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How do the prospectus, mental health service respond to the rising incidents of robber essay self harm among young people. The Oxford Medical Dictionary defines suicide as self-destruction that is performed as a deliberate act. Although it is strongly linked to self-harm , it is dissertation history noteworthy that self-harm is often not a suicide attempt, but actually a parasuicide -when self-harm is essays carried out for other reasons other than killing oneself. Write Dissertation Prospectus! Deliberate self-harm refers to “a wide range of behaviours and intentions including attempted hanging, impulsive self-poisoning, and superficial self-cutting in response to intolerable tension” (Skegg, 2005). According to The National Institute of Clinical Excellence (NICE), self-harm is an expression of university personal distress, and is not in itself, and illness. It is a situation in which a person inflicts harm on himself or herself in an attempt to end one’s life, relieve tension, escape anguish, change others’ behaviours, show desperation or cry for help (Hawton and James, 2005). Thus it ranges from behaviours with no suicidal intent through to history, actual suicide.
However, is has been proposed that some successful suicides are actually self-harming episodes that go wrong. Suicide and university coursework self-harm among teenagers usually occurs by means of self-cutting or self-poisoning. Other common examples include hitting or burning oneself, pulling hair or picking skins and self-strangulation. Generally, teenagers tend to use means that are readily available within their homes. Self-poisoning accounts for approximately 90% of reported hospital cases -usually involving over-the-counter preparations such as paracetamol and write dissertation aspirin, or psychotropic agents. Rarely, self-harm is carried out by mentoring essay more violent acts such as attempted hanging; in which case, it is write generally associated with higher suicidal intent.
While previous self-harm is a major determining factor for future suicides, the reverse is obviously not the case. Possibly, a major difference between these two increasingly prevalent occurrences is complete hopelessness often associated with suicide victims. It is widely believed that adolescents who commit suicides are products of broken homes, have history of family of self-psychiatric disorders or suicidal behaviour, substance misuse or have previously self-harmed. In self-harm, oftentimes the individual is merely crying for help in an extreme manner. This is fundamental to the rationale behind the extensive assessment recommended for all patients who have self-harmed.
Although these two conditions often overlap, differences have been highlighted between suicides and deliberate self-harm in terms of epidemiology and prevalence. While suicide rates increase with age, the majority of deliberate self-harm occur in people under 35 years of age. Gender variation has also been widely observed, with suicides being more common in males and deliberate self-harm in females. Also, differences arise in the psychiatric status of the experimentation, patients. Write Dissertation Prospectus History! Post mortem studies of suicide victims show that there is experimentation usually an underlying psychiatric disorder such as depression associated with the victim’s mental health. Write Prospectus! This is not always the case with self-harm patients. Although there could be a history of depressive illness, self-harm is frequently an impulsive act, probably enhanced by on alzheimer's disease alcohol or drug consumption (Hawton and James, 2005). Self-harm is a serious public health problem and dissertation prospectus history young people are particularly affected by it (Mental Health Foundation, 2006). A case of on alzheimer's disease a patient who has self-harmed is dissertation prospectus history a chance for the health services to effectively evaluate and address any relevant underlying problems and is an opportunity to successfully avert potential future suicides.
The extent of self-harm and suicides among young people has been accurately described as an unknown quantity (Bywaters and Rolfe, 2002). Reportedly, 8 out of every 100,000 deaths in England and Wales each year are suicide cases. There are an to write essays estimated 25,000 adolescent self-harm presentations annually in hospitals in England and Wales (Hawton et al, 2000) and write dissertation history government research report that as many as 1 in college, 17 young people have attempted to write prospectus history, harm themselves. Suicide is the pay for coursework, second most common cause of death among 15- to 34-year olds. These rates are even higher (20-50 times) in psychotic patients than in the general population. Prospectus History! The often-vast variation between different prevalence sources is most likely an indicator of animal experimentation essay geographic, epidemiogical and prospectus history cultural variation in self-harm trends. Global suicide rates in of a place, young people have increased during the past three decades. According to the Office of National Statistics (1999), 1.3% of 5-10 year olds have tried to harm, hurt or kill himself/herself.
More than four times this proportion (5.8%) of the older children aged 11 to 15 years old report having attempted to self-harm or commit suicide. Most child and adolescent mental the health services take the prospectus history, school-leaving age of 16 as their upper limit. Thus most available statistics are only for mentoring essay children up to the age of 16. It is important that children who fall within this narrow and oft-omitted age-gap (16-18 year olds) are not neglected, and are properly catered for. The statistics also show that among the prospectus, 5-10 year olds, boys were almost twice as likely to self-harm than their female counterparts. Likewise, children of single-parent homes also had more tendencies for deliberate self-harm than children of couple-parent families. Surprisingly, children with no siblings had slightly more chance of experimentation committing self-harm than children from larger families.
40% of these children who had tried to self-harm had a mental disorder, and one in three had experienced 3 or more stressful life events. In contrast, among the 11-15 year olds, self-harm appears to be more prevalent among girls (58%) than boys. However, these older children are apparently more likely to self-harm if they have a lot of siblings. 50% of write these adolescents who had tried to harm, hurt or kill themselves had a mental disorder and over 40% had experienced 3 or more stressful life events. Parents generally tend to an expository that the attractions of a particular place, underestimate their children’s self-harm tendencies and history, as illustrated by the vast differences in parents and dissertation children’s accounts of self-harm and suicide attempts. This gives an insight into the level of an expository explains the attractions of a particular place shrouding and write secrecy that is associated with these phenomena and casts doubts on the validity and reliability of these widely accepted statistics. Stigmatisation and ostracization commonly associated with suicide and self-harm victims and families is the write essay that explains the attractions of a, most likely reason behind under-reporting and write prospectus denial. In addition, prevalence of suicides is largely underestimated because of reluctance of coroners to classify cause of pay for coursework death as suicides, especially in children.
A large proportion of the so-called “open verdicts” are, in fact, suicides (Hawton and James, 2005). Self-harm techniques such as self-cutting usually go unnoticed. As the most common method of prospectus history DSH by teenagers, the implications are that the rates of self-harm amongst adolescents are grossly under-reported. Thus it is robber industry important to note that these daunting statistics might actually represent a conservative estimate of the reality of self-harm and suicide attempts among young people . Investigating potential socio-demographic and write prospectus history clinical predictors of mentoring essay suicide, Cooper et al (2005) concluded that there was an approximately 30-fold increase in risk of suicide in deliberate self-harm patients than in write, the general population. Furthermore, suicide rates were found to be highest within the first 6 months after the initial self-harm episode. This is the basis for early assessment and treatment as will be discussed in subsequent sections. Examining trends and characteristics of self-harm in adolescents between 1990 and disease 2000, Hawton et al (2003) found that the prevalence of write dissertation history self-harm among young females was on industry the increase.
These rising rates could reflect latent negative effects of a number of social changes. Write Dissertation Prospectus! Possible reasons for this increase include increased rates of family breakdowns, increasing rates of substance misuse, media influences and common peer behaviours. In a self-report survey, Hawton et al (2002) studied the prevalence of deliberate self-harm in adolescents aged 15 and 16 years old, and the factors associated with it. In this age group, females were more likely to mentoring essay, self-harm than males. Dissertation! Ethnicity-wise, teenagers of white origin were more likely to self-harm than their Asian counterparts. Black young people were the least likely to self-harm. In addition, teenagers who lived with other family members apart from their parents were more likely to self-harm than those who live with one or both parents. Smokers also had more incidents of self-harm than non-smokers, with frequency increasing with number of on alzheimer's cigarettes smoked in girls. Similar trends were observed with young people who consumed alcohol. Expectedly, bullying and other forms of write history abuse (physical or sexual) was a major determining factor for adolescents who self-harm. Other factors which played a role in on alzheimer's disease, self-harm amongst young people were sexual orientation worries, trouble with police and write family or friends who harm themselves.
Although self-harm is observed in all age-groups, it has an average age of onset of mentoring essay 12 years old (Fox and dissertation prospectus history Hawton, 2004). Thus the importance of addressing this problem in university coursework, adolescents is dissertation history blatantly obvious. Factors that have been substantiated to be strongly associated with self-harm amongst adolescents are very similar to characteristics associated with suicidal patients. Mentoring Essay! These include: Depression Substance misuse Physical or sexual abuse Low self esteem Physical ill-health Disputes with parents, siblings or friends School or work problems. In an ecological and person-based study, Hawton et al (2001) investigated the dissertation prospectus, influence of the economic and social environment on deliberate self-harm and suicide. Improving on the methodical limitations of previous studies, the experimentation conclusion, researchers studied DSH patients over 10 years.
The relationship between socio-economic deprivations was shown to be very significant in males and females. These findings have been collaborated by a more specific study (patients under 18 years old). Socio-economic deprivation was significantly associated with overdose, self-injury and poisoning by illicit substances (Ayton et al, 2003). Dissertation History! Accounting for an expository that explains the attractions of a particular place confounding factors, correlations remained significant, further validating the results of the study. Although the relationship between ethnic density and deliberate self-harm tendencies is write history not well established, Neeleman and colleagues (2001) demonstrated variable deliberate self-harm rates in various minority groups, suggesting protection and risk in write essay that particular, different areas. This is prospectus a gap in the literature for future research. School stress has also been shown to play a role in DSH in teenagers (Hawton et al, 2003). The findings from widespread international research suggest that the most determining risk factors for college youth suicide are mental disorders and a history of write prospectus psychopathology (Beautrais, 2000). Others could be individual and personal vulnerabilities, social, cultural and contextual factors. Possible motives for to write college self-harming behaviour other than death are highlighted below (Hawton and write prospectus James, 2005): To escape from mentoring essay unbearable anguish.
To change the behaviour of others. To escape from prospectus a situation. To show desperation to university, others. To make others feel guilty. To gain relief of tension. To seek help.
Furthermore, research has provided a useful insight into the factors that can influence repetitive self-harm behaviours despite aftercare and treatment. Dissertation History! This is important in the assessment of patients who have self-harmed to identify those who are likely to self-harm again and prevent such episodes. Factors that are associated with repeated self-harm as highlighted by Hawton and disease James (2005) include personality disturbance, depression, alcohol or substance misuse, disturbed family relationships, social isolation and poor school records. Hawton et al (1999) demonstrated that self-harm repeaters differed from the non-repeaters in having higher scores for write dissertation history depression, hopelessness and trait anger, and lower scores for self-esteem. Specific reasons that have been cited for self-harm by to write essays young people, as highlighted by the National Inquiry (2006) include: · Strained relationships with parents. · Worry about academic performance.
· Childhood abuse (sexual, physical or emotional) · Low self-esteem or rejection. · Problems to do with race, culture or religion. 2. Responding To Young People Who Self-Harm. 2.1 Guidelines And Evidence For Good Practice. The National Institute for write dissertation prospectus Clinical Excellence (NICE, 2004) has proposed guidelines for the short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. In addition, The Royal College of Psychiatrists (RCPSYCH) also provides guidance on animal experimentation essay conclusion managing young people up to the age of 16 who deliberately harm themselves.
Such guidelines are readily applicable to dissertation prospectus, the Health service i.e. Accident and coursework Emergency departments and Child and Adolescents Mental Health Services. Integrating these treatment guidelines and the findings of related research, the management of write these young self-harm patients will be extensively discussed under the following sub-titles: Assessment Treatment planning Admission to hospital Treatment options Medical and surgical management Referral and experimentation conclusion discharge following self-harm Pharmacological interventions Family support Prevention. A comprehensive child and adolescent mental health service needs to take all the above facets into consideration when treating this group of extremely vulnerable patients.
The NICE guidelines (2004) emphasize the importance of treating patients who have self-harmed with the same care, respect and privacy as any other patient. In fact, the likely distress associated with self-harm may necessitate additional care and tact when dealing with these patients. Also, health services are urged to dissertation prospectus, provide appropriate training to all staff (clinical and non-clinical) that has any form of contact with the patients to fully equip them with the to write college, necessary skills and knowledge to effectively understand and care for people who have self-harmed. Ideally, training should cover areas such as crisis counselling, risk assessment, stress management, mental health triage, cultural awareness, working with families and confidentiality issues (Wynaden et al, 2000). Clearly, the importance of ensuring patients’ safety while in hospital is colossal. These patients should be offered an environment that is safe, supportive and minimises any distress. The NICE guidelines (2004) suggest a separate, quiet room with supervision and regular contact with a named member of prospectus staff to college essays, ensure safety at all times.
The high rate of self-harm patients who repeatedly self-harm or go ahead to commit suicide in the future makes it imperative to write dissertation, conduct an extensive and detailed assessment of young people who self-harm . Young people who have self-harmed in a potentially serious or violent way should be assessed either by a child and adolescent psychiatrist, a specialist mental worker, a psychologist, a psychotherapist or a psychiatric nurse (Hawton and pay for coursework James, 2005). The NICE guidelines propose that all people who have self-harmed should be offered this preliminary assessment at triage, regardless of the severity of the write dissertation, attack. Apart from the obligatory emergency physical assessment, this will give an captains industry insight into the patient’s mental health, the level of distress and their willingness to co-operate with the medical team. In addition, the patient’s psychosocial situation and the ability of parents or guardians to ensure their safety should be addressed (RCPSYCH, 2006). As the dissertation, first point of contact, ambulance staff have a crucial role to play in barons essay, the initial assessment of young people who have self-harmed (NICE, 2004). The Australian Mental Health Triage Scale is write dissertation prospectus a validated comprehensive assessment scale that provides a means of efficiently rating clinical urgency so that patients can be seen in a timely manner. This scale has been shown to improve staff confidence and attitudes in dealing with clients with mental health problems, thus improving patients’ outcomes in to write college, the long-run (Broadbent et al, 2004). Research has shown the importance of cultural, ethnic and racial awareness and sensitivity in the assessment process.
Some cultures regard suicide attempts as taboo, and it is always good practice to prospectus history, take such factors into consideration. In addition, a language interpreter may be required to communicate effectively with the patient and family. 2.1.2 Treatment Planning. Following the preliminary assessment, it is considered good practice to have an action or treatment plan (Hawton and James, 2005). The treatment plan should take into animal experimentation essay account all aspects of the patient’s management in hospital, ranging from treatment options to pharmacological and psychological interventions to discharge planning. 2.1.3 Admission To Hospital. At this point, temporary admission should be considered especially for patients who are who are very distressed, for people who may be returning to an unsafe or harmful environment and for people in whom psychosocial assessment proves too difficult for any number of reasons (NICE, 2004). If admission is indicated, a paediatric, medical adolescent, or designated unit should be utilised as appropriate. Despite the NICE guidelines, some schools of though believe that regardless of the toxicological or physical state of the young person, hospital admission is desirable, so that adequate further physical and psychosocial assessments can be carried out, and management/crisis interventions can be planned and initiated (Hawton and prospectus history James, 2000). Mentoring Essay! The paediatric ward will usually suffice, unless, and especially with patients in the older end of the age range, there is a more suitable unit available.
Waterhouse and Platt (1990) investigated the difference in outcomes between self-harm patients who were admitted to dissertation, hospital and those were discharged as outpatients. Experimentation Essay Conclusion! The findings of the study showed slight significance between the two intervention groups. It is the role of the admitting staff to obtain agreement for write history the mental health assessment of the pay people to write essays, patient from parents or relevant guardians, and to alert all members of staff of each young person’s needs. Write Dissertation History! As with all in-patients, hospitalised young patients who have self-harmed should be properly cared for mentoring essay and monitored. In addition, responsibilities of staff of the mental health team will include providing consultation to the young person and his/her family, the paediatric team and prospectus history staff of the on alzheimer's disease, social services and education departments. The Crisis Recovery Unit at the Bethlem Hospital in prospectus, London, a national specialist unit for people of 17 years and above who repeatedly self-harm, have a different and slightly radical approach to pay people to write essays, the in-patient treatment of these patients (Mental Health Foundation, 2006). Their philosophy is that the individuals should take responsibility for their actions. This practice-supported technique focuses on write dissertation history helping young people realise for themselves that self-harm is not an effective strategy for dealing with their problems.
It encourages these patients to talk about essay that explains of a place, their problems and explore alternative coping strategies, including strategies for dealing with the urge to self-harm. Write Dissertation Prospectus! However, the effectiveness of pay people college essays such an intervention in younger patients (11-16) is not certain, as these children might not be mentally mature for such self-realisation tactics. 2.1.4 Treatment Options. Treatment options for adolescents who have harmed themselves could be individual-based, family-based or group-based. Individual-based interventions include but are not limited to write dissertation prospectus, problem-solving, cognitive behavioural therapy and anger management. Family therapy could be in the form of to write college essays problem-solving or structural or systemic therapy, and write prospectus group therapy could involve any of pay for coursework these techniques performed in dissertation prospectus, teams or groups. Problem-solving therapy or brief psychological therapy as it is animal experimentation essay conclusion otherwise known, is a brief treatment that is aimed at prospectus, helping the young patient to captains industry essay, acquire basic-problem solving skills to identify and prioritise their problems (Mental Health Foundation, 2006). Write Dissertation History! The process involves implementing discussed possible solutions to a specific problem, and reassessing the situation to review progress -sort of like a self-audit process. The basics of problem-solving therapy as identified by Hawton and James (2006) are highlighted below: · Identifying and deciding what problems to tackle first. · Agreeing goals of therapy with the patient as much as is possible.
· Working out steps to robber barons captains, achieve goals. · Deciding how to tackle the first step. · Dealing with psychological factors that obstruct progress. · Working through subsequent steps. This method of problem-solving therapy appears to improve depression, hopelessness and general problems in prospectus, deliberate self-harm patients significantly more than control therapy (Townsend et al, 2001). Industry Essay! This finding has been variously collaborated in other studies and the results are considered reliable. Prospectus! This therapeutic process usually takes 5 to 6 one-hour sessions, and can be delivered by any experienced mental health professional with suitable training and supervision (Mental Health Foundation, 2006). It is direct and easily understood and is thus suitable for the younger patients. It helps the pay people to write college, adolescent when he or she is faced with future crisis or trigger factors. Cognitive Behavioural Therapy. This form of psychotherapy is based on write dissertation the belief that psychological problems are the product of an barons essay individual’s faulty way of prospectus history viewing the world.
In this case, the essays on alzheimer's, therapist aims to modify the patients’ cognitive processes and write dissertation history beliefs using techniques that are similar to those described above (problem-solving therapy), but with behavioural techniques. Although widely used adopted in psychotherapy in the treatment of pay for university depression, cognitive behavioural therapy (CBT) has limited evidence of use in self-harm patients. Even in depression, its use has been shown to be less effective as monotherapy than fluoxetine monotherapy and in combination with fluoxetine (March et al, 2004). Dialectical Behaviour Therapy. Dialectical Behaviour Therapy (DBT) is an intensive therapeutic technique that was introduced to help those who repeatedly harm themselves. It could involve as long as a full year of individual therapy, group sessions, social skills training and access to write prospectus, crisis contact (Mental Health Foundation, 2006). Fewer behavioural incidents have been reported with this treatment when compared with an input unit run on psycho dynamically oriented principles (Katz et al, 2004), thus strengthening findings by Rathus and Miller in 2002. In addition, an older study (Linehan et al, 1991) had shown very significant differences in likeliness to repeat self-harm in patients undergoing dialectical behaviour therapy and the control group.
The NICE guidelines (2004) suggest the use of dialectical behaviour therapy in self-harm patients who have a diagnosis of borderline personality disorder, but stress that this should not preclude the use of other strongly validated psychological treatments with vast evidence-based support. As the name implies, family therapy is a branch of psychotherapy that treats family problems as a source of the adolescent’s underlying therapy. Family interventions can be structured or systemic and can also be home-based. Basic aspects of this treatment option would include improvement of specific skills and essay conclusion emotions to promote sharing of feelings and negotiation between family members. Elements of assessment of dissertation prospectus history families of self-harm victim should include (Hawton and on alzheimer's James, 2005): · Family structure and relationships. · Recent family life events, e.g. death, relocation, divorce e.t.c.
· History of psychiatric disorder, including suicide attempts in the family. There is some anecdotal evidence that demonstrate the importance of family therapy in young people who self-harm, especially those have well-documented family issues or strained family relationships. However, evidence base to support the use of family therapy interventions is scarce and quite weak. In a randomly controlled case study, Harrington et al (1998) compared an intensive family therapy intervention with standard self-harm aftercare. The results of the study found no significant differences between the two groups of subjects in terms of write prospectus history improved outcomes. Group therapy could include the previously discussed problem solving and cognitive behavioural therapy. The Oxford Medical Dictionary defines group therapy as psychotherapy involving at least two patients and mentoring essay a therapist. Simply put, it is the administration of any psychological therapeutic methods described above in groups.
Normally, people with similar problems meet to discuss and analyse their problems and possible ways of overcoming them. Write! Although this intervention could be time-saving, the possibility of confrontation and tension between the robber captains industry, group members is a potential barrier to its effective implementation. Also, the negative connotation of write dissertation prospectus suicide and self-harm might prevent patients from barons captains essay effectively participating in such group sessions. In a small-randomised parallel trial in Manchester, England, Wood et al (2001) strove to evaluate the dissertation, effectiveness of group therapy for repeated deliberate self-harm in adolescents by comparing combination of routine care and group therapy with routine care alone. Results showed that adolescents who had group therapy were less likely to repeat self-harm than those who only robber barons captains industry received routine therapy. Overall, the evidence for clinical management and dissertation history prevention of repeated episodes of mentoring essay deliberate self-harm in young people is limited. A systematic review by Burns and colleagues (2005) found that group therapy was the only specific programme that had significant effects on the rates of write history repetition of self-harm. Expensive interventions such as intensive aftercare have no clear advantages over standard aftercare. 2.1.5 Medical And Surgical Management.
Clearly a person who has harmed himself/ herself will have some form of pay people to write college essays injury, whether superficial or systemic. Responding to adolescents who self-harm will obviously include treatment of dissertation history consequences of the self-afflicted injury. The treatment of self-injury would be the same as for any other injury, taking into account the level of pay for coursework distress and emotional disturbance experienced by the patient (NICE, 2004). The most common products of self-injury -wounds and write prospectus poisoning must be treated accordingly. Wounds may require wound assessment and exploration and together with a full discussion of the patient’s preferences should be cleaned and dressed appropriately. In more severe cases, minor surgery might be necessary to properly mend any damages. Treatment for mentoring essay ingested substances would be dependent on the nature of the poison. Samples should be collected as soon as possible for laboratory analysis. The overall aim would be to write prospectus, reduce absorption, increase elimination or chemically neutralize the adverse biological effects of the to write essays, poison.
The guidelines proposed by the National Institute of Clinical Excellence emphasizes the dissertation history, consideration of pay for coursework gastro-intestinal decontamination only in self-harm patients who present early, are fully conscious with a protected airway, and are at risk of significant harm as a result of the poisoning. Activated charcoal could be administered 1 to 2 hours after ingestion. Emetics and history cathartics should not be used in the management of self-poisoning. Pay People To Write Essays! Recommendations by TOXBASE or the National Poisons Information Service (NPIS) should be followed to write dissertation prospectus history, prevent further complications and harm. Gastric lavage and whole bowel irrigation should only be used when specifically recommended by relevant bodies.
2.1.6 Pharmacological Interventions. Generally, the use of pharmacological agents in treating adolescents who have self-harmed is built on the basis that depression is an underlying problem in these patients. Comparing antidepressant therapy with placebo in robber industry essay, patients who had deliberately initiated self-poisoning or self-injury, significant odds ratios were achieved. Furthermore, significantly reduced rates of further self-harm were observed for depot flupenthixol compared to placebo. The current controversy over selective serotonin reuptake inhibitors in children and adolescents (Wong et al, 2004), especially those with suicidal ideation must be taken into dissertation history account when prescribing for this group of patients. Like with all aspects of health care, and particularly mental health care, the choice of intervention depends on the individual patient’s condition. Montgomery et al (1979) have demonstrated a significantly greater likelihood of repeated self-harm in patients treated with the placebo agent compared with those treated with flupenthixol.
Differences in the outcomes of that the attractions of a patients treated with antidepressants and those treated with placebo, though not as large, were still significant (Montgomery et al, 1983). The introduction of pharmacological agents in the management of such patients would ultimately depend on the outcomes of psychosocial and physical assessment, and should be aimed at prospectus, treating the patient’s underlying problems or particular diagnosis rather than simply treating self-harming behaviour. Whatever, therapeutic decisions are made, clinicians should ensure that the patient (or where not possible, parents or guardians) are made aware of the treatment options available, including the likely advantages and disadvantages, and essay involved in making a choice. 2.1.7 Referral and Discharge Following Self-Harm. Referral and discharge of an adolescent after self-harm would depend on the outcomes of the prospectus, extensive assessment that would have been previously conducted (section 2.1.1).
It is important that the patient remains as involved as possible in decisions that are made regarding his/ her management. Adolescents who have harmed themselves may need a range of other health or social services. Referral to these professionals and other relevant agencies bears witness to the importance of adopting a multi agency approach (section 2.3). University! Proper documentation of all relevant interventions and history conversations will ensure a seamless transfer from one health service to another and culminate in essays, improved quality of care and better outcomes. 2.1.8 Family Support. This is quite different from family therapy as discussed under treatment options (section 2.1.4). Rather than attempt to resolve underlying family problems in write, a bid to address the source of the adolescent’s problems like the latter, family support refers to moves that could be taken to help parents and siblings deal with the traumatic experience of self-harm in the family. Common family reactions following suicide or self-harm by adolescents include denial, guilt, shame, anger, depression, substance misuse and overprotection of other children and siblings.
These issues have to be addressed effectively and in a timely manner to avert further tragic family occurrences. It would be the experimentation essay, responsibility of the resident psychologist to evaluate family members and provide the appropriate counselling and treatment. A large part of dissertation prospectus history responding to the increasing rates of self-harm among adolescents in the UK is mentoring essay initiating preventive measures. The National Inquiry into self-harm among young people found that school-based work appears to be one of the most promising areas where prevention of self-harm among young people can be effectively tackled. Also it is widely recognised that young people would rather turn to dissertation, young people than adults in their time of need. In response to this, schools have started implementing peer support schemes. It must be appreciated that prevention strategies should be both primary and secondary, i.e. should target self-harmers as well as the general young population as appropriate. Child and adolescent mental health services must put in place programmes to disease, effectively reach their target population.
Measures should be put into action to promote good mental health and emotional well being (Mental Health Foundation, 2006). In addition, educational awareness programmes should be initiated to provide information to the general public towards reducing the stigmatisation associated with self-harm and suicides. The mental health service could pilot a 24-hour help line to address adolescent’s problems. This would provide an avenue to discuss one’s problems and obtain advice and support on how to deal with them. 25% of young people who were asked what could be done to prevent adolescents from harming themselves responded that someone to listen, advise and support in times of need would be beneficial (Fortune et al, 2005). Secondary prevention is even more crucial as a 30-fold increase in risk of suicide has been demonstrated in young people who had previously self-harmed.
Direct intervention is indicated for these patients to prevent repeated self-harm. Various distraction techniques have been reported by these young people as helping to take their minds off the urge to inflict harm on write dissertation prospectus history themselves. Pay People To Write College Essays! These include physical exercise, writing negative feelings on paper and ripping it up, using a red felt-pen to write prospectus history, mark instead of cut, hitting a punch bag to vent anger and frustration, writing in a diary and talking to a friend (Mental Health Foundation, 2006). Professional prevention of repeated episodes of self-harm would include psychological and write essay that the attractions of a place psychosocial assessment and interventions as described in earlier sections to try and prospectus resolve causal problems and improve emotional well being and general mental health. 2.2 Assessing The Needs And Risks of coursework Young People Who Have Self-Harmed.
Psychosocial assessment in patients who have self-harmed can be classified broadly into assessment of need and assessment of risks. Prospectus History! Specialist mental health professionals should carry out both assessments. Research has found typical psychological and psychosocial factors associated with deliberate self-harm (Webb, 2002). Disease! However, the dissertation prospectus history, breadth and sensitivity of tools and essays disease methods utilised in these studies mean that psychosocial factors have been less consistently measured. Write History! In fact, it has been suggested that positive psychosocial factors might actually play a role in providing protection against self-harming behaviour. Assessment of Needs. Needs assessment should be comprehensive and include evaluation of the social, psychological and pay people college essays motivational factors specific to the individual’s act of self-harm, current suicidal intent and hopelessness (NICE, 2004). In addition, a full mental health and social needs assessment must be included. As always, all conversations and interventions must be clearly documented in the patients’ notes to ensure seamless transition from one healthcare professional to write, another, and to enable follow-up. Assessment of Risks. This should include identification of the main clinical and demographic characteristics that are potential risk factors for repeated self-harm or suicide (NICE, 2004).
A standardised risk assessment scale could be used, but should complement rather than replace extensive individual assessment. Psychosocial assessment is important because it provides an insight into the longer-term needs and risks of the patient and forms a basis for therapeutic decisions. 2.3 The Multi Agency Approach To Management of Adolescents Who Self-Harm. The involvement of multiple agencies or services in the care of patients who have self-harmed is crucial to obtaining good outcomes. This approach is much more than the usual inter-professional approaches to patient care as recommended in hospitals.
Matter-of-fact, inter-professional patient care merely forms a small part of the multi agency approach in mentoring essay, mental health care. The Royal College of Psychiatry (2006) emphasizes the importance of a full and longer-term approach to providing care for self-harm patients that will require the prospectus, co-ordinated activities of local and health authorities together with an awareness of the write the attractions of a particular place, important role that non-statutory sector agencies play. The nature of these episodes of self-harm and the age group being considered necessitates the involvement of a wide range of professionals in health and non-health sectors in write prospectus history, order to address all aspects of the pay for, incidence appropriately. Health professionals who will be invariably involved in management of these patient groups are emergency department staff, paramedical and ambulance staff, general practitioners, pharmacists, counsellors, paediatricians, paediatric nurses, psychiatrists, prison health staff, clinical psychologists, mental health nurses, community psychiatric nurses and social workers. Other public services professionals may have direct contact or be involved in dissertation prospectus, the care of these patients. These include occupational therapists, art therapists, the police and professionals who work in the criminal justice and education sectors (NICE, 2004). In addition, child protection services may be involved depending on the family background. Thus it is clear that the pay for university coursework, full range of resources and interventions required by young people who harm themselves span the responsibilities of a range of agencies and sectors of care (RCPSYCH, 1998). Paramedical and Ambulance Staff.
As the first health care contacts that an adolescent will have after a self-harm episode, ambulance staff and write history paramedics have an increasingly important role in university coursework, early assessment and write dissertation prospectus treatment of self-harm. Urgently needed at this point is an pay people to write essays assessment of physical risk to ascertain the extent of the injury and provide first-aid treatment at once. In cases of self-poisoning, ambulance staff should ensure to prospectus, obtain all substances and/or medications found at the scene and hand them over at the emergency department. They should be well trained and equipped to assess and make quick life-saving interventions. Training should address in particular, the captains industry, different methods of self-harm and the appropriate treatments. NICE guidelines (2004) recommend that ambulance trusts, the emergency department and mental health trusts should work in partnership to develop locally agreed protocols for ambulance staff to follow in the care and transport of self-harm patients.
Emergency Department Staff. The accident and emergency (AE) staff in the hospital are probably the main care-providers for these patients at write history, this acute stage. It is their responsibility to keep the injured patient alive and prevent as much damage as possible. Experimentation Essay Conclusion! If this is write dissertation prospectus history not achieved, all subsequent care providers may have no role to play (in the event of death of patient). They should be properly trained to recognise and counter common self-inflicted injury. These professionals often have direct contact with the ambulance staff and proper communication between these two services is critical. General Practitioners and Paediatricians.
Effective communication between primary and pay people essays secondary care is necessary in order to write dissertation, allow continuity of care for these patients. Paediatricians are especially involved to provide adequate care for children. Mental Health Services. The role of mental health professionals such as psychiatrists, psychologists, and experimentation mental health nurses in providing care to self-harming young people is very evident. It is their duty to assess and treat any mental health problems such as depression, schizophrenia e.t.c. All the psychosocial and psychological assessments and dissertation history interventions previously discussed is their responsibility. When problems are identified in mentoring essay, living conditions or other social aspects of the write prospectus, young person’s life, social workers are brought in to address these, and where necessary, make alternative arrangements to resolve the pay people essays, problems.
In the infrequent case of illegal activities associated with the incidence of adolescents’ self-harm, members of the police force or other criminal justice professionals are required to resolve these issues. For example, underlying sexual abuse as a trigger factor for self-harm would necessitate police intervention. Write Dissertation! Child protection procedures must also be implemented when a young person’s self-harming is indicative of mistreatment. Children and adolescents spend most of robber captains industry their time in school, and thus the dissertation, school staff could have a major role to play in taking care of mentoring essay young people who have self-harmed. Caution should be applied when dealing with children.
In particular, children and adolescents with learning disability should be treated with care, and history if necessary enrolled in a special needs institution. Given that the arrangement of the various units that provide the different services may be complex, integrating these services could seem quite chaotic and disorganised. The health authority/board should work with partner local authorities, trusts and primary care groups to ensure that inter-agency boundaries do not create fault lines in service delivery (RCPSYCH, 2006). There should be accurately developed policies to ensure that all the provider agencies have service agreements that enable and govern protocols for assessing and treating young people who harm themselves to be implemented and used effectively. The fundamental idea of a comprehensive child and adolescent mental health service provider is the takes a multi agency approach and is not restricted solely to a psychiatric service (Morley and Wilson, 2001). Essays On Alzheimer's Disease! The four tiers of intervention that should be included in such services are outlined below (National Health Service, 1995): Tier 1: Non-mental health specialists.
These are professionals who by virtue of their work with children, young people and families, are in a position to write dissertation prospectus, identify early signs of mental health problems. These could be midwives, health visitors, school nurses and counsellors. These practitioners can provide general advice and treatment for less severe problems, and contribute towards mental health promotion. Tier 2: Child and adolescent mental health specialists working in community and barons captains industry essay primary care settings. Write Prospectus History! E.g. primary mental health workers, psychologists and counsellors in GP practices, paediatric clinics, schools and youth services. They can provide more specialist interventions and university training to practitioners at dissertation, tier 1 level. Tier 3: At this stage, the multi-disciplinary and multi agency specialist child and adolescent mental health professionals work as team, as appropriate to provide extensive assessment and treatment to children and young people with more complex and persistent disorders.
Tier 4: In-patient and animal conclusion highly specialised child and adolescent mental health services, including specialist and forensic units usually offering services across several areas. These are essential tertiary level services for children and young people with the most serious problems. They can include secure forensic adolescent units, eating disorders units, specialist neuro-psychiatric teams, and other specialist teams (for children who have been sexually abused, for write dissertation history example), usually serving more than one district or region. 3. Pay People Essays! General Discussion. The reality of self-harm in adolescents paints a grim and depressing picture. The vulnerable nature of the history, patient group makes management and treatment interventions even more difficult to implement effectively. With increased access to televisions, the pay for coursework, Internet and other sources of information and prospectus entertainment, young people today are exposed to all sorts of essays negative influences that could hamper mental health and emotional well being. These, combined with numerous other factors are possible factors behind the rising incidents of self-harm among young people in the United Kingdom.
Despite the magnitude of the problem, there is a baffling dearth of research investigations into this area. Prospectus! Applying the findings of the self-harm studies and adhering to an expository essay explains the attractions of a particular place, available guidelines, a comprehensive child and prospectus adolescent mental health service can be established to university, effectively target all aspects of underlying factors in self-harm. Ethnicity distribution findings has useful implications for management of suicidal behaviour, and should always be taken into consideration during assessment when predicting risk of repeated self-harming episodes. Likewise, other potential risk factors and write history confounding factors should be accounted for in individual cases. Assessment should always look out for features that are indicators of strong suicidal intent, high lethality, extreme precautions against being discovered and underlying psychiatric illness. Despite little evidence to show advantages over discharge, guidelines recommend a minimal overnight admission to allow for disease comprehensive assessment and proper implementation of dissertation appropriate treatment. Admission must be in a suitable ward or unit and should ensure support and safety at all times. The treatment options are vast and could range from medical, surgical or pharmacological management to psychosocial and psychological interventions. Larger studies would be beneficial to essay conclusion, gain a more accurate insight into the reliability and generalisability of these interventions in this group of patients. There appears to be more research and information in the literature for psychological and psychosocial interventions such as problem-solving, cognitive behavioural therapy, dialectical behaviour therapy and group therapy, than for pharmacological management e.g. the use of anti-depressants or anti-psychotics following self-harm in young people.
Ultimately, the choice of treatment depends on the individual patient and history his/ her inherent risk factors. Assessment of an expository essay explains the attractions of a needs and risks (psychosocial assessment) must be carried out before discharge to ascertain the patients’ ability to cope and dissertation prospectus the extent of their suicidal ideation. The outcomes of such assessment would further determine suitable treatment path and the necessary agencies and services to employ. For a comprehensive child and mental health service to efficiently respond to animal experimentation essay conclusion, the rising incidents of self-harm among young people, there is need to write dissertation prospectus history, appreciate the importance of inter-professional collaboration within the hospital setting. Integration of people and skills will improve the quality of care provided, and robber enhance the write prospectus, services understanding of self-harm in young people. In addition to this the importance of external multi-agency involvement is noted, as the full range of interventions required by robber captains these highly susceptible patient group necessitates the input of a wide range of agencies and sectors of care. Write Dissertation! Thus collaboration with other health and non-health services is crucial and university coursework should involve professionals such as the police, school workers, social workers and child protection agencies, as necessary. It is important to note that the mental and physical health of the adolescent is not isolated, and could be an indicator of other family or social problems. A child and adolescent mental health agency can keep its services comprehensive and effective by keeping up-to-date with new and write dissertation prospectus history proven treatment options that could be applied to its young patients.
Also, suitable training is essential for write an expository essay that of a all staff that will have any form of contact with these patients to prospectus, adequately cater for them. The views of the targeted young people should be considered, when making local health policies. In a qualitative study investigating young people’s perceptions about helpful contacts (Mental Health Foundation, 2006), it was found that young people found voluntary local organisations, friends and mentoring essay health visitors most helpful in their distressful times. Furthermore, investigating what sort of help they would like on offer, most people thought that one on one support and/ or counselling would be helpful. Other popular interventions were group support, facilitated self-help groups and creative initiatives and multimedia/ Internet access. In reality adolescents were more likely to seek help from write history friends and their general practitioners. As sources of information, these contact points are not trained to provide such specialist help. Young people should be made aware of services provided by child and adolescents mental health agencies to educate them on the available benefits of reaching out to them in write that place, time of need.
The limited literature available on this topic is a potential setback to effective resolution of the dissertation, current problem. Nevertheless, the interventions and assessment made in patient care should remain evidence-based as much as possible. It must be understood that the an expository explains the attractions of a particular place, treatment of write dissertation prospectus history young people who self-harm should not be just solely psychiatric, and should adopt the recommended multi agency approach in order to an expository explains the attractions particular place, effectively target all latent aspects of the problem. Young people’s opinions should not be ignored, and findings on interventions they consider helpful must be applied within reason to achieve patient satisfaction and encourage them to seek help from the appropriate sources. Anderson, M., Woodward, L., Armstrong, M. (2004) Self-harm in young people: a perspective for mental health nursing care. International Nursing Review 51, 222-228. Write Prospectus! Ayton, A., Rasool, H., Cottrell, D. (2003) Deliberate self-harm in children and adolescents: association with social deprivation.
European Child and Adolescent Psychiatry 12, 303-307. Beautrais, A. (2000) Risk factors for suicide and pay people college essays attempted suicide among young people. Australian and New Zealand Journal of Psychiatry 34, 420. Broadbent, M., Jarman, H., Berk, M. (2004) Emergency department mental health triage scales improve outcomes. Journal of prospectus history Evaluation in Clinical Practice 10, 57-62.
Burns, J., Michael, D., Hazell, P., Patton, G. (2005) Clinical management of essay deliberate self-harm in young people: the need for evidence-based approaches to reduce repetition. Australian and New Zealand Journal of Psychiatry 39, 121-128. Bywaters, P. and Rolfe, A. (2002) Look beyond the scars: Understanding and responding to self-harm and self-injury. Write Prospectus History! [WWW] http://nch.org.uk/uploads/documents/selfharm.pdf (December7th 2006). Cooper, J., Kapur, N., Webb, R., Lawlor, M., Guthrie, E., Mackway-Jones, K., Appleby, L. (2005) Suicide after deliberate self-harm; a 4-year cohort study. The American Journal of Psychiatry 162, 297-303. Fortune, S., Sinclair, J., Hawton, K. (2005) Adolescents views on prevention of self-harm, barriers to to write college, help-seeking for self-harm and how quality of life might be improved: A qualitative and quantitative study. Oxford: Centre for suicide research, University of Oxford. Fox, C. and Hawton, K. (2004) Deliberate self-harm in adolescence. Jessica Kingsley Publishers, London. Harrington, R., Kerfoot, M., Dyer, E., McNiven, F., Gill, J., Harrington, V., Woodham, A. (1998) Randomised trial of a home-based family intervention for children who have deliberately poisoned themselves.
Journal of American Academy of Child and Adolescent Psychiatry 37, 512-518. Hawton, K., Fagg, J., Simkin, S., Bale, E., Bond, A. (2000) Deliberate self-harm in adolescents in history, Oxford, 1985-1995. Journal of Adolescence 23, 47-55. Hawton, K., Hall, S., Simkin, S., Bale, L., Bond, A., Codd, S., (2003) Deliberate self-harm in animal conclusion, adolescents; a study of history characteristics and trends in robber, Oxford, 1990-2000. Journal of write prospectus Child Psychology and Psychiatry 44, 1191-1198. Essays On Alzheimer's Disease! Hawton, K., Harriss, L., Hodder, K., Simkin, S., Gunnell, D. (2001) The influence of the economic and write dissertation prospectus social environment on deliberate self-harm and mentoring essay suicide: an ecological and person-based study. Psychological Medicine 31, 827-836. Hawton, K. and James, A. (2005) ABC of write adolescence: Suicide and deliberate self-harm in young people.
British Medical Journal 330, 891-894. Hawton, K., Kingsbury, S., Steinhardt, K., James, A., Fagg, J. (1999) Repetition of self-harm by adolescents: the role of psychological factors. Journal of barons industry Adolescence 22, 369-378. Hawton, K., Rodham, K., Evans, E., Weatherall, R. (2002) Deliberate self-harm in adolescents: a self report survey in schools in England. British Medical Journal 325, 1207-1211.
Katz, L., Cox, B., Gunasekara, S., Miller, A. (2004) Feasibility of dissertation prospectus history dialectical behaviour therapy for suicidal adolescent in-patients. Journal of write essay that the attractions particular American Academy of Child and Adolescent Psychiatry 43, 276-282. Linehan, M., Armstrong, H., Suarez, A., Allmon, D., Heard, H. (1991) Cognitive behavioural treatment of history chronically parasuicidal borderline patients. Archives of General Psychiatry 48, 1069-1064. Robber Barons Captains Industry Essay! March, J., Silva, S., Petrycki, S. The Treatment for Adolescents Depression Study (TADS) team (2004) Fluoxetine, cognitive behavioural therapy, and their combination for adolescents with depression: Treatment for dissertation history Adolescents With Depression Study. Animal Experimentation Essay Conclusion! A randomised controlled study. Journal Of American Medical Association 292, 807-820. Dissertation History! Mental Health Foundation (2006) Truth Hurts: Report of the national inquiry into self-harm among young people. [WWW] http://www.selfharmuk.org/docs/selfharmreportlowres.pdf (December7th 2006) Montgomery, S., Montgomery, D., Jayanthi-Rani, S., Roy, D., Shaw, P., McAuley, R. (1979) Maintenance therapy in repeat suicidal behaviour: A placebo-controlled trial. Proceedings of 10th International Congress for Suicide Prevention And Crisis Intervention, Ottawa, 227-229. Montgomery, S., Roy, D., Montgomery, D. (1983) The prevention of recurrent suicidal acts. British Journal of Clinical Pharmacology 15, 183-188.
Morley, D. and Wilson, P. (2001) Child and pay people to write college essays adolescents mental health: its importance and dissertation prospectus how to commission a comprehensive service. College! Guidance for primary care trusts. Dissertation History! [WWW] http://www.youngminds.org.uk/pctguidance/YM_PCT_Guidelines.pdf (December7th 2006) Neeleman, J., Wilson-Jones, C., Wessely, S. (2001) Ethnic density and deliberate self-harm: a small area study in southeast London. Journal of pay for university coursework Epidemiology and Community Health 55, 85-90. National Health Service, Health Advisory Service (1995) Together we stand, a thematic review of child and adolescent mental health service. National Institute for Health and Clinical Excellence (2004) Self-harm: The short-term physical and dissertation history psychological management and secondary prevention of self-harm in primary and secondary care. [WWW] http://www.nice.org.uk/guidance/CG16/guidance/cfm/English (December7th 2006) Office of National Statistics (1999) Children and adolescents who try to harm, hurt or kill themselves. [WWW] http://www.statistics.gov.uk/downloads/theme_health/Childselfabuse_v1.pdf (December7th 2006).
Rathus, J., and Miller, A. (2002) Dialectical behaviour therapy adapted for suicidal adolescents. Suicide Life Threat Behaviour 32, 146-157. Skegg, K. (2005) Self-harm. The Lancet 366, 1471-1483. The Royal College of Psychiatry (2006) Managing deliberate self-harm in on alzheimer's disease, young people. [WWW] http://www.rcpsych.ac.uk/publications/collegereports/cr/cr64.aspx (December7th 2006). Townsend, E., Hawton, K., Altman, D., Arensman, E., Gunnell, D., Hazell, P., House, A., Van Heeringen, K. (2001) The efficacy of problem-solving treatments after deliberate self-harm: a meta-analysis of randomised controlled trials with respect to depression, hopelessness and improvement in problems. Psychological Medicine 31, 979-988. Waterhouse, J. and Platt, S. (1990) General hospital admission in write dissertation prospectus, the management of parasuicide. A randomised controlled trial. The British Journal of Psychiatry 156, 236-242.
Webb, L. (2002) Deliberate self-harm in adolescence: a systematic review of psychological and psychosocial factors. Journal of Advanced Nursing 38, 235-244. Wong, I., Besag, F., Santosh, P., Murray, M. (2004) Use of selective serotonin reuptake inhibitors in children and adolescents. Drug Safety 27, 991-1000. Essay! Wood, A., Trainor, G., Rothwell, J., Moore, A., Harrington, R. (2001) Randomised trial of group therapy for repeated deliberate self-harm in write prospectus, adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 40, 1246-1253. Wynaden, D., O’Connell, B., McGowan, S., Popescu, A. (2000) The educational needs of nurses’ in essays on alzheimer's, the area of mental health. The Australian Electronic Journal of Nursing Education 6, No.1.
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Vous l’avez compris : ce deuxième volet des Conseils du Vieux Briscard a pour thème la difficulté de concevoir des Personnages Non Joueurs, et le désespoir subséquent du meneur de jeu qui a perdu de longues heures à penser des personnages invariablement éphémères. Ce désespoir n’est d’ailleurs pas total ni irrémédiable, car le MJ a, par ses PNJ, l’occasion précieuse et délicieuse de se créer toutes sortes de personnalités et d’être, à chaque scène, un mafieux intimidant, un chevalier au c?ur pur, un baladin ironique, une belle romantique. An Expository Explains Of A Particular? Loin de coloniser ses scénarii et de tirer la couverture à lui, le MJ offre à ses joueurs quelques facettes de ce qu’il est, quelques vues de ce qu’il pourrait être, et le plaisir qu’il aura eu à les faire exister influencera le plaisir que les joueurs auront à les rencontrer. Ils sont vraiment incontournables, car sans un minimum de travail sur eux, les meilleurs scénarii sonnent creux. History? Vos joueurs vivraient dans un monde stéréotypé assez ennuyeux, et, pire que tout, prévisible. Animal Experimentation Essay? Car vos PNJs, c’est VOUS, meneur de jeu. History? Si vos joueurs vous connaissent trop, ils détecteront infailliblement vos stéréotypes et réagiront en conséquence : Oh ! Un noble dédaigneux ! Quasi le même que le mois dernier ! Oh ! Un tavernier bourru mais sympa ! Oh ! Un sorcier retors et menteur ! Faisons semblant de lui faire confiance et tuons le ! ! Oh ! Un faux jeton ! etc. Experimentation Conclusion? etc.
Je ne vais donc pas insister sur l’importance du PNJ, j’ai l’impression de défoncer des portes ouvertes. Write Dissertation History? Fort bien, voici donc les Conseils du Vieux Briscard sur le sujet. On peur diviser les PNJs en grosso modo trois population : Les seconds rôles. Les personnages centraux. Ce sont des personnages qui apparaissent le temps d’une scène ou deux. Robber Captains? Ils peuvent être des adversaires comme le tout venant. History? Ils ne jouent qu’un rôle secondaire dans l’intrigue.
Leurs apparitions sont courtes, et sauf dans le cas où ils sont agressifs, ils font quasi partie du décor. To Write Essays? Si des joueurs s’intéressent particulièrement à un figurant, il ne vous reste plus qu’à improviser un très basique second rôle. Ces personnages apparaissent plusieurs fois dans votre scénario, où revêtent une importance particulière. Dissertation Prospectus? Vos joueurs sont appelés à dialoguer et interagir avec eux, plus d’une réplique en tout cas. Animal? Leurs actions ont une influence limitée mais réelle sur le scénario. Les personnages centraux. Ces personnages sont au centre de votre intrigue. Write Dissertation Prospectus? Ce sont eux X qui en tirent les ficelles, ou qui assument le rôle du grand méchant, ou bien celui de la victime, et bien d’autres.
Ils ont une action directe et souvent irréversible sur le scénario. Disease? Leur disparition ou leur mort entraîne un basculement de l’intrigue. History? Ils sont le principal souci des joueurs (généralement) quand ceux-ci ont conscience de leur existence. An Expository Essay That Explains The Attractions Of A Particular? Ils sont incontournables. Write Dissertation Prospectus? Veillez à ce que leur taux de survie soit élevé, donc. On Alzheimer's Disease? Ceci dit, un scénario peut très bien ne pas inclure de premier rôle ! Notamment quand l’intrigue n’a pas de composantes humaine intrinsèque (comme une catastrophe naturelle, l’exploration d’un donjon ou une opération commando). Une fois que vous avez catalogué vos PNJs, une grosse part du boulot est faite ! ! Les PNJ se définissent également selon leur rôle dramatique.
En effet, si un personnage prend la forme d’une personne (psychologie à l’appui), il reste au fond une fonction dramatique du scénario, c’est à dire un opposant (vrai méchant, PNJ-obstacle style concierge d’immeuble /flic /automobiliste maladroit, sphinx, monstres, etc.) ou un adjuvant (qui file des coups de main : compagnons d’aventure, vieux professeur, indicateur, quidam providentiel. Write? ). Ce rôle peut également être un principe dramatique, une épreuve (comme tout obstacle, en théorie) et donc un enseignement : un PNJ peut représenter en lui-même un exemple, un modèle, une énigme, un rebondissement, un conflit. Ces précisions ne sont utiles que pour les seconds rôles et les personnages centraux. Elle est importante parce qu’elle sera la première impression de vos joueurs et qu’elle peut permettre de traduire, par une expression ou une attitude, des informations que vous préférez voir les joueurs déduire plutôt que de les leur mâcher. Write An Expository Essay Particular? Suivant le réalisme de votre univers, vous pouvez être plutôt subtil ou carrément caricatural. History? Les films de série B sont un bon catalogue de seconds rôles marqués par leur physique : comptable maigre et myope, bûcheron barbu et velu, barde svelte et souriant, voleur au nez pointu. Conclusion? Sortir de ces archétypes est évidemment un bon moyen de surprendre les joueurs. Essayez également d’imaginer comment parle et bouge un perso doté de tel ou tel physique : le langage est très important parce le ton de voix, l’accent ou le vocabulaire que vous utiliserez vont permettre à vos joueurs de distinguer les différents PNJ qui, sinon, ont tous la même apparence : la vôtre. Le profil psychologique.
Je vais reprendre ici un concept qui est très bien expliqué dans l’article ’Création d’un personnage’ du présent zine. Dissertation? Tout PNJ possède sa psychologie particulière, sa ’motion’ : des objectifs, une manière de réagir, des motivation, des craintes, des obsessions, des phobies. Pay People To Write? Plus le PNJ est important, plus sa ’motion’ doit être détaillée. Dissertation? A l’inverse, plus le PNJ est secondaire, moins elle a d’importance. Pay People To Write? Qu’un individu lambda, au sein d’un mouvement de foule, soit pris d’une crise d’acrophobie, qu’est ce que ça peut bien faire ? Alors que la psychologie d’un personnage central peut très bien être l’objet de tout un scénario. Cette psychologie a plusieurs composantes. Write? D’abord elle dépend du milieu du PNJ, de sa condition sociale, et ensuite de son histoire personnelle  . Quelle est la nationalité du PNJ ? Quelles sont les caractéristiques culturelles propres à sa nation (préjugés notamment) ? Dans quelle culture baigne t’il ? Sa condition sociale : quelle est la place du PNJ dans l’échelle sociale de son pays ? Qu’est ce que cela implique comme comportement face à ses compatriotes ? Face aux étrangers ? En cas de crise ? Quelle est sa position face à sa condition ? face à son gouvernement/à la loi ? Son histoire personnelle : quelle est la vie de ce PNJ ? pourquoi est il comme il est aujourd’hui ? (ce chapitre peut tenir des pages dans certains cas). Un figurant ne dispose dans sa description que des motions de son milieu, et dans certains cas de son groupe, voir de son rôle dramatique. Write Explains The Attractions Of A Place? Dans tous les cas, la description des figurants se fait par groupes de figurants. Write Prospectus History? C’est suffisant ! Ne vous prenez pas la tête avec vos figurants.
Un second rôle dispose d’une description qui lui est propre, et qui inclut son milieu, sa condition sociale et une ou deux ligne de précisions. Pay For? Pas plus ! Sinon vous perdez de l’énergie en vain ; croyez moi, vos joueurs n’accordent que peu d’importance aux seconds rôles. Un personnage central se décrit de la même manière qu’un second rôle. Write Dissertation? Mais n’hésitez pas à le détailler ! Plus il sera détaillé, plus votre scénario sera ’réactif’, c’est à dire qu’en exploitant le profil psychologique de votre PNJ, vous pourrez faire face à l’imprévu et improviser ! Si vous n’arrivez pas à vous intéresser à votre personnage central, ne paniquez pas ; vous avez sûrement affaire à un second rôle un peu trop étoffé. Mentoring Essay? Taillez dans sa description ! Un figurant , comme un second rôle , dispose généralement des ressources inhérentes à sa condition : habitation, argent, alliés, etc… Dans des cas très rares on write dissertation les détaillera pour ce type de PNJs.
Pour un personnage central , il vous faut détailler un peu plus. Qui sont ses amis ? ses alliés ? ses ennemis ? sa fortune ? ses contacts ? son influence ? ses possessions importantes ? Passons maintenant aux caractéristiques, en termes de jeu, de vos PNJs, et leur influence sur leur longévité. Mentoring Essay? Car si vous voulez qu’un PNJ tienne plus qu’une partie face aux joueurs, il leur faut un minimum de ressources ! Pour les figurants : Seuls les hostiles méritent des caractéristiques ; encore vous faut-il les réduire au maximum et utiliser le mêmes pour un même groupe de figurants. Write Dissertation Prospectus? Un figurant peut très bien avoir des caractéristiques élevées, notamment quand il s’agit de spécialistes (genre garde du corps), mais relégués à un rôle de second plan. Les seconds rôles et les personnages centraux. Assurez vous que leurs caractéristiques soient en proportion de la puissance des joueurs et au-dessus dans le cas d’un personnage central surtout si c’est un adversaire. Captains Essay? N’oubliez d’ailleurs jamais que la ruse et la débrouille assurent un taux de survie plus élevé que la force brute. Techniquement, c’est une source de blessures mais aussi d’XP pour vos PJ, en tant que personnage c’est le niveau zéro de la profondeur psychologique et en tant que fonction dramatique, le monstre se contente en général de matérialiser le danger, d’introduire un peu de tension et beaucoup d’hémoglobine. Write Prospectus History? C’est pas pour dire mais je trouve ça tout nul.
Si on on alzheimer's disease fait un peu d’étymologie sauvage, on write prospectus constate que monstre vient de la monstration, de l’action de montrer : c’est un révélateur, dans la tragédie classique il a pour but de démontrer la valeur du héros (civilisé) triomphant des forces instinctives et bestiales (la Nature). Animal Experimentation Essay Conclusion? Ce serait dommage de se limiter à ce schéma, mais un monstre devrait être en général la matérialisation d’un danger : Godzilla est le risque nucléaire, le requin des Dents de la Mer symbolise et punit les péchés des personnages secondaires, le John Doe de Se7en l’excès dans le châtiment, le vampire représente essentiellement l’appétit sexuel, les Orcs de Tolkien sont l’image de la dégénérescence des Elfes, . Write Dissertation Prospectus History? Créer un monstre, c’est faire vivre un danger, pas juste animer un voyage trop long. University? Et coller à ce monstre une forme de psychologie, une logique et des objectifs va le rendre plus crédible, et donc plus inquiétant (créer de beaux monstres sera le thème d’un prochain article). (ça peut être un monstre), celui qui remet en question le pouvoir des héros (vos PJ, a priori) et les fait évoluer. Write Dissertation Prospectus? Par exemple, un super-balaise in-tuable qui barre la route des aventuriers peut les amener à découvrir le principe de la négociation, à jouer la psychologie, le charme, la ruse. Mentoring Essay? bref à accéder à un usage efficient de leurs cerveaux. Write Dissertation? Ce PNJ-obstacle peut-être un PNJ-énigme, pas un sphinx poseur d’énigme, mais par exemple un fugitif mystérieux, un dément incompréhensible ou un conspirateur diabolique qui n’est en fait que la personnification d’une question de votre choix (ludique, intellectuelle, morale, éthique. Pay People To Write Essays? ) à laquelle les PJ vont devoir répondre pour la vaincre ou la résoudre.
Une concierge revêche, un flic soupçonneux (à qui il faudra prouver son innocence), un démon gardien, un vrai sphinx, un enfant trop terrorisé pour livrer les informations qu’ils possèdent sont autant de PNJ-Epreuve. Vos PNJ sont en même temps des spécimens d’humanité et peuvent être dotés d’un physique particulier, de citations rappelant la vision du monde qu’ils expriment (La loi c’est moi !, C’est vraiment trop injuste. Write? , J’veux pas d’ennuis. Animal Essay Conclusion? etc.), d’une profession transparente ou problématique (trapéziste-alcoolique, flic avec chien, infirmière compatissante, baladin porte-parole, cuisinier tout maigre. Write Dissertation History? ). Encore une fois, cela amène à nuancer la conception d’un personnage par la multiplication des points de vue sur ce qu’il est et peut produire des PNJ particulièrement savoureux par croisement de ces différents axes. Roman Jarlsson, Primogène Gangrel  : Dans une petite ville de banlieue parisienne se tient une cour de la Camarilla privée de Duc depuis longtemps. Pay For? Au sein du Primogénat, on dissertation trouve ce fameux Roman : Physiquement, il n’a pas les caractéristiques animales de la plupart des Gangrels, ce qui signifie 1) son humanité et 2) sa résistance à la Frénésie. Pas très grand, noueux, avec une gueule de dur (mâchoire carrée, balafré, mal rasé) et son look de baroudeur, il exprime aussi sa fonction de combattant et sa résistance. To Write Essays? Face aux joueurs, il doit être une sorte de repère moral, gardien d’un certain équilibre et des lois de la Camarilla pouvant, sans perdre son calme, leur arracher la tête d’une seule main s’ils le fâchent ou brave les Traditions. Write Dissertation? Pour manifester ce danger et son self-control, Roman joue régulièrement avec des allumettes (alors que les Caïnites ont normalement peur du feu) et fume de gros cigares (qui indispose les autres, ça l’amuse beaucoup). D’origine allemande, il murmure (peu) avec un très léger accent et va droit au but.
Paf, le perso est posé. Kadi, esclavagiste et adversaire des PJs : Cet homme est le chef d’une organisation occulte qui organise la traite des blanches, de leur ’recrutement’ en Europe (de l’Est ou de l’Ouest), de leur transport et de leur ’placement’ dans des pays lointains. Experimentation Conclusion? Son nom véritable est inconnu même de ses proches lieutenants. Dissertation? Il est intégré dans la mafia locale, qui prélève sa taxe sur ses activités illégales. Mentoring Essay? Il ne quitte que rarement la France, et ne sort jamais d’Europe. Dissertation Prospectus History? Il est tout à fait sans scrupules, et ne considère pas avoir affaire à des êtres humains lorsqu’il parle ’marchandise’.
Très nerveux, sa face lisse est sans arrêt agitée de tics. Animal Experimentation Conclusion? Il parle un français impeccable, sans accent. Write Dissertation? De sa personne, on mentoring essay dirait un oriental corpulent d’une quarantaine d’années, avec un vague air turc. Write Dissertation Prospectus? Son crâne est rasé et lisse comme une boule de billard. Robber Barons Industry Essay? Il est toujours tiré à quatre épingles. Dissertation Prospectus History? Il déteste notoirement les arabes, sans que personne n’en connaisse la raison exacte, mais on mentoring essay pense que c’est lié à son passé trouble et mal connu.
Deux exemples de PNJs second rôle Renaud Chancrain, homme de main de Kadi : Renaud est chargé des basses ?uvres de Kadi. Write Prospectus? Kadi fait appel à lui chaque fois qu’il lui faut avoir recours à l’intimidation et/ou la violence. Pay People Essays? Renaud a pour cela d’excellents contacts dans la mafia locale, et sait toujours trouver les personnes qu’il faut, du tueur professionnel à la minable petite frappe. Physiquement Renaud est un colosse en blouson noir et à la nuque rasée. Write? Il a toujours un cran d’arrêt sur lui, qu’il remplace par un pistolet quand il sent un coup foireux. That The Attractions Of A Particular? S’il se sent surclassé, il laissera tomber ses airs de matamores pour révéler sa vraie lâcheté. Jean-Baptiste Frémion, banque de donnée sur pattes : Installé comme juriste dans le Londres des années 1890, Jean-baptiste en a exploré les bas-fonds autant que la bonne société. History? Il dévore les journaux, parle un anglais parfait et a une culture générale impressionnante ; on experimentation essay conclusion peut même dire qu’il est une bibliothèque vivante, bien utile à ceux qui ont recours à ses services (les PJS). Dissertation Prospectus? Malheureusement il est aussi dépressif, alcoolique et perpétuellement sarcastique, ce qui le rend parfois insupportable et souvent indisponible (puisque complètement saoul), juste histoire que les dits PJs ne se laissent pas aller à considérer son aide comme une facilité permanente.  Ceci n’est pas de la psychologie veritable, c’est simplement un artifice de conception de scenario. An Expository That Of A Place? Je n’ai aucune, mais vraiment aucune pretention a appliquer ce systeme a la realite ; le JdR obeit a d’autres loi qui sont celles, plus facilement intelligibles, de la dynamique dramatique.
 J’ai interprete recemment ce PNJ assez typique dans un GN Vampire, la Mascarade, d’ou le contexte. Les commentaires sur cet article. Ceci est un exercice a 4 mains. L’acouchement a ete difficile. Ca me rappelle le bouquin d’Orson Scott Card sur les personnages et points de vue. Ajouter un commentaire. forum vous enregistrer forum vous inscrire. Tous les éléments et personnages sont des marques déposées détenues par leur propriétaire. Write History? Ils sont utilisés ici sans autorisation particulière, dans un but d'information.
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Stroke Risk . Essay 1 My Happy Place After school, It was a tradition to history, ask my mom if she let me go to pay people to write essays, my favorite park. She would always say, Yes, but be back before dark, honey. Leaving my Power Rangers backpack like thunder in the living room, and write history, running fast to my favorite place in the world was my every day. My favorite food may be a little different. It's not the traditional pizza or pasta, it’s definitely something I could have everyday, at barons captains essay any time of day. Some people probably have never even tried it fresh because it’s easier to buy in a can. It’s not something grown locally. Although, you. When I was in grade school my parents were always at work until late at night. They really couldn’t afford a babysitter, so I always had to find a place to hang our after school.
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My Rural Vietnamese Home It is hard for me to forget the place where I were born and grew up. The house is located in thinly populated village in Vietnam. At that house, I have many sweet and unforgettable memories. Although I had to pay for, go far away from the house for a long time, I still cannot forget. History of Pizzza Hut Pizza Hut: a Beginning.
History of Pizzza Hut Pizza Hut: A Beginning The journey began in 1958, when two college students and brothers from dissertation prospectus, Wichita, USA, Frank and Dan Carney, opened the first Pizza Hut restaurant at their hometown on June 15, 1958. After borrowing $600 from their mother, they purchased some second-hand. 02/23/2012 Rough draft My Wonderland Living in Germany was one of the essays disease, most beautiful times of all of the nineteen years that I have been living. We moved to Germany when I was seven years old; and at the time I did not want to move. I was use to my life with my extended family and my childhood friends. Vatica n city is where the pope lives. The main meals served at the cafes varied from pizza to tortillini. The pizzas were not exactly like Pizza Hut's pizza . They were crispy thin with very few toppings available. Most pizzas came with cheese, pepperoni and a watery tomato sauce.
The tortillini had soft. Pizza is the greatest cuisine in the world and write dissertation prospectus, my favorite food . Mostly everyone in the world has had pizza in some way or form. First, the taste, depending on the topping you choose; pizza can be different for everyone. On Alzheimer's Disease. It can be spicy if you add jalapenos, or choose to spread some red peppers over. Blog on Book What My Mother Doesn't Know.
I got to go. Dissertation Prospectus. Nowhere! My family never goes on vacations. So I was stuck home for animal conclusion, a week without my two best friends. I wasn’t going to write dissertation prospectus, just sit home and feel sorry for myself though. I decided to essays disease, be ‘clever’ as my mother said and plan my own “vacation”for a day in Boston. History. My first stop was having breakfast. hose who eat their slices with two hands, and those who (dare I say) like to cut their pizza with a fork and knife.
Some people soak up the essays on alzheimer's, olive oil with a napkin, while others don’t mind a greasy slice. Some people like the crust, while others live for write prospectus, that first bite. Write Essay That Explains Particular. Some people decorate their slices. My favorite food is pepperoni pizza . Dissertation Prospectus History. I believe my father’s pepperoni pizza is the best and most delicious pizza in the whole wide world. Coursework. I love everything about my dad’s pizza but what I love the most is the smell, the exquisite taste and the fact that it is an affordable meal. Dissertation Prospectus. Just by looking at the. Liebaert Heidi Sura English Comp. Write An Expository Essay Explains Place. II 03-26-13 Fast Food , Roughly Speaking We live in prospectus, the health conscious society. Pay For University Coursework. Every day we are bombarded with nightly news broadcasts discussing various risks involving the so called “plague” of history fast food on this great nation. As an admitted convenience junkie. Three years ago, on a school assignment, I took a tour of the experimentation essay, food bank in Tulsa, Oklahoma.
That tour, and the disturbing statistics, made a lasting impression on me. Much has been reported on the hunger issue and the widespread famine in countries around the world. While many celebrities are using. My Cat Gregory Gregory is my beautiful gray Persian cat. Write Dissertation. He walks with pride and grace, performing a dance of disdain as he slowly lifts and lowers each paw with the coursework, delicacy of a ballet dancer. His pride, however, does not extend to history, his appearance, for he spends most of write an expository essay explains the attractions of a his time indoors watching television. ?Joseph Jones Kathleen Mahoney Fundamentals of Electronic Prod. | G322 7/9/2016 Food Record Analysis 1.How did the three days you analyzed compare to your usual eating pattern? These three days I was unable to bring my lunch. This is unusual for write dissertation prospectus, me on most days.
2.How many calories from carbohydrates. or a relationship. She has been my first love since grade school (so CORNY ?). We were also good friends yet I can’t tell her how I feel about her. Essays Disease. We were seatmates since grade 1 up to dissertation, grade 6 (but not anymore in high school).
Even my good friends do not know who my crush was because I don’t want them. Ashley McNeely Pizza Pizza is one of my favorite foods and I could probably eat it every day if I had the chance. Living in Chicago I have had deep dish pizza once or twice, but it just doesn’t do it for me. Mentoring Essay. I like my crust thin, the thinner the better. Write. Some days I want a ton of essays cheese and toppings.
? My Little Happiness If you ask me what did you do in the winter holiday, I want to say that almost everything I did was related to the great festival——the Spring Festival. It is not only an ordinary traditional festival but also the greatest and dissertation prospectus, most important festival in China. We celebrate it with. Television, my little secret to relaxation. Whenever I need to take a break from my work or studying, all I need to do is switch the television on and just zone out for a little while. Then I’ll be recharged and ready to finish off all my work or continuing to study. Write Essay The Attractions Place. I usually only watch movies or my regular. 1. Dissertation Prospectus. Intro Lesson (Ages 3-7) Greetings, names, follow simple instructions, identify and recognize 3 colors ABC song Hello, What's your name, My name is. Pay People College Essays. , Goodbye, Give me. red, blue, green, flower, stand up, sit down, hands up, hands down, jump, run, turn around, pass, touch. . ?Fast food is write prospectus, cheap, convenient, filling, and to many of animal experimentation essay us it tastes good. Write. Unfortunately, eating just one fast food meal can pack enough calories, sodium, and fat for an entire day or more. Eating fast food on a regular basis can lead to a host of captains industry essay different health problems. Dissertation. Still, the quick-and-cheap.
Men and Women's Brains Respond Differently When It Comes to Food. to an article in to write college, the Kansas City Star, men and women’s brains respond differently when it comes to food . Scientists have discovered women have a much harder time saying no to favorite foods then men do. History. This study could shed some light on the increasingly dangerous up-ward trend of barons captains obesity. Making desisions based on demand and forcasting. Then, from the calculation provided, and interpretation of the coefficient of determination, indicating how it will influence ones decision to open a pizza business in the Stafford, TX.
An explanation of different variables that may improve the dissertation history, coefficient of determination will also be discussed. Stafford. descriptive essay: Take time to brainstorm If your instructor asks you to pay for university coursework, describe your favorite food , make sure that you jot down some ideas before you begin describing it. For instance, if you choose pizza , you might start by writing down a few words: sauce, cheese, crust, pepperoni, sausage, spices. In my opinion, the best food in the world is Italian food . First, Italian food has many kinds of prospectus history recipes like pizza , spaghetti, soup, and disease, pasta. My favorite recipe is pasta. Dissertation Prospectus History. Pasta has many kinds.
I can make it as I like, such as I add vegetables, chicken, shrimp or also cheese with mix salsa, and. The Best Day I Spent with My Family. The Best Day I Spent With My Family The best day I spent with my family was during the 2008 Alabama Football season. The atmosphere of the mentoring essay, University of dissertation prospectus history Alabama during football season is one of the great experiences; it’s like one big family. But this was Alabama’s Homecoming game against Arkansas. Korea, My name is in Fifth Grade. I am looking for a pen pal! I love Art and sports. Coursework. I have many friends in write prospectus, fifth grade. An Expository Explains Place. I am a B+ and A- student.
I am on write select soccer in Whitefish Bay. I love drawing flowers, dragons, and animals. I have a cat and dog. My cat’s name is Ginger and an expository explains the attractions of a particular place, my dog’s name.