Psychological Systems, 2009). He called her names like ‘whore’ and this extended to his adult life. On average, Paul Kenneth Bernardo does not exhibit most of the 12 character traits considered to portray the highest degree of psychopathy. According to an analysis on the PCL-R scale, he scores 25, a score that should not raise alarming concerns over one’s psychopathy. However, the degree of harm that the serial rapist and killer created sent ripples of apprehension on every parent and girl in the township. As much as PCL-R scale provides helpful insights to the level of psychopathy in anyone’s life, it does not reveal the real capability of a person based on the few traits he possesses. References (AMCIS), Americas Conference on Psychological Systems. (2009). Psychopathy: Association for Information Systems Year 2009. Dubai: Emirates: Lessons for Evolving Markets. American Life and Society Organization. (2009, June 21). The Psychopathy and the Environment In American History. New York, USA. Retrieved October 26, 2013, from http://www.autolife.umd.umich.edu/Environment/E_Overview/E_Overview7.htm Association of American Psychologists. (2012). Leadership that Defines Psychology: Analysis of Private Companies in the United States. Management Journal , 98-109. Carson, D. A., Douglas, J. M., Julius, S. J. (2001). An Introduction to the Psychology. Chicago: Sage. Fredrich, K. (2011). Principles of Psychology in America. Washington DC: Siege Publishers. Gee, P. J. (1995, June 21). Literacy, Discourse and Biblical Teachings. New York, New York, USA. Gus, M. (2012). The Significance Psychology (4 edition). Thousand Oaks: Sage Publication. Jan, M., Mitho, K., Bhatti, V., Ghulam, A. J. (2012, June 21). Theories of Psychology, Criminology, Understanding Crime: A Critical Analysis. New York, New York, USA. Kietzman, J., Hermkens, K., McCarthy, I., Sylvester, B. (2009, June 30). Psychology and Social media? Get serious! Understanding the functional building blocks of social media. Indiana University, Kelly School of Businesss, Indiana. Kirk, D. H. (2007). Case Study on Psychology: The role of Social And Political Factors in Renaissance Economy Versus Insurgency. Carlifonia: Naval Post graduate Monetary. Longstaff, S. (2010, June 21). An Ethical Dilemma for Psychopaths. New York, New York, USA. McLeod, S. (2012, Dec 8). Attachment Theory. Retrieved Nov 7, 2013, from Simply Psychology: http://www.simplypsychology.org/mary-ainsworth.html Psychology, Theories of Art, and Cultural Naratives. (2000, April 28). Psychology, Theories of Art, and Cultural Naratives. Chicago, Chicago, USA.

Research Paper on California Public Education - 2634 Words

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Essay On The American Dream - 1945 Words

We have come a long way from the publication of the Declaration of Independence in 1776. In hopes of change, colonies came together to declare independence against the British King for his indictments. The Declaration of Independence was made entirely opposing the Kings unfair motives, injustice of systems, and the absence of public services. For which these opposing actions towards the king, was the general idea to become the American Dream. That dream consists of equality, justice, and freedom. The dream of freedom is for everyone to say and do as they please regardless of sexual preference, religious believes, race and body image. Freedom is opportunities to educate oneself, to better them and their children’s future. But after†¦show more content†¦Another example is based in Afghanistan, where women get stoned to death for adultery. The rules of stoning are grotesquely disturbing. First, the woman is buried up to her chest. Secondly, the stones thrown at her can not be too big, or too small but just perfect so she suffers. Then, the husband is more than welcome to join in on the stoning, and even persuades the woman’s children to grab a stone as well. These two women didn’t have a chance for a fair trial for their rights or freedom. Americans lost sight of what really is the American Dream, because Americans can exercise their rights and freedom, and some even take advantage of it. The American Dream provides people the freedom of opportunities to seek and own their home, and send their children to great schools to prosper. Americans also have opportunities to get health insurance threw employers and or reduced to free health insurance threw the government if unemployed or in poverty. America also has security from law enforcement and military stopping genocide and unjust acts against Americans, while fair trials in court keeps America civil. Whilst other countries set you up for failure, by not providing these sort of system s, opportunities, and freedom. Many people from around the world leave behind their homes in search of the values America has to offer them. The fascinating news is that immigrants that are destroyed by theirShow MoreRelatedEssay On The American Dream1004 Words   |  5 PagesThe American Dream: Is it Only a Dream? From the moment colonists stepped foot on American soil, freedom flowed through their skin. The new country would bring endless opprotunities to anyone who wished to pursue their dreams. Through years of effort, the United States was born and along with it a sense of equality and meaning. Today, America has much to stand for. Although times were rough along the way, the American dream is one of being free and having a voice. America has proven itself to beRead MoreAmerican Dream Essay3358 Words   |  14 PagesTHE AMERICAN DREAM THE AMERICAN DREAM Section #1 a. The impact cultures in North America have on the United States is that each region adapted the traditions and/or beliefs of those who settled in that area by maintaining dance, music, and crafts. Many English settlers did not respect the Native American cultures, and were seen as uncivilized and/or savages. Basically there was a clash of cultures, with new ideas pushing away old ways and mayor cultures oppressing others. b. ImmigrationRead MoreThe American Dream Essay755 Words   |  4 PagesA great dream, The American Dream. Or is it? Is my American Dream the same as your American Dream? Does it help? Or is it harmful? Do you know? â€Å"To achieve wealth, status, business, family, house, and (a) car(s).† That is the modern american dream. That’s is quite different compared to the original American Dream, â€Å"Every person has the opportunity to achieve their own idea of happiness.† Which version is your version? Or maybe your version is different. 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Many people might think of the American Dream as being able to get a job in order for them to be able to help their family members who they left back in their native country, while for others the American Dream will be to be able to purchase their first home in the United States, while for others the American Dream might be to have a good job in order for them to pay forRead MoreAmerican Dream Essay992 Words   |  4 Pagesdifferent issues as they settle in the United States. Although these problems may vary, the message is the same; the American dream is a lot more difficult to achieve than previously thought. Although every immigrant is different in the problems they face while in the country, one problem seems to stand out from the rest. The biggest obstacle for immigrants to overcome to achieve the American dream is in the field of jobs. The biggest problem immigrants face is finding work in which they can support themselves

Nursing Care Plan For Catherine

Question: Discuss about the Nursing Care Plan For Catherine. Answer: Nursing diagnoses: Disturbed thought processes related to the inability to coordinate daily activities. Disturbed sleep pattern related to hyperactive mental stimulation secondary to bipolar disorder with manic presentation (Hooks, 2016). ASSESSMENT PLANNING/OUTCOME IMPLEMENTATION EVALUATION NANDA Nursing diagnosis Disturbed thought processes Evidenced by: In the past two weeks, Catherine exhibited bizarre and excited behaviours that saw her do house activities in half, commencing one without finishing the other. When her husband, Greg, questioned about anything, she got defensive and irritable. She also spoke in a rapid way without coordinating the topics, an evidence of flight of ideas. She started knocking on the doors of her neighbours in the name of starting a keep-fit club. She applied too much makeup and was dressed in bright colored clothes and jewelry. She also has delusions of grandeur as she says that the neighbours have brought her to the hospital because they are jealous of her super powers. Short term goals In the first 24 hours of admission, Catherine shall demonstrate a mood that is stable and shall practice coordinated activities that promote self-care. They include taking a bath, completing one task after the other, interacting well with the other patients among others (Barlow, 2011). After 48 hours, Catherine shall be able to control her processes of thoughts and demonstrate it physically by being rational and organized in the unit. She shall also cease to exhibit delusions such as the grandiosity that she feels. Long term goal Catherine shall relate well with her husband and stop being irritable by regaining her normal mood status. Moreover, her daily activities shall be restored, and the disturbances to the neighbours shall cease. Furthermore, Catherine shall have an enhanced mental orientation for as long as it takes. Nursing Interventions: During the phase of mania Identify the stimulants within Catherines environment and remove them to enhance sleep and promote relaxation. Monitor the levels of lithium in Catherines blood. Channel Catherines energy in pace activities and also in one direction. Implement the precautions against suicide when Catherines mood swings to depression. Consider the use of other mood stabilizers such as carbamazepine if clozapine and olanzapine do not work (Smith, 2016). During the phase of depression Formulate a contact of safety with Catherine after doing a suicide assessment. Establish the baseline information of Catherine by assessing the intensity and level of her depression. Select activities for Catherine which ensure that she succeeds and accomplishes them in order to boost her self-esteem. Spend much time with Catherine by utilizing the provisions of Hildegard Peplaus theory of interpersonal relations. Observe Catherine on a daily basis for compliance to medications and any adverse effects (Blake, 2012). Day 1-2: Catherine interacts with other clients although the manic characteristics are still expressed. Moreover, she took a bath, went to the toilet and spread her bed without any help. Thus, the goal was partially met. Day3: Catherine remains destructed and fails to demonstrate an understanding of her illness. She still insists that she was wrongly brought to the hospital for treatment and mental assessment. She also remains uncooperative to Greg and her daughter after visiting, and it has sparked some emotional instability to Greg because he often tears and remains worried about his wife. NANDA Nursing Diagnosis Disturbed sleep pattern Evidenced by: Catherine has been having difficulties in sleeping and could wake up during the wee hours of the night such as 3 am and make calls to her friends. She can also wake up at midnight and knock on the doors of her neighbours to explain to them about her plans. The sleeping problems were translated to disturbances. Expected Outcome: Catherine sleeps comfortably just like any other normal adult Short term goals Catherine shall have a regular pattern of sleeping for an adult with an average of 8 hours per day. She shall also have enough time resting during the day and between activities such as family visits and group therapy. This is to be achieved on her first day in the facility. Catherine shall not disturb other patients and the hospital staff during the night to promote their comfortability unless if it is necessary during activities such as emergencies and physiological needs like micturition and defaecation. Long term goal After discharge, Catherine and her family shall report a normal sleeping rate and eliminated levels of lethargy due to disturbed sleep. Nursing Interventions: Administer a mood stabilizer and a tranquilizer during the night for a proper sleep. Adjust the environment to favour a comfortable sleep during the night in order to prevent provocation of Catherines disturbed sleep (Gen et al., 2017). Reassure Catherine that sleep is good for health and she should have enough for a comfortable day. Offer Catherine some clean sheets and blankets and enhance her self-care by asking her to spread the bed for a comfortable look that she wishes to have. Use a calm language or an authoritarian approach when asking Catherine to go to sleep depending on the necessity of the approach. Put off the lights and regulate the room temperature to enhance a peaceful sleep for Catherine during the night. This is also suitable for other patients. Monitor the effects of mood stabilizers to prevent an overdose and adverse reactions. If necessary, administer amitriptyline 75mgs when needed as an antidepressant during the depressive phase of Catherines bipolar (Hazard, 2016). Utilize Cognitive Behaviour Therapy to help Catherine moderate her moods and engage in activities that promote sleep such as meditation (Jones, 2012). Enroll Catherine in group therapy so that she can learn some sleeping techniques from other patients with a similar problem (Munsterberg, 2014). Administer therapeutic drugs against a headache, and other side effects of antidepressants and mood stabilizers. Side effects like sweating, acute akathisia, tardive dyskinesia among others deprive Catherine of sufficient sleep. Day 1: Catherine exhibits some difficulties in sleeping but still manages to sleep for 5 hours for the entire night. Day2: Catherine begins to have a normal sleeping pattern with the help of medications. Day 3: She now sleeps well without any form of night disturbances and awakenings. She only woke up due to the urge to evacuate the bowels. The goal was fully met. Nursing care plan rationale First diagnosis. The nurse has a responsibility of protecting Catherine and ensuring that the environment is safe to prevent any form of environmental agitation and fear. Lithium has side effects especially weight gain and therefore needs to be monitored to manage themin advance. Channeling energy in one direction promotes conservation. Taking suicide precautions prevents the overwhelming pressure for suicide especially during the depressive phase of bipolar. Mood stabilizers act by preventing agitation (S.27.04 Emotional processing in mood disorders, 2014). Second diagnosis Reassurance promotes patient comfortability. Clean sheets and blankets ensure that the patient sleeps well and remains calm through the night. Calm communication with Catherine develops rapport and enhances trust. A reduced light in the room during the night promotes sleep by activating retina pigments during the night (Terao and Hirakawa, 2016). Group and cognitive behavior therapies enhance alertness, lowers anxiety and promotes a feeling of confidence as Catherine will realize she is not the only one with the same problem. Compliance to medications prevent the manic and depressive symptoms of bipolar disorder (Munsterberg, 2014). References Barlow, D. (2011).Unified Protocol for Transdiagnostic treatment of emotional disorders. 1st ed. Oxford: Oxford University Press. Blake, T. (2012). Three medication pathways for bipolar disorder.Nursing, 42(5), pp.28-35. Gen, A., Kalelio?lu, T., Karamustafal?o?lu, N. and Eml, M. (2017). Peripheral Biomarkers in Bipolar Disorder Manic Episode.Journal of Mood Disorders, p.1. Hazard, J. (2016). Amitriptyline.Reactions Weekly, 1599(1), pp.20-20. Hooks, R. (2016). Developing nursing care plans.Nursing Standard, 30(45), pp.64-65. Jones, S. (2012). Cognitive behaviour therapy in the treatment of bipolar disorder.Bipolar Disorders, 4(4), pp.275-275. Munsterberg, H. (2014).Psychotherapy. 1st ed. Auckland: The Floating Press. S.27.04 Emotional processing in mood disorders. (2014).European Neuropsychopharmacology, 15, p.S355. Smith, J. (2016). Olanzapine is effective at a cost in adolescent bipolar manic episodes.In pharma Weekly, NA;(1616), p.22. Terao, T. and Hirakawa, H. (2016). "Light Modulation Therapy" for Bipolar Disorder.Bipolar Disorder: Open Access, 1(1).

Nestle Alcon Value of Listing free essay sample

Alcon’s value was completely buried in food and beverage ocean (Nestle) ‘Best way to show the intrinsic value of this fantastic company might be to make it public to let the market decide what the real value should be’ Growth rate: twice the Nestle groups growth rate Should have higher valuation multiple than Nestle group Nestle’s EBITDA multiple: 12. 7X (in line with competitors) Other businesses embedded in that multiple masked a food and beverage business that was trading at a discount to its peers – Alcon and 26% stake in L’Oreal Guarding the Credit Rating: Early 2002 Nestle would pay $10. 3 billion in cash for pet food company Undertake debt reduction program after acquisition Nestle’s current rating: AAA SP and Moody’s analysts put the company on its watch list Firmly kept the highest credit rating possible Reasons for the carve-out of Alcon: Market to reflect the full value of Alcon Only food and beverage analysts follow Nestle group Pharmaceutical Analyst do not consider Alcon being part of Nestle To come out conglomerate discount Paying of Nestle’s debt to maintain stellar credit rating Can use appropriate market multiple Can use stock option to pay compensation Listing options: Now Nestle has to choose one of the listing options out of the 4 available to them. They have asked Credit Suisse First Boston to analyze these options and give them a report as to the consequences of each. The four options can be summarized as under: Swiss Listing: Simple to IPO Alcon in Zurich Swiss subsidiary of another Swiss company Already operated under Swiss securities laws Would simplify relations between Nestle and Alcon Minimize future administrative costs of outstanding common shares Would limit Nestle and its underwriters to the pool of capital in Switzerland Switzerland is a developed market with few restrictions. Moreover, it will be faced with certain drawbacks such as US investors having to deal in foreign currency resulting in higher transaction costs. Also the US pension funds and mutual funds are restricted from buying foreign shares. Hence, it would decrease the base of investors of Alcon. Dual Listing: Help target specialty pharmaceutical investors Forced to abide by US as well as Swiss securities laws – not always consistent with each other Trading normally seemed to center on one market, even if the shares were initially introduced in two places USA Listing Reincorporate Alcon as a US based subsidiary Fully subject to US corporate income tax Not able to claim deductions in US for royalty payments paid to Swiss parent company Management signaled that this is not an option Nestle would not move Alcon out of Switzerland Corporate governance Rename the firm Alcon, Inc. rather than Alcon. AG. , Amend the incorporation documentation to conform to US standards wherever possible Create a board of directors, with prominent independent US business figures; structure the board to resemble other US boards with characteristics such as staggered terms Financial reporting Regularly quarterly reporting of earnings under US GAAP Dividend payments in USD by establishing a hedging facility converting dividends declared in Swiss Francs into dollar denominated payments Exchange listing ADR would highlight Alcon’s foreign status Engage major settlement and custodian banks to create a share registry system to make procedures for trading shares and voting rights more like those for other US companies Operations Keep HQs, top management, and RD facilities in Texas From US – revenues: 53% and operating income: 58% However, this option has been rejected by the Nestle executives as they want the IPR to stay in Switzerland. Also, this has major cost benefits which it will lose in case it gets listed in US. American Depository Receipts (ADRs): Most familiar instrument May be targeted by US pharma funds May be seen as candidate for international diversifications Minimizes cross-national differences in securities regulations and trading conventions List Alcon in Switzerland and issue ADR in US. Still US investors have an underlying economic exposure to USD/CHF exchange rate. Advantages: Access more investors Broader shareholder base Increases liquidity of shares and making it less risky Good corporate governance – filing US GAAP accounts, meeting certain standards of corporate governance Increased firm’s valuation Cross-listed firms have higher returns and a lower cost of capital May make a firm and its products more recognizable in US May be useful as an acquisition currency Easier for foreign firms to compete for managerial talent since they can offer managers stock options in the form of ADRs May also increase executive pay – universe of comparable companies broadens to US and global firms which usually have higher levels of compensation Disadvantages: May not retain its Swiss identity Requires more transparency in operations and results May become a takeover candidate Undermining Nestle’s corporate culture and protection it enjoys from takeover Listing of Alcon and unbundling the value: Food and Beverage (FB) Industry Company %FB Industry Enterprise Value EBITDA EBITDA Multiples Cadbury Schweppes 51% 15,518 1,511 10. 3 Campbell 91% 16,254 1,475 11. 0 Danone NA 21,854 2,138 10. 2 General Mills 100% 28,104 1,484 18. 9 Heinz 100% 19,855 1,912 10. 4 Kellog 100% 18,262 1,640 11. 1 Kraft 100% 33,082 6,608 5. 0 Nestle 94% 97,500 7,662 12. 7 Unilever NA 50,038 NA NA Mean 11. 2 Median 10. 7 Pharma Company Company % Pharma Industry Enterprise Value EBITDA EBITDA Multiples Allergan 63% 9,728 434 22. 4 Bausch Lomb** 15% 2,150 222 King 86% 10,429 426 24. 5 Teva 88% 8,345 448 18. 6 Forest 100% 14,128 449 31. 5 Mean 24. 2 Median 23. 4 Valuation of Nestles Parts Enterprise Value EBITDA EBITDA Multiples Nestle FB 78,249. 25 6,978. 70 11. 2 LOreal 9,100. 00 NA Alcon 16,568. 09 683. 3 24. 2 Nestle 103,917. 34 7,662. 00 13. 6 This sums up the valuation multiples for each of the parts of Nestle. Thus summarizing, we can say that ADRs or Dual Listing should be opted for by Nestle for the listing of Alcon. Also, this listing will contribute significantly towards unlocking the value for Nestle in the desired fashion.