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The theory focuses on the major psychosocial variable of low self-esteem. Three forms of
personality organization could lead to depression have been identified.

J Dominant other- patient has relied on a person for self-esteem. Satisfaction is

experienced only through an intermediary.
J Dominant Goal- when a person utilizes and realizes that a desired unrealistic goal
may never be accomplished, the person evaluates them with an all-or-nothing
J Constant Mode of feeling- The patients inhibits any form of gratification because of
strongly held taboos.

This view of depression looks at patient¶s belief systems in relation to their experiences.
Even in the absence of an appropriate precipitating stressor.



The theory refers to a traumatic separation of the person from significant objects of
attachment. Two issues are important to this theory: Loss during childhood as a predisposing
factor for adult depressions and separation in adult life as a precipitating stress. The first
issue proposes that a child has ordinarily formed a tie is ruptured. The child experiences
separation anxiety, grief, and mourning.

Other studies indicate that depressed patients seem to experience more potential loss from
death, separation and other causes than do normal and other diagnostic groups.

Another perspective on this theory focuses on the negative impact of maternal depression on
infants and children. This is expressed by the infant as flat affect, lower activity,
disengagement, and difficulty in being consoled.

Some discussions suggest that successfully coping with an early loss can be beneficial or
have immunizing effects in the development of resilience.


Learned helplessness, as a technical term in animal psychology and related human

psychology, means a condition of a human being or an animal in which it has learned to
behave helplessly, even when the opportunity is restored for it to help itself by avoiding an
unpleasant or harmful circumstance to which it has been subjected. Learned helplessness
theory is the view that clinical depression and related mental illnesses result from a
perceived absence of control over the outcome of a situation.

Learned helplessness can also be a motivational problem. Individuals who have failed at
tasks in the past conclude erroneously that they are incapable of improving their
performance. This might set children behind in academic subjects and dampen their social

Children with learned helplessness typically fail academic subjects, and are less intrinsically
motivated than others. They may use learned helplessness as an excuse or a shield to
provide self-justification for school failure. Additionally, describing someone as having
learned to be helpless can serve as a reason to avoid blaming him or her for the
inconveniences experienced. In turn, the student will give up trying to gain respect or
advancement through academic performance.



Freud believed was a turning inwards of aggression instincts. He theorized that a child¶s
early attachment to an object, usually the mother, contains a mixture of love and hate. When
a child looses the object or their dependency needs are frustrated feelings of loss coexist
with anger. The experience is turned inward and experienced as depression.

Schizoaffective Disorders
Although the exact etiology of schizoaffective disorder is unknown, it may involve the balance of
dopamine and serotonin in the brain. Others believe that it may be due to in utero exposure to
viruses, malnutrition, or even birth complications.

Although the cause of schizoaffective disorder is unknown, the cause may be similar to
schizophrenia nature versus nurture. To date, no specific genetic markers have been identified.
Environmental causes of malnutrition, viral infections, or complication at birth may play a role.
Finally, abnormalities of the neurotransmitters serotonin, norepinephrine, and/or dopamine
could all have a role in this disorder. More research is needed to fully elucidate the causes of
schizoaffective disorder.

The symptoms of schizoaffective disorder are different in each person. Often, people
with schizoaffective disorder seek treatment for problems with mood, daily function, or
abnormal thoughts.

Psychosis and mood problems may occur at the same time, or by themselves. The
course of the disorder may involve cycles of severe symptoms followed by

The symptoms of schizoaffective disorder can include:

Ô Changes in appetite and energy

Ô Disorganized speech that is not logical
Ô False beliefs (delusions), such as thinking someone is trying to harm you
(paranoia) or thinking that special messages are hidden in common places
(delusions of reference)
Ô Lack of concern with hygiene or grooming
Ô Mood that is either too good, or depressed or irritable
Ô Problems sleeping
Ô Problems with concentration
Ô Sadness or hopelessness
Ô Seeing or hearing things that aren't there (hallucinations)
Ô Social isolation
Ô Speaking so quickly that others cannot interrupt you
Differential Diagnoses and work-up

Laboratory Studies

* Sequential multiple analysis

* Complete blood cell count
* Rapid plasma reagent
* Test of thyroid-stimulating hormone or thyroid function tests
* Urine drug screen
* Urine pregnancy test
* Urinalysis
* Lipid panel
* HIV test

Imaging Studies

* If the patient's neurologic findings are abnormal, CT or MRI rule out any suspected
intracranial pathology may be appropriate.

Other Tests

* Perform psychological testing to assist with diagnosis (eg, Structured Clinical Interview for
Axis I DSM-IV Disorders [SCID-1]).
* Several scales are available for rating the severity of disease in patients with schizophrenia
or schizoaffective disorder.
o These scales may be useful in assessing the patient's progress (eg, Positive and
Negative Symptom Scale for Schizophrenia [PANSS]).
o These scales include those for positive and negative symptoms and many for
depression and bipolar rating (eg, Hamilton depression scale, Young mania scale). These tools
can be used for baseline and outcome measurements.
o The cut down, annoyed, guilty, and eye opener (CAGE) Questionnaire is useful to
inquire about alcohol consumption in patients with schizoaffective disorder.
* Perform electroencephalography, if indicated.

Histologic Findings

Findings include decreased amounts of cortical gray matter and increased fluid-filled spaces.

Desafinado by: Dayle RJ C. Marquez

oLiterally means ooff-key´ or out of tune.
Like Bossa Nova, Some critics had called the bossa nova style "music for off-key singers" because its harmonies and
intervals sounded odd to them. In psychiatric guests, we call them so because of attitudes we view as odd to them.
After all, despite Desafinado, it is still music; despite psychiatric illness, there is still a rendezvous for the lost soul and
the seeking body to meet.

The violin sings

Notes of wishes and dreams
An eternal hand touches every string
The violin sings in accordance to the King

The violin sings

An audience listens
Every note¶s appreciated, in their minds sank in
Cheers are heard amidst the spotlight beams
The violin sings with bliss within

The lights are gone

In the realm stays no one
The violin¶s alone, the show¶s done
King¶s hand is still clinging, but it seems far-flung

Time is surging, time is fleeting

The violin becomes historic, but the King¶s still a King
Desafinado, when the notes sing
Desafinado, every voice from the string

The audience is never seen

But the violin still has bliss within
Desafinado after all is never an evil thing
Hands that held it is but a King

Desafinado, after the bright beams

Desafinado, after the audience screams
Desafinado, under the hands of the King
Desafinado, it may seem
A family is a perfect melody for everything.
(the introduction)

We always hear music in its perfect forms; great notes, blending melodies. The
strumming makes us touch the soul of the world and the slashes heal every wounded heart.
This world is the stage; where we play each instrument for an audience we never saw. This
world is the stage; where an audience we never wanted whacks us in times of off-key. Then we
bleed; and all we need is a hand that will pressure the cut and will keep us from bleeding.

It¶s an early Thursday morning. The usual lazy day every student would have wished to
just enjoy the fluffy pillows and toys. Then I decided to march into the hall; A prison, where the
soul and the body are supposed to meet again. The aura, the tang, the people; it made me think
and eventually made me realize that I am here- a place known to be a rendezvous of the lost
soul and the seeking body. Strolling along the red corridors, I saw women; A woman of sex, a
lady of money, a child of family.

A voice came in and it says oLopez´. Later did I know I am to talk with this woman:
Lopez, Nina. A lady of her forties perhaps, properly dressed, and healthy until she started
talking and I realized I am talking with the body. The former idea of this hall came in and it
reminded of the rendezvous. Then I started to extract the gist and out talks always boil down to
children and at time, the husband. I started checking the chart and it all presented her history-
strolling in the dock, was brought to a social group, and was endorsed to this rendezvous and
these are all cause by a single thing- a wife looking for her husband for the sake of the
established family which is now facing an impending demise.

Then a paper flashed into my vision which says oschizoaffective disorder´ and in its side
written the words oFinal Diagnosis´. This is perhaps the vessel where the soul is to be found and
should this vessel dock in the rendezvous to meet the seeking body.

Schizoaffective disorder, a perplexing mental illness distinguished by a combination of

symptoms of a thought disorder or other psychotic symptoms such as hallucinations or
delusions (schizophrenia component) and those of a mood disorder (depressive or manic

And I opened some books and they say

The coupling of symptoms from these divergent spectrums makes treating patients who are schizoaffective

Schizoaffective disorder is defined using the a   

 criteria or by          a      a 
coding. Schizoaffective disorder has features of both schizophrenia, including hallucinations, delusions, and distorted
thinking, and a mood component, such as depression or mania.

The diagnosis is made when the patient has features of both illnesses but does not strictly meet diagnostic
criteria for either schizophrenia or a mood disorder alone. Unfortunately, determining if a patient has 2 separate
illnesses (schizophrenia or a mood disorder), a combination of illnesses (schizophrenia and a mood disorder), or
perhaps even a distinct and separate illness apart from schizophrenia or a mood disorder is difficult. Making the
diagnosis of schizoaffective disorder can be difficult because it encompasses 2 other diagnostic entities, namely
schizophrenia and mood disorders. An accurate diagnosis is made when the patient meets criteria for major
depressive disorder or mania while also meeting the criteria for schizophrenia. Moreover, the patient must have
psychosis for at least 2 weeks without a mood disorder.

Men with schizoaffective disorder tend to exhibit antisocial personality traits. The age of onset is later for
women than for men, and the exact etiology and epidemiology is unclear because of limited research in this area.
Patients with schizoaffective disorder are thought to have a better prognosis than that of patients with schizophrenia.
Treatment consists of both pharmacotherapy and psychotherapy.

The prognosis for patients with schizoaffective disorder is thought to lie between that of patients with
schizophrenia and that of patients with a mood disorder. That is, the prognosis is better with schizoaffective disorder
than with schizophrenic disorder but worse than with a mood disorder alone.

Ô Individuals with the bipolar subtype are thought to have a prognosis similar to those with bipolar type I,
whereas the prognosis of people with the depressive subtype is thought to be similar to that of people with
schizophrenia. Overall, determination of the prognosis is difficult.
Ô The incidence of suicide is estimated at ten% (Williams, 1998). Also consider difference in suicide attempts
among different ethnic groups. Caucasian individuals have a higher rate of suicide than African Americans.
Persons who immigrated to a country have higher suicide rates then people born in that country. In regards
to gender, women attempt suicide more than men, but men complete suicide more often.
Ô Schizoaffective disorder affects more women than men, but this appears to be influenced the fact that more
women are in the depressive subtype as comparedcwith the bipolar subtype.
Ô A poor prognosis in patients with schizoaffective disorder is generally associated with a poor premorbid
history, an insidious onset, no precipitating factors, a predominant psychosis, negative symptoms, an early
onset, an unremitting course, or their having a family member with schizophrenia.

oShe needs a hand to pressure the bleeding; A rendezvous where the lost

La Couverture
(the cover)

We see a broken painting with bizarre earrings. As oDesafinado´ is musical oddity, the painting is a
picture of a broken soul. The anxious brush strokes represent the symptoms presented by the guest. It also
establishes the complexity of a person¶s loves and how it affects the whole picture of a being. The earrings
represent the ears. A person must have an ear to listen and must also have an ear where she can relay her
feelings. The closed eyes represent the longing of the seeking body for the lost soul. The closed lips indicate the
µclosed¶ personality of the guest for she seldom talks about the very gist of her family life. Lastly, the theme of the
book, Vintage; A word that can have several meanings. Its primary definition is "of old, recognized and enduring
interest, importance or quality." It can be used as a noun or as an adjective, and is usually associated with the
quality of aging, enduring or improving over time. As the guest age, may she endure and improve. May the
seeking body find the lost soul.

soul will dock and meet the seeking body.´

c c

Contact with Psychiatric Scabies
by: Dayle RJ C. Marquez

All we though it¶s a jinx

All we thought it stinks
When his eruption drinks
The yellow solution sinks

The droplets flow like a drizzle,

Growths inflamed, elevated pustule
Drops of white, the opening sizzle
Without such scratch, he is cattle

To touch tantamount to risk

To scratch, to replay the disc
The soiled, the clean in spontaneity mixed
Wash his growths from the black creek

The flies on the growth, they¶re smitten

No acts taken after the datum taken
Knowledge, care- passionately given
Tomorrows of today are threaten

Each yellow drizzle means tomorrow

To dry the cracks of his sorrow
For his flesh be like as Monroe
To do away from the waiting crow.

Healing in the tip of stick on skin

Circumlunar yellow liquid, closure it shall mean
Bandaged deans of yellow and green
Plastered eruptions rejoice the Dean

Every piece of brown, soiled cuff

With zenith of affirmation for it to slough
To flatten out his scarring buff
They shall act, unlike his muff

To touch and innately feel

The eruptions melt, from sword to steel
Perform each mandate says in the bill
To have a contact, the illness shall peel



Ô If patients are suicidal, homicidal, or gravely disabled, admit them to an inpatient psychiatric unit.
Inpatient treatment is mandatory for patients who are dangerous to themselves or others and for
patients who cannot take care of themselves.
Ô Patients who have schizoaffective disorder can greatly benefit from psychotherapy and well as
psychoeducational programs.
„ They should receive therapy that involves their families, develops their social skills, and
focuses on cognitive rehabilitation.
„ Psychotherapies should include supportive therapy and assertive community therapy in
addition to individual and group forms of therapy and rehabilitation programs.
Ô Family involvement is needed in the treatment of this particular disorder.
Ô Treatment includes education about the disorder and its treatment, family assistance in
compliance with medications and appointments, and maintenance of structured daily activities (ie,
schedule of daily events) for the patient.

Ô Consult a neurologist to rule out neurological disease.


Ô No specific diet is recommended for patients with schizoaffective disorder.


Ô Restrict activity if patients represent a danger to themselves or to others or if they are gravely
disabled. Otherwise, encourage patients who are schizoaffective to continue their normal routines
and strengthen their social skills whenever possible.


Several medications are used to treat schizoaffective disorder. Agent selection depends on whether the
depressive or manic subtype is present. Early treatment with medication along with good premorbid
function often improves outcomes. In the depressive subtype, combinations of antidepressants (eg,
sertraline, fluoxetine) plus an antipsychotic (eg, haloperidol, risperidone, olanzapine) are used. In
refractory cases, clozapine has been used as an antipsychotic agent. In the manic subtype, combinations
of mood stabilizers (eg, lithium, carbamazepine, divalproex) plus an antipsychotic are used. Of the many
medications and combinations available to treat schizoaffective disorder, a few are reviewed below.


These agents ameliorate psychosis and aggressive behavior.

ö Stuart, G and Laraia M. (2005): Principles And Practice of
Psychiatric Nursing 8th edition Singapore: Elsevier Pte Ltd
Health Sciences Asia
ö Bersabe, Ruel (2>> cMental Health and Psychistric Nursing
cEdition; Manila: Educational Publishing House

ö Videbeck, S (2>> c Psychiatric Mental Health Nursing, 2nd

edition Philadelphia, USA: Lippincott, Williams and Wilkins.

ö Pasquali, ElaineAnn, et al (c Mental Health Nursing: A

Holistic Approach 2nd edition: Princeton: The CV Mosby

ö Kalman, Natalie and Waughfield, Claire ( c Mental

Health Concepts USA: DelMar Publishers, Inc.

ö Morgan, Arthur James and Johnston, Mabel (

c Mental
Health and Mental Illness, 2nd edition; JB Lippincott

ö Doenges, Marilyn et al. ( cNursing Care Plan 3rd Edition:

Philadelphia: FA Davis Company

ö Griffith, Eleonor ( c : Drug Handbook and Prescription;

Pittsburg DelMar Publishingc

Guests should be separated according to case and

Therapies applied by affiliates must be evaluated

Therapeutic Communication shall strictly be
observed at all times.

A case study MUST BE A CASE STUDY and not

just a mere requirement for passing the exposure.

We shall respect the names we usually call our


Unloading is important in every exposure. I

would have wanted to do such activity in our

I would have
Used therapeutic communication at all times

Dug into the very gist of Schizo-affective

disorder to help my guest come back to reality

Effectively used my time in studying

interventions that can make clients talk at times
when they are withdrawn
Started my interaction with my client as early as
I entered the mess hall

Not laugh at client¶s bizarre attitudes and talks

Talked to other affiliates to let my client just do

the things she can do independently