Recommendation Report Example Essay

Summary: Smash Design decide to purchase new chairs and some ergonomic items to solve the problem of employees feel uncomfortable and get sick in their work environment. This report evaluate the Herman Miller Chairs and Steel Case Leap Chairs, Simple Package and Deluxe Package offer by Staple supplies, and Rocco and Rita’s Gym membership. Aeron Chairs with higher price than Leap Chair, but have more functions to comfort a human body than Leap Chair also with a longer warranty. Deluxe Package offer by Staples covers more ergonomic items than Simple package, the price is higher. Rocco and Rita’s Gym offer the deal of annual fee $50 per employee if we sign up more than 50 people. Final recommendations come up with purchase Aeron Chairs, Simple Package offer by Staples, and sign up Rocco and Rita’s Gym membership. Introduction: Smash Design recently received a lot of complaints about sore backs from our employees. After I did some research, I found out absenteeism is up by 10% this year. This problem is caused to chairs are getting old, also were not good designed that use body science to decrease the pressure and prevent backaches. After the discussion with Ellen page, we decided to buy some new chairs, ergonomic keyboards and mouse pad to solve the problem of employees feel uncomfortable and get sick in their working environment. We also decided to sign up gym memberships located at next building for our employees. Exercises will help employee to develop fitness. Ellen Page has asked me to evaluate the better chair Herman Miller and Steel Case chairs. Compare the simple packages and deluxe package small ergonomic items. This report is not including absenteeism report, and also not includes yoga option. Criteria: For the main purpose of improve the working environment for the employees, and make them feel more comfortable, we applied the following criteria: 1. Comfort: For solving the problem of employee feel uncomfortable and get sick in their working environment. Products must be well design with special attention to ergonomics, reducing the pressure and preventing injuries. 2. Warranty: Smash Design invests on some expensive chairs, for the purpose of return, products must can last at least 5 years, and also with 5-year or more warranty. 3. Price: Maximum $1000 per employee includes office chairs, ergonomic office supplies, and gym membership. Analysis: Chairs Herman Miller Aeron Chairs: Aeron Chair is created by Herman Miller with special attention to ergonomics it can fit all the human body and provide them comfort support, and adjustment is easy to use. Aeron Chair’s PostureFit function can support pelvis lean forward naturally then the spine can be align, and prevent backache. Kinemat tilt technology can let human body’s joints pivot naturally. Breathable fabric material can keep body pressure even and decrease the body pressure. Aeron chairs provide lifetime warranty to the customers. It sells at $900 per chair. Staff will help set up chairs and arrange workstations to reduce injuries, if purchase more than 5 chairs. Steal Case Leap Chairs: Leap Chair is created by Steel Case with features of changeable back shape can support entire spine when the user change his posture, and also can decrease the spine stress and spinal ligaments. The back control system can let the user adjust the back angels until it match user’s comfort. Leap Chairs provide three-year warranty to the customer. It sells at $700 per chair. Herman Miller Aeron Chair Steal Case Leap Chairs Comfort Very Comfort Comfort Warranty Lifetime Three years Price $900 $700 Staples Ergonomic Office Supplies Simple Package: Simple package provides ergonomic items such as gel pad for mice and keyboards, stress balls, massage devices, at the come up with the price of $100 per person. Deluxe Package: Deluxe package provides same items as simple package also with additional items such as footrest, neck supports, monitor support and specially design electronic devices. Rocco and Rita’s Gym Memberships If more than 50 people sign up, we can get the deal of annual fee $50 per employee. Conclusion: Aeron Chairs were designed use ergonomics to decrease pressure. The back support technology can prevent backaches. Adjustable sacral support can fit different people. Aeron Chairs are lifetime warranty. If purchase more than 5 chairs, staff will help to set up the chair to make it fit for different employees. The price is $900. Leap Chairs are designed for human comfort, with adjustable back shape and arm, but has not much function as Aeron Chairs, only 3 years warranty. The price is $700, lower than Aeron Chairs. Staple Ergonomic Supplies offer Deluxe Package and Simple Package. Simple Package offers Gel pads for mice and keyboards, Stress balls, Massage devices, and the price is $100 per person. Deluxe Package also include other  ergonomic supplies and electronic devices, but the price $250 per person. Rocco and Rita’s Gym offer the deal of annual fee $50 per employee if we sign up more than 50 people. Recommendation: I recommend we purchase Aeron Chairs for our employee, Aeron chair meet the most criteria, and have addition offers. Staple Deluxe package covers more ergonomic items than Simple package, but it’s over pricing. And Aeron Chairs’ functions already cover some usability of ergonomic items. So I recommend we buy the Simple Package from Staples supplies. Sign up the gym membership will exceed $50 of the budget per employee, but I still strongly recommend we sign up the gym membership to improve employees’ fitness.

Fluorescent Light Science Experiment

Fluorescent Light Science Experiment Learn how to make a fluorescent light glow without plugging it in! These science experiments show how to generate static electricity, which illuminates the phosphor coating, making the bulb light up. Fluorescent Light Experiment Materials fluorescent bulb (tubes work best. Its okay if the light is burnt out.)Any of the following:Saran wrap (plastic wrap)plastic report folderpiece of woolinflated balloondry newspaperanimal fur or fake fur Procedure The fluorescent light needs to be perfectly dry, so you may wish to clean the bulb with a dry paper towel before starting. You will get brighter light in dry weather than in high humidity.All you need to do is rub the fluorescent bulb with the plastic, fabric, fur, or balloon. Do not apply pressure. You need friction to make the project work; you dont need to press the material into the bulb. Dont expect the light to be as bright as it would be plugged into an outlet. It helps to turn off the lights to see the effect.Repeat the experiment with other items on the list. Try other materials found around the home, classroom, or lab. Which works the best? Which materials dont work? How It Works Rubbing the glass tube generates static electricity. Although there is less static electricity than the amount of electricity supplied by wall current, it is enough to energize the atoms inside the tube, changing them from a ground state to an excited state. The excited atoms release photons when they return to the ground state. This is fluorescence. Usually, these photons are in the ultraviolet range, so fluorescent bulbs have an interior coating that absorbs the UV light and releases energy in the visible light spectrum. Safety Fluorescent bulbs are easily broken, producing sharp shards of glass and releasing toxic mercury vapor into the air. Avoid applying a lot of pressure to the bulb. Accidents happen, so if you snap a bulb or drop one, put on a pair of disposable plastic gloves, carefully use damp paper towels to collect all the pieces and dust, and place the gloves and broken glass in a sealable plastic bag. Some places have special collection sites for broken fluorescent tubes, so see if one is available/required before putting the bulb in the trash. Wash your hands with soap and water after handling a broken fluorescent tube.

Animal Testing Research Paper

Abstract With animal testing, the killing and harming innocent animals, being around for centuries with little change, will exploiting the facts that the public does not know about, help put an end to all the product and medication testing on animals? Introduction Animal testing has been around for centuries, when it really should be one of those â€Å"cruel memories† of things we have done in the past, but will not let in happen again in the future. Rats, Mice, Rabbits, and a whole slew of other animals are forced to endure massive quantities of testing substances or endure pain by having harmful chemicals applied to their bodies, even though the testing may have nothing to do with anything relatable for human use. My purpose for this subject is to let people think twice about buying a product, or hopefully helping put this inhuman testing to an end. When did animal testing originate? The history of animal testing goes back to the writings of the Greeks in the 4th and 3rd centuries BC. Aristotle (384-322 BC) and Erasistratus (304-250 BC) were among the first group of people to perform experiments on living animals. A physician in 2nd-century Rome, dissected pigs and goats and is known as the â€Å"father of vivisection†, when his real name is Galen. Avenzoar, whom is also a physician but of Arabic, also practiced dissection in 12th-century Moorish Spain, and introduced animal testing as an acceptable experimental method of testing surgical procedures before applying them to human patients. (Cohen Loew, 2013) What is animal testing? Animal testing, a phrase that most people unsure of exactly what is involved but have heard it before. There are many names, animal testing, animal experimentation or animal research, it all refers to the experimentation carried out on animals. Its main purpose in why it is used, is to assess the safety and effectiveness of everything from medication to cosmetics. We also use it to help find a better understanding of how the human body works. Supporters believe it is a necessary practice and obliteration to animals for our bettering and the deaths of the animals are well worth the cause. Then there are those opposed to animal testing because they believe it involves the torture and suffering of innocent animals (Ian Murnaghan BSc (hons), 2011) Who does animal testing affect? Animal testing affects everyone in the modern world today. It is primarily used to help save lives. The testing is performed so that there is a better understanding of what reactions drugs may have, so that we can figure out which drugs help which diseases, as well as observe how certain drugs affect conditions such as pregnancy and other side effects they may cause like cancer. Another part of animal testing is to help promote a product or to understand the effects of those products and the percentile of which those effects may cause. This might include testing makeup, lotions, or food products. Animal testing main support is from those people that believe the animals in our world today, are a close link to humans, and therefore allow them to be tested to see what effects drugs, products, or foods have on our society. A second opinion humans have, is that animal testing is a cruel and inhumane, torturous act, and should not be done to anyone or anything, no matter what the benefit might be to the human species (Contributor, 2012). Animal Testing Funds The United States government spends up to the sum of $14. 5 billion in a year in any research involving experimentation on animals. These experiments will often lead to death or unwarranted consequences for the animals involved. Some projects are funded for decades by the siphoning of the US taxpayers dollars and resulting in cruel treatment and deaths of an unfathomable number of animals. About 47% of research grants have an animal research-based component according to NIH, National Institutes of Health, and documents. The number has been very consistent over the last decade (Newcomer, 2013). Where do companies get money for testing? Many companies today get their funding for research from the NIH. Other companies also receiving money from the NIH are numerous colleges around the U. S. A. whom are primarily receiving grants to experiment on animals. The NIH is a biomedical research facility located in Bethesda, Maryland. They are part of the United States department of Health and Human Services. These agencies are primarily used to do biomedical and health-related research. NIH uses the Intramural Research Program to conducts scientific research through. 80% of the NIH funding, is used as research grants to outside researchers. They give approximately 500,000 grants to an approximate 325,000 researchers that consists of more than 3000 institutions. In 2010 alone, NIH spent around $10. 7 billion on just clinical research. On top of that, they also spent $7. 4 billion on genetics-related research, $6. 0 billion on prevention research, $5. 8 billion on cancer research, and $5. 7 billion on biotechnology research which almost all include the torture of other species on Earth (Health, 2013). How much does it cost? Each year in the United States, there are approximately 100 million animals that are tormented and killed in experiments conducted to better humans. Much of this cruelty is highly supported by the National Institutes of Health, and the United State government, since the NIH is a department of the government. The NIH allocates a minimum of 40% of its annual research budget just towards animal experimentation. Based on the NIH’s 2010 budget, this accounts for more the $16 billion in US taxpayer money alone (PETA, 2013). Substitutes for Animal Testing There are nearly 50 different alternative methods and testing strategies that have been developed, validated and/or accepted by international regulatory authorities. These non-animal methods usually take less time to complete then using the crude, archaic methods animal testing that they meant to replace. In addition, these methods cost only a fraction of what animal experiments burn through, cash wise, and are not affected by a species differences from humans that make applying test results to humans difficult or impossible (PETA, Alternatives to Animal Testin, 2013). Corrositex Testing Corrositex is a non-animal alternative toxicology test. Although this is not a classical â€Å"in vitro† style test, Corrositex uses a synthetic membrane-based detection system to determine the UN packing group classification of chemicals, consumer products, or other hazardous materials. The results, expressed as a break-through time, correlate well with rabbit dermal corrosively tests. In the Corrositex testing system, a glass vial filled with a chemical detection fluid and is capped by a proprietary bio-barrier membrane. This membrane is designed to mimic the effect of corrosives on living skin. Corrositex measures the time required for a test article to pass through a hydrated collagen matrix and supporting filter membrane (Corrositex, 2010). Technological Advancements The NIH has recognized that animal models do not always accurately predict a drug efficacy in people, and they are starting to support the generation of more reliable and predictive models. The use of different human cell types, in series of combinations, will help generate micro-sized physiological systems which can â€Å"talk to each other† and better address the biological complexities of whole living organisms. This â€Å"human body chip† technology would start to allow scientists to look for specific profiles in cells and would help identify human safe compounds to allow testing on people. This technology represents significant advantages over animal models because it relies on human cells which is more like what they are going to be applied to then the use of a completely different species, and is more likely to be predictive of what happens in people in the product or drugs current form (Society, n. d. ). What happens during testing? The government describes an animal experiment as a â€Å"procedure† that is ‘likely to cause pain, suffering, distress or lasting harm. ’ Many experiments cause extreme suffering, often to the point of the animal’s death. Even when they are not being experimented on, animals suffer stress in laboratories where they are typically kept in barren containers or kennels, often in solitary confinement. After the animals have been used in experiments, they are usually killed to prevent being released and causing an evolutionary process in the wild that was created in the lab (Aid, 2013). Killings Injuries According the U. S. Department of Agriculture, in 2006 there were about 670,000 animals that were used in procedures which did not include more than a momentary pain or distress. About 420,000 were used in procedures in which pain or distress was relieved by anesthesia, while there were 84,000 which were used in studies that would cause pain or distress that would not be relieved. In the UK, research projects are classified as mild, moderate, and substantial which is measured in terms of the suffering that they, the researchers conducting the study, say they may cause. There is also a fourth category of â€Å"unclassified†, which means the animal was anesthetized and killed without recovering consciousness, according to researchers (Ryder, 2013). Subjected to horrible unsafe procedures Research reveals that only 5% to 25% of the animal tests and human results are agreeable! Most of the drugs passed by animal tests are discarded due to the fact that they are useless to humans. The conditions under which the animals are subjected to these human experimentations, have caused tumors in rodents, while the animal test results were declared to be of little relevance for humans! The only explanation being offered for this declaration, is the mere fact that there are anatomical and physiological differences between animals and humans. It is important to note that even though animals are almost always used in cancer research, they never get the human form of cancer which also affects membranes like the lungs. With all that research being done that only yield maybe 5% success, almost 9% of the anesthetized animals in the laboratory die. These animals have a better chance of dying then actually helping us develop something successful. Most medical experts agree that data from animal test cannot be extrapolated safely to human patients without any altercations to the drugs (Buzzle, 2013). Companies using and not using animal testing There are a lot of companies that test on animals that we buy from every day. Some of these companies are 3M, Air Wick, Almay, Band-Aid, Blue Buffalo, Febreze, and the list goes on. There are some companies though that do not test on animals such as Abercrombie Fitch, Absolute Green, Aloe Vera of America, and more. It seems like all the companies we know and buy from use some form of animal testing for their product, and yet there are others companies that we have not have hardly heard of, don’t test on animals. Companies use the warning labels saying â€Å"animal tested† Animal testing by manufacturers seeking to market new products may be used to establish product safety. In some cases, after considering available alternatives, companies determine that animal testing is necessary to assure the safety of their product or ingredient. FDA supports and adheres the provisions of applicable laws regulations, and policies the governing animal testing. FDA supports the developments and uses of alternatives to whole-animal testing, as well as adherence to the most humane methods available with the limits of scientific capabilities when animals are used for testing the safety of cosmetic products (FDA, 2006). Types of animals being tested on, and what is tested on them Researchers use many different types of animals, mice, rabbits, dogs, ferrets, and fish to name a few. The type of animal selected for study often depends solely depends on a combination of factors; previous research involving that animal type, scientific relevance, accessibility, and practical aspects of implementation of the product or item being tested. Government agencies also require that any drugs used in humans needs to be tested in at least two different types of animals, one of which is not able to be a rodent. The reason is that a drug can have very different effects on different species of animals (Nordin, 2009). All the animals used in testing/studies Right now, millions of mice, rats, rabbits, primates, cats, dogs, and other animals are locked inside cold, barren cages in an unfathomable number of laboratories across the country and even the world. Exact numbers are not available because mice, rats, birds, and cold-blooded animals- who make up over 95% of creatures used in experiments, are not covered by even the minimal protections of the Animal Welfare Act and therefore go uncounted (PETA, Animal Testing 101, 2013). Types of products used on animals during testing Mice and rats are forced to inhale toxic fumes, dogs are force-fed pesticides, and rabbits have corrosive chemicals rubbed onto their skin and eyes. Many of these tests are not even required by law, and have often produced inaccurate or misleading results that were pointless towards the end affect when the results had to be tossed and started over for being inaccurate towards the desired end result. Even if a product harms animals, it can still be marketed to consumers. Cruel and deadly toxicity tests are also conducted as a part of the massive regulatory testing programs that often funded by USA taxpayers’ money without them even knowing (PETA, Animal Testing 101, 2013). Conclusion Animal testing should not be something that is taken lightly, where as innocent animals are being tested with harmful products, and it is not fair to them. With our advancements in technologies every day, why are we still using innocent animals to test our products on which in turn may not even give us the results needed or give us false results which makes the tests of those animals useless and obsolete? With people knowing what many of these animals go through, would they sign their own pets up to go through that? Having a heart on this issue is what will end it, animals have lives, should be able to live it in their nature desired ways that is unaffected by humans.

Biomedical Informatics Essay Example | Topics and Well Written Essays - 1000 words

Biomedical Informatics - Essay Example The Six Sigma refers to a quality level that is prone to minimal operational or experimental errors. In statistical analysis, Six Sigma represents standard deviation that indicates the level of variation in an experiment or operation (Pokharkar et al. 1160). The highly disciplined strategy entails three elements that include process improvement, re-design, and process management (Pokharkar et al. 1161). The Six Sigma strategy was initially dominant in the manufacturing industry where it played a noble role in meeting the client’s needs based on the DMAIC method (Snee 4). However, other industries including the health care industry have since adopted the six-sigma strategy to address the heightened competitive market pressures (Pokharkar et al. 1160-1163). Indeed, Lean and Six Sigma strategies have been fundamental in clinical and translational research where they enhance various processes. The strategy can achieve this by eliminating delays and errors, enhancing quality, and facilitating the timely adoption of biomedical discoveries. The NIH Roadmap for Biomedical Research and the NIH Clinical and Translational Science Award program recognize the potential of the six-sigma quality improvements in clinical trials (Schweikhart and Dembe 748). Various scholars establish that Lean and Six Sigma relate and try to improve total quality management by deriving a more discrete and me asurable operation. The strategy also quantifies results and aims at delivering certain quality improvements within a given period. Clinical trials rely on six-sigma quality improvements to concentrate on process management, adopt standardized method for monitoring process improvement, and making sure that the trials address the clients’ needs. In most cases, the six sigma strategy works together with the lean strategy, which aims at improving delivery time, reducing operation costs, minimizing cycle times, and

The benefits of Using the Smart Phones Essay Example | Topics and Well Written Essays - 750 words - 1

The benefits of Using the Smart Phones - Essay Example According to Polichar et al. et al. individuals use Smartphones to fulfill their individual needs regardless of the functions and the interface of the phone, they customize their phones according to their own needs to benefit from the phones (Polichar et al. et al. 629). Clough et al. et al. argues that Smartphones are utilized by both adult and youth population to attain education that is informal in nature. In this report I am going to argue that Smartphones are benefiting adults and teenagers in various aspects of life (Clough et al. et al. 359). In order to find studies that have already focused on my report’s topic, I went through various libraries such as the ProQuest database. Secondly, I even conducted a search through the Google’s search engine under the option of Google Scholar and found various articles from various journals to assist me in my assignment. The journals from which I obtained the journal articles includes: Journal of Computer Assisted Learning as well as Personal and Ubiquitous Computing and others. Following the sources along with their annotations that I am going to utilize to complete my report and defend my stance: Polichar et al. et al. conducted a study named (Empowerment through Seamfulness: Smart Phones in Everyday Life) in order to figure out how adults use mobile phones such as Smartphones to satisfy their needs (Polichar et al. 629). To conduct this study they conducted interviews from 21 participants and these participants were using Smartphones such as BlackBerry and iPhone. Clough et al. conducted a study to figure out the link between Smartphone use and informal learning and figured out that individuals use Smartphones for the purpose of conducting informal education that is intentional in nature (Clough et al. 369). He and fellow researchers even identified that owning a Smartphone influenced users

The Myths of Marijuana Essay Example | Topics and Well Written Essays - 1250 words

The Myths of Marijuana - Essay Example The purpose of the essay is to shed light on the mystified shell of Marijuana and reinvents its real essence which is absolutely harmful. Moreover, the essay would examine the conditions in which such mystification of Marijuana and its use takes place and reveal the channels and agencies through which the myths of Marijuana are propagated. It is an irony that both the proponents and opponents of marijuana are part of the great debate on the myths of marijuana. Curiously, each side accuses the other of creating myths about marijuana. However, the present essay does not attempt balance between the contesting perspectives on the myths of marijuana, rather, challenges the myths which are favoring marijuana and exposes not only the myths but also the way such myths came to existence. Office of National Drug Control Policy, in the document- 'Marijuana Myths and Facts: The Truth Behind 10 popular misconceptions', points out that 'Marijuana is the most widely used illicit drug in the United States' (2005, p.4). The crumbling fact is that Marijuana is the most popular narcotic drug among the majority of illicit drug users. There is a growing number of people in the United States who have at least once used Marijuana. ... Historically speaking, it is important to note that the youth started to become attracted into marijuana by the tumultuous 60s and 70s. The insecurities of modern life in general and the anti-establishment feelings in particular created a kind of social vacuum or a moral anomaly which tempted the people to cut their roots from traditional forms grievance addressable channels such as religious authorities, community organizations and family. On the other hand, the empty promises of a brave new world were thick in the air. The youth who were looking forward to get out of the rotten system found their easy solace in Marijuana along with Beatles and rock music. It all indicates that socio economic conditions play a vital role in the production, distributions and consumption of narcotic drugs in general and marijuana in particular as it has a carefully crafted cultural aura around it. However, the youth of 60s and 70s did not live much with their illusions. The reality was striking and naturally they came out of the grip of marijuana to perceive the reality as reality. In addition, the first time users were mostly above 19 and the potency of the available variety of marijuana was considerably less in 60s and 70s. And, the use of Marijuana was a time bound fashion than a concrete lifestyle. On the contrary, the globalized world in twenty first century is strikingly different in regards to marijuana and its marketing, propaganda, trade routes and use. The "weed" of the so called Woodstock era has paved way for new generation marijuana which is greatly stronger than the old ones. Most strikingly, the first use age is dramatically dropped into 17. In other

Personality Disorder Carer and Family Support Impact

Personality Disorder Carer and Family Support Impact ARE PSYCHO-EDUCATIONAL AND SUPPORT PROGRAMMES FOR FAMILY AND CARERS EFFECTIVE IN REDUCING RELAPSES AND FACILITATING RECOVERY OF PEOPLE SUFFERING FROM PERSONALITY DISORDERS? ABSTRACT Background Carers and families of people suffering from personality disorder are in desperate need of support and services. Providing these services can reduce relapses and facilitate recovery in sufferers of personality disorder. The Research Question How can psycho-educational and support programmes for carers and families of those with personality disorder improve their recovery? Methodology The results of this study were obtained through a systematic literature review. Results Diagnosis and treatment of personality disorder are still complex and often confusing issues, even for professionals. Still, treatment can produce recovery and this recovery can be expedited if carers and families are provided with programmes to equip them to effectively face the challenges that personality disorder presents. Conclusions Providing psycho-educational and support programmes makes carers more effective and can help treat personality disorder. Social Workers can help to bridge a gap in the services that is adversely affecting the treatment outcomes of sufferers and hence placing greater strain on the Health System than is necessary. Contextualisation The carers and families of individuals suffering from personality disorders are an underserved population. Considerable strain is placed upon them and their loved ones and they are often at a loss as to how to effectively perform their duties and assist the recovery of those they care for. If more psycho-educational and support programmes for carers and families were provided, it is possible that treatment for personality disorder could be improved. Personality disorders can be defined as: â€Å". . . psychiatric conditions relating to functional impairment, or psychological distress resulting from inflexible and maladaptive personality traits.†1 Personality disorders are explained in the two most prominent classification schemes, the DSM-IV, where personality disorders can be found in Axis II, and the ICD-10. The definitions in these diagnostic classification systems are much the same. Defining ‘severe personality disorder has proved problematic for experts, who have yet to establish a generally accepted definition. The suggestion of the Royal College of Psychiatrists (1999) that severe personality disorder is marked by extreme societal disturbance and at least one extreme personality disorder has provided some guidance.2 Alternatively, having two severe disorders could mean that the sufferer has one disorder that expresses itself in more than one extreme way, or could simply indicate one deeply disturbing disorder. One study graded the severity of personality disorder on 163 subjects and found that the patients whose personality disorder was described as ‘complex demonstrated the greatest number of symptoms and recovered the least. Personality disorder carers are people who support a person who suffers from any form of personality disorder, whether they are relatives, friends or partners. Often, carers give sufferers emotional and financial support and may even act as informal social workers. Previous studies have shown that carers of people with personality disorder benefit from psycho-educational and support programmes. Psycho-educational programmes are educational programmes that contain an element of counselling or therapeutic activity for the family. The main aim of these programmes is to minimise the strain experienced by families and carers of people with mental illnesses, here personality disorder. Psycho-educational and counselling programmes exist ultimately to facilitate recovery and reduce relapses; indeed, the success of programmes is usually measured by examining relapse rates. Programmes attempt to provide adequate support, information, signposting to appropriate resources, advocacy and respite for carers. They also coach carers to increase their problem solving abilities, improve their communication and help them construct their own support networks. Support programmes for carers of people with a mental illness attempt to support the contribution that carers make to the lives of those they care for. They work toward advances in policy that will augment the services that satisfy carer requirements. Support programmes prompt dialogue between members of the government and carers, as well as encouraging carer involvement in the creation and delivery of carer and patient services. Further, support services connect carers with agencies to assist them in their role and facilitate modes of best practice in aiding carers. The Research Question This literature review examines a number of studies on personality disorder, its effect on carers and issues connected with diagnosis and treatment in an attempt to determine whether psycho-educational and support programmes for family and carers are effective in reducing relapses and facilitating recovery of people suffering from personality disorders. If social workers are to work effectively with this client base, they must put aside antiquated beliefs that personality disorder cases are hopeless and that those who suffer from personality disorder never get better. This study reveals that one of the greatest challenges to carers and families is obtaining the support they need and the services they are entitled to, and Social Workers can be instrumental in bridging gaps in the Mental Health system. Methodology This dissertation undertakes a systematic literature review of health care and psychological literature to address key issues in the support of carers of people suffering from personality disorders. Several different studies and a range of approaches were examined. Although the number and breadth of studies was a strength of the review, the variety of approaches made it challenging to compare the overall merits of one study against another. The literature was obtained through a variety of means. Google searches, journal articles, working group reports, service provider reports and academic papers were used. The research methods that appear in the utilised material included telephone interviews, questionnaires and surveys, face-to-face interviews and meta-analysis. Some were literature reviews themselves and some simply reported on the outcomes when a group of treated individuals was observed. Of the studies that involved observation of a group, very few included a control group in the study so methodological rigour was not as great as it could have been. Neither is it certain that studies where self-reporting was used are as empirically reliable as one would like, as sufferers of personality disorder tend to over- or under-report their symptoms . Some of the studies that were conducted recently showed positive outcomes, but the long-term follow-up for the same groups may make the figures less significant. Even where there has been longterm follow-up, some of those who took part in the initial study may not be included because of death, inability or unwillingness to participate, or inability to be located. The methodological rigour of the studies is further complicated by the fact that the process of diagnosis and treatment of personality disorder is fraught with complexities. The categories for personality disorder are somewhat defined by behaviours and are not theoretically based or grounded in common mechanisms of the disorder. The actions and symptoms of patients are so extremely varied that both diagnosis and treatment are difficult to present, much less to assess. Yet just because a comprehensive catalogue of truths about personality disorder cannot be presented does not mean that no reliable statements can be made. The evidence that is presented here is solid enough to make general assertions regarding the affects of carer support on patients based upon the evidence, and that is what it intends to do. Assessing the impact of support and education for carers upon the sufferers of personality disorder themselves proved more challenging than, for example, assessing the impact of treatment on sufferers, for which there is abundant literature. Still, the impact of psycho-educational and support programmes on consumers has been assessed and outcomes observed. Additionally, the evidence for the improvement of the lives of carers and the quality of care they give their charges is strong, and this fact bolsters the hypothesis that improved care for carers improves the mental health of those for whom they care. These conclusions are definitely linked, especially given the statistics that show that improvement for personality disorder takes place over a long period of time and is facilitated by positive interpersonal relationships with people who are equipped to deal with the symptoms that people with personality disorder exhibit. The presence of positive relationships with carers who are tr ained, educated and supported will assuredly improve the ‘treatment conditions for those with personality disorder. In narrowing the scope of the literature to be included in the study, several factors had to be noted. Some of the literature was so grounded in certain programmes for certain countries that many sections were not transferable to this review. For example, the results of the Network for Carers (2004) report were based upon specific programmes offered in Australia, so some information had to be excluded. However, this document was very helpful in establishing general facts about the needs of carers and the impact of programmes upon their ability to care for sufferers. It was also a thorough exposition of the opinions of carers,through which their voice was clearly heard. There were also other limitations regarding the particular demographic studied. The NHS National Programme on Forensic Mental Health Research and Development Expert Paper on Personality Disorders primarily assessed offenders with personality disorder and not merely members of the wider public suffering from the disorde r. Because of this, significant sections of the material had to be ignored. Still, this paper was useful in understanding the complexities of treatment and diagnosis of personality disorder, and provided definitions for contextualisation. In evaluating the quality of the data, the analytical tool Critical Appraisal Skills Programme (CASP) was used to assist in making sense of the evidence. This tool is advantageous to those who are strangers to qualitative research, assessing the merits of a source with regard to rigour, credibility and relevance.CASP initially asks two screening questions, the first addressing research aims and significance. The second screening question considers whether the research interprets subjective experiences of participants.Answering these two questions with a ‘yes then leads to eight more questions covering issues such as recruitment strategies, collection of data and ethical issues. In a literature review there are several ethical issues that must be considered, especially when dealing with a vulnerable population such as sufferers of mental illness. For each study used in the review it was necessary to consider whether ethical standards were maintained throughout the study, includi ng the manner in which consent was obtained and the way that confidentiality was upheld. Another ethical consideration is the handling of the outcomes of the study with the participants after the study.9 In the data observed here, it is not always explicit that consent was obtained but is often implied. Eliciting feedback from carers carries implied consent even if consent was not explicit, for obviously no individual would be forced to comment against his or her will. Confidentiality is maintained through omitting names and keeping the results impersonal. Yet the information given for studies is in its final and often abbreviated form, and the background work is not always documented comprehensively enough to ascertain whether all ethical considerations have been taken into account. One ethical consideration that is not always considered is the treatment of ethnic minorities in research projects, especially those for whom English is not their first language. The wording of questions and the criteria by which outcomes are judged is often tainted by cultural bias for those being assessed outside their native surroundings. It is practically impossible to remedy this, because part of the methodological rigour of the study depends upon all participants being treated and assessed in the same way. Differentiation on the basis of cultural differences would compromise the consistency of the study, but the impact of cultural factors is most certainly felt by those of foreign origin. Discussion of Findings Traits The traits exhibited by sufferers of personality disorder differ immensely because of the wide scope of the disorder. Examples of traits range from anxiety, narcissism and compulsivity to defiance, abnormal attachments and avoidance of social situations. Sufferers may demonstrate an arrogant interpersonal style, or may show extreme submissiveness. Personality disorders are linked with negative results in the wider population such as marital breakdown, criminal actions and professional difficulties.The anomalies of personality disorder are apparent in the thought patters, expressions and levels of self-control of sufferers. The patient will display abnormalities in the way that he or she interacts with others which will appear in a range of circumstances. There are various types of personality disorders, and each has its own banners of dysfunction. It has been recognised that the kinds of personality disorders covered in DSM and ICD are a small cluster when contrasted with the array o f personality impairments that can be identified in large configurations of people.11 Personality disorders can be divided into three clusters, A-C. In the first cluster disorders relating to paranoia and schizophrenia are found. Cluster B includes antisocial and narcissistic disorders, and Cluster C focuses on avoidant, dependent and obsessive-compulsive disorders. Prevalence It is estimated that between 6% and 15% of the population have one or more personality disorders of some kind—different studies produce different results.13 The goal of one study was to estimate the prevalence of personality disorders in a local sample and discern the most common demographic groups therein. The frequency of the DSM and ICD personality disorders and the interactions between disorder clusters and demographic qualities was assessed in a local sample of 742 participants between the ages of 34 and 94 over two years.14 The results showed that the overall prevalence of DSM-IV personality disorders was approximately 9%. Among the disorders, antisocial personality disorder was the most common and appeared in almost 5% of those assessed. Dependent personality disorder and narcissistic personality disorders were rare. The prevalence of many of the individual disorders was only 1% to 2%. For ICD-10 disorders, the overall presence in the surveyed group was 7%. Again, the prevalence for individual disorders was 1% to 2%. The most common disorder in for the ICD disorders was dissocial personality disorder at 3%. Dependent personality disorder was, again, very rare. Who is affected? Studies dedicated to uncovering the risk factors for personality disorder produced a variety of results. Prominent factors that may lead to a personality disorder include having a parent who is involved in or has been convicted of a crime, having a parent with deficient parenting abilities and being part of a large family. Factors such as low intelligence also feature in the list of risk factors. However, this study and studies that are similar raise certain issues about the nature of judging which factors should be included as risk factors for personality disorder. These sorts of factors could be criticised for having prejudicial antecedent assumptions regarding what it means to be a functioning human being. It is likely that people from lower socio-economic classes will have a tendency to fit these categories more than their middle- or upper class counterparts.Care should be taken in describing risk factors to ensure the language used is not biased by class. In the study mentioned above, several demographic characteristics were assessed with regard to prevalence of personality disorder. The outcomes demonstrated that Cluster A disorders were more common in males than in females. Cluster A disorders were also more prevalent in participants who were divorced or separated than those who were married or widowed. Subjects who had never been married were the most susceptible sub-group of all. In the Cluster B category, men were again more prone to having a personality disorder than women. Cluster B disorders were most common in the youngest age range surveyed and least common in the oldest range. Further, this cluster was most prevalent in participants who lacked a high school diploma and was least prevalent in participants who graduated from high school and continued their education afterwards. The odds of having one of these disorders decreased approximately 6% for each year an individual aged. One possible explanation for the increase of prevalence of disorder with age could be that people of more mature generations are less likely to have, know about or report symptoms of personality disorder. The prevalence of Cluster C disorders was most closely related to marital status, again showing that participants who had never been married were most likely to have one of these disorders. The likelihood of having a Cluster C disorder was almost 7 times greater in those never married when contrasted with those who were married or widowed. The results of this study broadly match a number of previous studies whose results showed the prevalence of personality disorders in the general population to be 9-13%. However, there were some differences between previous studies on prevalence and this study. The present study found a notably higher prevalence of antisocial personality disorder and a much lower prevalence of histrionic and dependent personality disorders than previous studies. These differences could have been caused by methodological variants and the diagnostic criteria used such as which version of the DSM was utilised. The differences could also be a result of participant source, form of assessment, assessors experience and data collection methods. Notable strengths of the study were that the participants were obtained through a community sample and personally interviewed by psychologists who have a significant amount of experience in cross-examination. The limitations included the fact that not all subjects coul d be interviewed and that the sample size was not really large enough to pick up on very rare disorders. The results of other studies have been less conclusive. An American study examined the theory that personality traits stop transforming by the time an individual reaches the age of 30. One of the major strengths of this study was the sample size of 132,515. The subjects, aged 21-60, participated in a web-based Big Five personality measurement. The results of this study showed that qualities such as being agreeable and conscientious increased during adulthood up through middle age. The quality of being neurotic diminished for women but remained static for men.20 Both men and women decreased in openness after the age of 30, and while men increased in extraversion from 31 to 60, the same quality diminished in women in the same age range.21 While the sample size of this study was certainly impressive, one concern was that conducting the study over the internet might bias it toward younger subjects. Another concern was the cohort effect, since people of earlier generations might not engag e with psychological instruments with the same ease as those who are younger. Overall, the multiplicity in paradigms of change did not affirm either that personality does not change after 30 or that it does. The study concludes that the traits examined are complex in nature and subject to an array of developmental influences. Historical View The onset of the de-institutionalisation of mental health establishments has produced a number of benefits. There is now less public stigma placed upon sufferers of mental illness and their traits and presence in wider society has come a long way toward normalisation. Suffers of mental illness have become less isolated and enjoy greater freedoms, including the freedom to choose from a selection of services. From a governmental point of view, deinstitutionalisation has saved them an enormous amount of money. However, the responsibility for managing and caring for mental illness sufferers has been transferred from the institution to the local community, and specifically to carers. Carers are involved in every possible aspect of the lives of their charges, even to the extent that their role could be characterised as an informal social worker. But the burden of the role combined with the lack of training, education and support often results in the damage of the psychological health of th e carer, as well as strict limitations on their life outside the caring role. The striking impact of caring on the lives of carers and other factors led to the undertaking of research on the involvement of families in managing and treating mental illness. From this came solid evidence of the benefits of such involvement, and the needs of carers began to be recognised. In recent years services have been put in place to assure that the needs of carers are met, and education for carers has been pinpointed as the most beneficial service for carers and consumers. Carers need to be educated in order to feel equipped to perform their tasks effectively. Specifically, carers named a need for â€Å"education about mental disorders† and information about treatment options† as their most salient needs. These statements are reinforced by studies from various countries where carers named the same things as most important for their success. Historically, studies examining the impact of educational programmes for carers have come from two different hypotheses. The first is that the chances of a consumer recovering from a mental illness are augmented if an educated and informed family surrounds him or her. Such a family will have deeper knowledge and sympathy for the condition of the sufferer and will be equipped to manage challenging behaviours. The second hypothesis is that because of the implications of their role, carers have an inherent right to access to adequate services. They have a right to services that will enhance their individual welfare and their effectiveness as carers. Assigning a course of treatment to personality disorder has always been an inexact science. Personality disorder is particularly complex to treat because the prime method of treatment is not always apparent after a diagnosis has been arrived at. The type of treatment which will prove most effective for the patient differs from individual to individual. Case conceptualisations can be helpful in assessing the individuals issues, identifying areas of risk and determining proper treatment goals.24 There is an abundance of research about treating personality disorder, but the studies cannot always be relied upon due to their lack of sound methodology. While some forms of treatment for personality disorder can reduce relapses and facilitate recovery, there is no simple panacea for this ailment. Cognitive treatments including cognitive-behavioural approaches have produced some pleasing results with personality disorder patients, as have psychodynamic treatments. Diagnosis Individuals who suffer from personality disorder encounter several issues with their diagnoses. They may be diagnosed through the means of an interview, a self assessment questionnaire or other means. Clinical psychiatrists often diagnose patients through interviewing them with regard to the DSM or ICD categories. This method is slightly better for detecting the existence or not of a personality disorder, but shows low accuracy for particular types of disorder. Self-report questionnaires like the Personality Diagnostic Questionnaire (PDQ-IV) and the Millon Clinical Multi-axial Inventory (MCMI) are also used to diagnose personality disorder. These questionnaires are considered imprecise because individuals tend to over-emphasise or under-emphasise the issues they are having. In addition to these methods of diagnosis, there are several semi-structured interview schedules to assist professionals. These schedules feature lists of questions that correlate to the DSM or ICD and the clinici an may then mark the patient and determine whether he or she has a disorder according to the criteria. Interview schedules have shown that they are slightly more reliable than other forms of diagnosis, but this success is only relative and the results are still much less valid than is needed. Really none of the diagnostic tools should be considered better than any of the others, for they are all faulty to the extent that they cannot be relied upon. There is a problematic absence of consensus regarding the reliability of diagnosing in general and the consistency of different diagnostic schemes. Part of the problem is that the explanations of personality disorders in the DSM and ICD feature a concoction of psychological traits and displayed behaviours, so that it becomes uncertain whether the diagnoses are attempting merely to pinpoint deviant actions or to identify traits whose presence is significant for determining personality disorder. The solidity of diagnoses for personality disorder is frequently questioned, and there are only a few disorders whose diagnoses are considered reliable. The diagnosis that can be made with the most certainty is antisocial personality disorder, because this problem can be identified by external actions that can be easily observed. Those who diagnose individuals with personality disorder are not always able to be precise in identifying which personality disorder they are dealing with, therefore m ultiple personality disorder diagnoses are common. Clinicians often find themselves confronting comorbidity, and prudent professionals test for the full scope of disorders. Comorbidity is quite common, with male legal psychopaths having an average of three disorders each. Women may have four.28 There is a great amount of interaction between the descriptors of the various types of personality disorder and so it is difficult to tell them apart. When dealing with multiple diagnoses, it is advisable to keep all disorders in mind when constructing a treatment regime, even if many of the features of the respective disorders overlap. The classification of disorders is also problematic, because the categories lack the quality of homogeneity present in reliable psychological categories of other types. Categories of psychological dysfunction work best when each class is different from others and common elements are contained within one class. This is not the case with personality disorders. For example, there are literally hundreds of ways to satisfy the criteria for borderline personality disorder, and so individuals with the same diagnosis may have utterly distinct behaviours, symptoms and needs. Axis I disorders feature frequently in those who suffer from personality disorder, particularly where there is substance abuse or depression. The classifications for personality disorder tend neither to be theoretically based, nor to stem from statistical research, which is presumably part of the reason that precise diagnoses are so elusive. The categories are so unreliable that abandoning the categories altogether and composing a new classification system is often proposed. While this may be the ideal way to correct the flaws, the time and effort already invested in the use of the present system is likely to ensure its continued existence. One approach to dealing with personality disorder is the trait approach. This approach states that a minimal amount of theories can illumine the majority of human behaviour. Observing the personality traits exhibited by an individual and placing them on a continuum from truly normal to extremely dysfunctional is more faithful to the structure of t he human psyche and tells clinicians more about the true nature of the dysfunction suffered by the patient. Currently, the most extensively developed trait theory relating to personality disorder is the theory of psychopathology. Treatment Cognitive-behavioural treatments (CBT) aimed at treating personality disorders have a tendency to take a broad approach. CBTs engage an array of behaviours, thoughts, preconceptions and internal emotional mechanisms. Many treatments are residential and are conducted with a group. They frequently include tenets of other methods such as psychodynamic therapy. Therefore it is an arduous task to pick out what, if any, elements are effective in a multi-dimensional approach so that they can be improved and repeated. Dialectical behaviour therapy (DBT) is a method of CBT focusing on female patients with borderline personality disorder. The goal of the therapy is to reduce or eliminate incidents of self-harm through group skills training. Group sessions address destructive thought patterns and social skills. Individual therapy can also be used. The outcomes for one study showed that women who were treated experienced reduced anger and self-destructive or suicidal thoughts. Their social skills improved and they required less psychiatric treatment. Arnold Lodge Regional Secure Unit has produced a treatment method aimed specifically at offenders with a personality disorder. The treatment programme centres on teaching patients socially acceptable mechanisms for problem solving. The patients work individually and with others and receive regular counselling. This regime is supplemented with services that are individually tailored to the needs of the individual, such as anger management sessions or substance abuse education. This form of treatment has been shown to reduce deficiencies in social functioning and self-control.32 While the initial studies are promising, long-term analysis will confirm or refute the true effectiveness of this type of treatment. Therapeutic communities, cognitive therapies and dynamic therapies may also be used to treat personality disorder. Therapeutic communities are tailored primarily for offenders and have produced promising results in terms of reduced recidivism and improved social integration. A study into the effectiveness of therapeutic community treatment of personality disorder explored whether this type of treatment improved the health of patients to the extent that the burden on Health Services eased. Several previous studies reported reductions in the use of psychiatric services after therapeutic community treatment. The previous studies were limited by the fact that they observed participants for one year only and lacked thorough follow-up. This study sought to fill the methodological gaps of the previous studies by tracking patients for years after treatment. They assessed the impact of treatment on Health Services by counting the number of admissions to hospital before and after treatment. Th e study found that therapeutic community treatment resulted in a statistically significant drop in in-patient admissions over the 3-year period. Those who were admitted to hospital tended to be the subjects who had the briefest experience of therapeutic community treatment. Another study involving therapeutic community treatment focused on individuals with severe personality disorder. The effect of p Personality Disorder Carer and Family Support Impact Personality Disorder Carer and Family Support Impact ARE PSYCHO-EDUCATIONAL AND SUPPORT PROGRAMMES FOR FAMILY AND CARERS EFFECTIVE IN REDUCING RELAPSES AND FACILITATING RECOVERY OF PEOPLE SUFFERING FROM PERSONALITY DISORDERS? ABSTRACT Background Carers and families of people suffering from personality disorder are in desperate need of support and services. Providing these services can reduce relapses and facilitate recovery in sufferers of personality disorder. The Research Question How can psycho-educational and support programmes for carers and families of those with personality disorder improve their recovery? Methodology The results of this study were obtained through a systematic literature review. Results Diagnosis and treatment of personality disorder are still complex and often confusing issues, even for professionals. Still, treatment can produce recovery and this recovery can be expedited if carers and families are provided with programmes to equip them to effectively face the challenges that personality disorder presents. Conclusions Providing psycho-educational and support programmes makes carers more effective and can help treat personality disorder. Social Workers can help to bridge a gap in the services that is adversely affecting the treatment outcomes of sufferers and hence placing greater strain on the Health System than is necessary. Contextualisation The carers and families of individuals suffering from personality disorders are an underserved population. Considerable strain is placed upon them and their loved ones and they are often at a loss as to how to effectively perform their duties and assist the recovery of those they care for. If more psycho-educational and support programmes for carers and families were provided, it is possible that treatment for personality disorder could be improved. Personality disorders can be defined as: â€Å". . . psychiatric conditions relating to functional impairment, or psychological distress resulting from inflexible and maladaptive personality traits.†1 Personality disorders are explained in the two most prominent classification schemes, the DSM-IV, where personality disorders can be found in Axis II, and the ICD-10. The definitions in these diagnostic classification systems are much the same. Defining ‘severe personality disorder has proved problematic for experts, who have yet to establish a generally accepted definition. The suggestion of the Royal College of Psychiatrists (1999) that severe personality disorder is marked by extreme societal disturbance and at least one extreme personality disorder has provided some guidance.2 Alternatively, having two severe disorders could mean that the sufferer has one disorder that expresses itself in more than one extreme way, or could simply indicate one deeply disturbing disorder. One study graded the severity of personality disorder on 163 subjects and found that the patients whose personality disorder was described as ‘complex demonstrated the greatest number of symptoms and recovered the least. Personality disorder carers are people who support a person who suffers from any form of personality disorder, whether they are relatives, friends or partners. Often, carers give sufferers emotional and financial support and may even act as informal social workers. Previous studies have shown that carers of people with personality disorder benefit from psycho-educational and support programmes. Psycho-educational programmes are educational programmes that contain an element of counselling or therapeutic activity for the family. The main aim of these programmes is to minimise the strain experienced by families and carers of people with mental illnesses, here personality disorder. Psycho-educational and counselling programmes exist ultimately to facilitate recovery and reduce relapses; indeed, the success of programmes is usually measured by examining relapse rates. Programmes attempt to provide adequate support, information, signposting to appropriate resources, advocacy and respite for carers. They also coach carers to increase their problem solving abilities, improve their communication and help them construct their own support networks. Support programmes for carers of people with a mental illness attempt to support the contribution that carers make to the lives of those they care for. They work toward advances in policy that will augment the services that satisfy carer requirements. Support programmes prompt dialogue between members of the government and carers, as well as encouraging carer involvement in the creation and delivery of carer and patient services. Further, support services connect carers with agencies to assist them in their role and facilitate modes of best practice in aiding carers. The Research Question This literature review examines a number of studies on personality disorder, its effect on carers and issues connected with diagnosis and treatment in an attempt to determine whether psycho-educational and support programmes for family and carers are effective in reducing relapses and facilitating recovery of people suffering from personality disorders. If social workers are to work effectively with this client base, they must put aside antiquated beliefs that personality disorder cases are hopeless and that those who suffer from personality disorder never get better. This study reveals that one of the greatest challenges to carers and families is obtaining the support they need and the services they are entitled to, and Social Workers can be instrumental in bridging gaps in the Mental Health system. Methodology This dissertation undertakes a systematic literature review of health care and psychological literature to address key issues in the support of carers of people suffering from personality disorders. Several different studies and a range of approaches were examined. Although the number and breadth of studies was a strength of the review, the variety of approaches made it challenging to compare the overall merits of one study against another. The literature was obtained through a variety of means. Google searches, journal articles, working group reports, service provider reports and academic papers were used. The research methods that appear in the utilised material included telephone interviews, questionnaires and surveys, face-to-face interviews and meta-analysis. Some were literature reviews themselves and some simply reported on the outcomes when a group of treated individuals was observed. Of the studies that involved observation of a group, very few included a control group in the study so methodological rigour was not as great as it could have been. Neither is it certain that studies where self-reporting was used are as empirically reliable as one would like, as sufferers of personality disorder tend to over- or under-report their symptoms . Some of the studies that were conducted recently showed positive outcomes, but the long-term follow-up for the same groups may make the figures less significant. Even where there has been longterm follow-up, some of those who took part in the initial study may not be included because of death, inability or unwillingness to participate, or inability to be located. The methodological rigour of the studies is further complicated by the fact that the process of diagnosis and treatment of personality disorder is fraught with complexities. The categories for personality disorder are somewhat defined by behaviours and are not theoretically based or grounded in common mechanisms of the disorder. The actions and symptoms of patients are so extremely varied that both diagnosis and treatment are difficult to present, much less to assess. Yet just because a comprehensive catalogue of truths about personality disorder cannot be presented does not mean that no reliable statements can be made. The evidence that is presented here is solid enough to make general assertions regarding the affects of carer support on patients based upon the evidence, and that is what it intends to do. Assessing the impact of support and education for carers upon the sufferers of personality disorder themselves proved more challenging than, for example, assessing the impact of treatment on sufferers, for which there is abundant literature. Still, the impact of psycho-educational and support programmes on consumers has been assessed and outcomes observed. Additionally, the evidence for the improvement of the lives of carers and the quality of care they give their charges is strong, and this fact bolsters the hypothesis that improved care for carers improves the mental health of those for whom they care. These conclusions are definitely linked, especially given the statistics that show that improvement for personality disorder takes place over a long period of time and is facilitated by positive interpersonal relationships with people who are equipped to deal with the symptoms that people with personality disorder exhibit. The presence of positive relationships with carers who are tr ained, educated and supported will assuredly improve the ‘treatment conditions for those with personality disorder. In narrowing the scope of the literature to be included in the study, several factors had to be noted. Some of the literature was so grounded in certain programmes for certain countries that many sections were not transferable to this review. For example, the results of the Network for Carers (2004) report were based upon specific programmes offered in Australia, so some information had to be excluded. However, this document was very helpful in establishing general facts about the needs of carers and the impact of programmes upon their ability to care for sufferers. It was also a thorough exposition of the opinions of carers,through which their voice was clearly heard. There were also other limitations regarding the particular demographic studied. The NHS National Programme on Forensic Mental Health Research and Development Expert Paper on Personality Disorders primarily assessed offenders with personality disorder and not merely members of the wider public suffering from the disorde r. Because of this, significant sections of the material had to be ignored. Still, this paper was useful in understanding the complexities of treatment and diagnosis of personality disorder, and provided definitions for contextualisation. In evaluating the quality of the data, the analytical tool Critical Appraisal Skills Programme (CASP) was used to assist in making sense of the evidence. This tool is advantageous to those who are strangers to qualitative research, assessing the merits of a source with regard to rigour, credibility and relevance.CASP initially asks two screening questions, the first addressing research aims and significance. The second screening question considers whether the research interprets subjective experiences of participants.Answering these two questions with a ‘yes then leads to eight more questions covering issues such as recruitment strategies, collection of data and ethical issues. In a literature review there are several ethical issues that must be considered, especially when dealing with a vulnerable population such as sufferers of mental illness. For each study used in the review it was necessary to consider whether ethical standards were maintained throughout the study, includi ng the manner in which consent was obtained and the way that confidentiality was upheld. Another ethical consideration is the handling of the outcomes of the study with the participants after the study.9 In the data observed here, it is not always explicit that consent was obtained but is often implied. Eliciting feedback from carers carries implied consent even if consent was not explicit, for obviously no individual would be forced to comment against his or her will. Confidentiality is maintained through omitting names and keeping the results impersonal. Yet the information given for studies is in its final and often abbreviated form, and the background work is not always documented comprehensively enough to ascertain whether all ethical considerations have been taken into account. One ethical consideration that is not always considered is the treatment of ethnic minorities in research projects, especially those for whom English is not their first language. The wording of questions and the criteria by which outcomes are judged is often tainted by cultural bias for those being assessed outside their native surroundings. It is practically impossible to remedy this, because part of the methodological rigour of the study depends upon all participants being treated and assessed in the same way. Differentiation on the basis of cultural differences would compromise the consistency of the study, but the impact of cultural factors is most certainly felt by those of foreign origin. Discussion of Findings Traits The traits exhibited by sufferers of personality disorder differ immensely because of the wide scope of the disorder. Examples of traits range from anxiety, narcissism and compulsivity to defiance, abnormal attachments and avoidance of social situations. Sufferers may demonstrate an arrogant interpersonal style, or may show extreme submissiveness. Personality disorders are linked with negative results in the wider population such as marital breakdown, criminal actions and professional difficulties.The anomalies of personality disorder are apparent in the thought patters, expressions and levels of self-control of sufferers. The patient will display abnormalities in the way that he or she interacts with others which will appear in a range of circumstances. There are various types of personality disorders, and each has its own banners of dysfunction. It has been recognised that the kinds of personality disorders covered in DSM and ICD are a small cluster when contrasted with the array o f personality impairments that can be identified in large configurations of people.11 Personality disorders can be divided into three clusters, A-C. In the first cluster disorders relating to paranoia and schizophrenia are found. Cluster B includes antisocial and narcissistic disorders, and Cluster C focuses on avoidant, dependent and obsessive-compulsive disorders. Prevalence It is estimated that between 6% and 15% of the population have one or more personality disorders of some kind—different studies produce different results.13 The goal of one study was to estimate the prevalence of personality disorders in a local sample and discern the most common demographic groups therein. The frequency of the DSM and ICD personality disorders and the interactions between disorder clusters and demographic qualities was assessed in a local sample of 742 participants between the ages of 34 and 94 over two years.14 The results showed that the overall prevalence of DSM-IV personality disorders was approximately 9%. Among the disorders, antisocial personality disorder was the most common and appeared in almost 5% of those assessed. Dependent personality disorder and narcissistic personality disorders were rare. The prevalence of many of the individual disorders was only 1% to 2%. For ICD-10 disorders, the overall presence in the surveyed group was 7%. Again, the prevalence for individual disorders was 1% to 2%. The most common disorder in for the ICD disorders was dissocial personality disorder at 3%. Dependent personality disorder was, again, very rare. Who is affected? Studies dedicated to uncovering the risk factors for personality disorder produced a variety of results. Prominent factors that may lead to a personality disorder include having a parent who is involved in or has been convicted of a crime, having a parent with deficient parenting abilities and being part of a large family. Factors such as low intelligence also feature in the list of risk factors. However, this study and studies that are similar raise certain issues about the nature of judging which factors should be included as risk factors for personality disorder. These sorts of factors could be criticised for having prejudicial antecedent assumptions regarding what it means to be a functioning human being. It is likely that people from lower socio-economic classes will have a tendency to fit these categories more than their middle- or upper class counterparts.Care should be taken in describing risk factors to ensure the language used is not biased by class. In the study mentioned above, several demographic characteristics were assessed with regard to prevalence of personality disorder. The outcomes demonstrated that Cluster A disorders were more common in males than in females. Cluster A disorders were also more prevalent in participants who were divorced or separated than those who were married or widowed. Subjects who had never been married were the most susceptible sub-group of all. In the Cluster B category, men were again more prone to having a personality disorder than women. Cluster B disorders were most common in the youngest age range surveyed and least common in the oldest range. Further, this cluster was most prevalent in participants who lacked a high school diploma and was least prevalent in participants who graduated from high school and continued their education afterwards. The odds of having one of these disorders decreased approximately 6% for each year an individual aged. One possible explanation for the increase of prevalence of disorder with age could be that people of more mature generations are less likely to have, know about or report symptoms of personality disorder. The prevalence of Cluster C disorders was most closely related to marital status, again showing that participants who had never been married were most likely to have one of these disorders. The likelihood of having a Cluster C disorder was almost 7 times greater in those never married when contrasted with those who were married or widowed. The results of this study broadly match a number of previous studies whose results showed the prevalence of personality disorders in the general population to be 9-13%. However, there were some differences between previous studies on prevalence and this study. The present study found a notably higher prevalence of antisocial personality disorder and a much lower prevalence of histrionic and dependent personality disorders than previous studies. These differences could have been caused by methodological variants and the diagnostic criteria used such as which version of the DSM was utilised. The differences could also be a result of participant source, form of assessment, assessors experience and data collection methods. Notable strengths of the study were that the participants were obtained through a community sample and personally interviewed by psychologists who have a significant amount of experience in cross-examination. The limitations included the fact that not all subjects coul d be interviewed and that the sample size was not really large enough to pick up on very rare disorders. The results of other studies have been less conclusive. An American study examined the theory that personality traits stop transforming by the time an individual reaches the age of 30. One of the major strengths of this study was the sample size of 132,515. The subjects, aged 21-60, participated in a web-based Big Five personality measurement. The results of this study showed that qualities such as being agreeable and conscientious increased during adulthood up through middle age. The quality of being neurotic diminished for women but remained static for men.20 Both men and women decreased in openness after the age of 30, and while men increased in extraversion from 31 to 60, the same quality diminished in women in the same age range.21 While the sample size of this study was certainly impressive, one concern was that conducting the study over the internet might bias it toward younger subjects. Another concern was the cohort effect, since people of earlier generations might not engag e with psychological instruments with the same ease as those who are younger. Overall, the multiplicity in paradigms of change did not affirm either that personality does not change after 30 or that it does. The study concludes that the traits examined are complex in nature and subject to an array of developmental influences. Historical View The onset of the de-institutionalisation of mental health establishments has produced a number of benefits. There is now less public stigma placed upon sufferers of mental illness and their traits and presence in wider society has come a long way toward normalisation. Suffers of mental illness have become less isolated and enjoy greater freedoms, including the freedom to choose from a selection of services. From a governmental point of view, deinstitutionalisation has saved them an enormous amount of money. However, the responsibility for managing and caring for mental illness sufferers has been transferred from the institution to the local community, and specifically to carers. Carers are involved in every possible aspect of the lives of their charges, even to the extent that their role could be characterised as an informal social worker. But the burden of the role combined with the lack of training, education and support often results in the damage of the psychological health of th e carer, as well as strict limitations on their life outside the caring role. The striking impact of caring on the lives of carers and other factors led to the undertaking of research on the involvement of families in managing and treating mental illness. From this came solid evidence of the benefits of such involvement, and the needs of carers began to be recognised. In recent years services have been put in place to assure that the needs of carers are met, and education for carers has been pinpointed as the most beneficial service for carers and consumers. Carers need to be educated in order to feel equipped to perform their tasks effectively. Specifically, carers named a need for â€Å"education about mental disorders† and information about treatment options† as their most salient needs. These statements are reinforced by studies from various countries where carers named the same things as most important for their success. Historically, studies examining the impact of educational programmes for carers have come from two different hypotheses. The first is that the chances of a consumer recovering from a mental illness are augmented if an educated and informed family surrounds him or her. Such a family will have deeper knowledge and sympathy for the condition of the sufferer and will be equipped to manage challenging behaviours. The second hypothesis is that because of the implications of their role, carers have an inherent right to access to adequate services. They have a right to services that will enhance their individual welfare and their effectiveness as carers. Assigning a course of treatment to personality disorder has always been an inexact science. Personality disorder is particularly complex to treat because the prime method of treatment is not always apparent after a diagnosis has been arrived at. The type of treatment which will prove most effective for the patient differs from individual to individual. Case conceptualisations can be helpful in assessing the individuals issues, identifying areas of risk and determining proper treatment goals.24 There is an abundance of research about treating personality disorder, but the studies cannot always be relied upon due to their lack of sound methodology. While some forms of treatment for personality disorder can reduce relapses and facilitate recovery, there is no simple panacea for this ailment. Cognitive treatments including cognitive-behavioural approaches have produced some pleasing results with personality disorder patients, as have psychodynamic treatments. Diagnosis Individuals who suffer from personality disorder encounter several issues with their diagnoses. They may be diagnosed through the means of an interview, a self assessment questionnaire or other means. Clinical psychiatrists often diagnose patients through interviewing them with regard to the DSM or ICD categories. This method is slightly better for detecting the existence or not of a personality disorder, but shows low accuracy for particular types of disorder. Self-report questionnaires like the Personality Diagnostic Questionnaire (PDQ-IV) and the Millon Clinical Multi-axial Inventory (MCMI) are also used to diagnose personality disorder. These questionnaires are considered imprecise because individuals tend to over-emphasise or under-emphasise the issues they are having. In addition to these methods of diagnosis, there are several semi-structured interview schedules to assist professionals. These schedules feature lists of questions that correlate to the DSM or ICD and the clinici an may then mark the patient and determine whether he or she has a disorder according to the criteria. Interview schedules have shown that they are slightly more reliable than other forms of diagnosis, but this success is only relative and the results are still much less valid than is needed. Really none of the diagnostic tools should be considered better than any of the others, for they are all faulty to the extent that they cannot be relied upon. There is a problematic absence of consensus regarding the reliability of diagnosing in general and the consistency of different diagnostic schemes. Part of the problem is that the explanations of personality disorders in the DSM and ICD feature a concoction of psychological traits and displayed behaviours, so that it becomes uncertain whether the diagnoses are attempting merely to pinpoint deviant actions or to identify traits whose presence is significant for determining personality disorder. The solidity of diagnoses for personality disorder is frequently questioned, and there are only a few disorders whose diagnoses are considered reliable. The diagnosis that can be made with the most certainty is antisocial personality disorder, because this problem can be identified by external actions that can be easily observed. Those who diagnose individuals with personality disorder are not always able to be precise in identifying which personality disorder they are dealing with, therefore m ultiple personality disorder diagnoses are common. Clinicians often find themselves confronting comorbidity, and prudent professionals test for the full scope of disorders. Comorbidity is quite common, with male legal psychopaths having an average of three disorders each. Women may have four.28 There is a great amount of interaction between the descriptors of the various types of personality disorder and so it is difficult to tell them apart. When dealing with multiple diagnoses, it is advisable to keep all disorders in mind when constructing a treatment regime, even if many of the features of the respective disorders overlap. The classification of disorders is also problematic, because the categories lack the quality of homogeneity present in reliable psychological categories of other types. Categories of psychological dysfunction work best when each class is different from others and common elements are contained within one class. This is not the case with personality disorders. For example, there are literally hundreds of ways to satisfy the criteria for borderline personality disorder, and so individuals with the same diagnosis may have utterly distinct behaviours, symptoms and needs. Axis I disorders feature frequently in those who suffer from personality disorder, particularly where there is substance abuse or depression. The classifications for personality disorder tend neither to be theoretically based, nor to stem from statistical research, which is presumably part of the reason that precise diagnoses are so elusive. The categories are so unreliable that abandoning the categories altogether and composing a new classification system is often proposed. While this may be the ideal way to correct the flaws, the time and effort already invested in the use of the present system is likely to ensure its continued existence. One approach to dealing with personality disorder is the trait approach. This approach states that a minimal amount of theories can illumine the majority of human behaviour. Observing the personality traits exhibited by an individual and placing them on a continuum from truly normal to extremely dysfunctional is more faithful to the structure of t he human psyche and tells clinicians more about the true nature of the dysfunction suffered by the patient. Currently, the most extensively developed trait theory relating to personality disorder is the theory of psychopathology. Treatment Cognitive-behavioural treatments (CBT) aimed at treating personality disorders have a tendency to take a broad approach. CBTs engage an array of behaviours, thoughts, preconceptions and internal emotional mechanisms. Many treatments are residential and are conducted with a group. They frequently include tenets of other methods such as psychodynamic therapy. Therefore it is an arduous task to pick out what, if any, elements are effective in a multi-dimensional approach so that they can be improved and repeated. Dialectical behaviour therapy (DBT) is a method of CBT focusing on female patients with borderline personality disorder. The goal of the therapy is to reduce or eliminate incidents of self-harm through group skills training. Group sessions address destructive thought patterns and social skills. Individual therapy can also be used. The outcomes for one study showed that women who were treated experienced reduced anger and self-destructive or suicidal thoughts. Their social skills improved and they required less psychiatric treatment. Arnold Lodge Regional Secure Unit has produced a treatment method aimed specifically at offenders with a personality disorder. The treatment programme centres on teaching patients socially acceptable mechanisms for problem solving. The patients work individually and with others and receive regular counselling. This regime is supplemented with services that are individually tailored to the needs of the individual, such as anger management sessions or substance abuse education. This form of treatment has been shown to reduce deficiencies in social functioning and self-control.32 While the initial studies are promising, long-term analysis will confirm or refute the true effectiveness of this type of treatment. Therapeutic communities, cognitive therapies and dynamic therapies may also be used to treat personality disorder. Therapeutic communities are tailored primarily for offenders and have produced promising results in terms of reduced recidivism and improved social integration. A study into the effectiveness of therapeutic community treatment of personality disorder explored whether this type of treatment improved the health of patients to the extent that the burden on Health Services eased. Several previous studies reported reductions in the use of psychiatric services after therapeutic community treatment. The previous studies were limited by the fact that they observed participants for one year only and lacked thorough follow-up. This study sought to fill the methodological gaps of the previous studies by tracking patients for years after treatment. They assessed the impact of treatment on Health Services by counting the number of admissions to hospital before and after treatment. Th e study found that therapeutic community treatment resulted in a statistically significant drop in in-patient admissions over the 3-year period. Those who were admitted to hospital tended to be the subjects who had the briefest experience of therapeutic community treatment. Another study involving therapeutic community treatment focused on individuals with severe personality disorder. The effect of p