Analysis of Physician Views Towards End-of-Life Care

Analysis of Physician Views Towards End-of-Life Care Introduction: It has been estimated that more than 15 million people will suffer cancer worldwide by 2020(1). According to the report by Ministry of Health, over 30000 people die because of cancer annually and about 70000 new cases occur every year(2). Therefore cancer is the third most common cause of death in Iran following coronary heart disease and accidents (3, 4). There are considerable evidences that most of patients who encounter a life-threatening condition such as cancer are growing rapidly in Iran in the last few decades (1, 5, 6). Unfortunately, most of these patients are diagnosed in the late stages of disease, therefore they reach a stage that surgery, chemotherapy and other curative interventions are unable to improve their quality of life. They often suffer severe distress, in physical, psychological, spiritual, social and financial dimensions (7)Hence, the relief from such a suffering is considered as a basic and universal human right (8) and a basic action in achieving Universal Health Coverage(UHC) which has been introduced by World Health Organization in recent years (9). Universal health coverage is defined as access to key promotive, preventive, curative , rehabilitative, and palliative care for all at an affordable cost(8). Palliative or hospice care is an interdisciplinary, comprehensive, patient-centered approach in response to these needs. In other word hospice is a model for end-of-life care based on a team approach to control symptoms, manage pain, and provide emotional and spiritual support for terminally ill patients and their families (10). According to the World Health Organization (WHO), palliative care is ‘an approach to improve the quality of life of for threatening illness situations (11). The hospice care is not to cure disease but alleviate symptoms and improve quality of life at the end of life are the main objectives. Furthermore the mission of hospice care is to enable the end of life patients to die at home, with their beloved people around them (12). Despite the fact that cancer is a leading cause of mortality with rapidly growing rate and late stage diagnoses in Iran, very little is known about the physicians’ beliefs, attitudes and experiences about of end-of-life care. This study surveyed Iranian physicians’ attitudes and practices on end-of-life care for the first time. Materials Methods: A cross-sectional study was conducted among all doctors who participated in the biggest regional annually conducted educational seminar in the Tabriz city and end of year medical students in September 2012. This Physicians came from East-Azerbaijan and some provinces in north-east of Iran. Generally seminar is conducted annually and consists of clinician-specialists in different specialty groups. The seminar presented the opportunity to obtain current information on End of life care training, knowledge and attitudes, demographic and organizational characteristics, and personal experience with end of life patients. The population consisted of 560 medical students, general physicians, specialist and sub-specialists. The sample size was determined based on the WHO recommendation on 400 sample and results of a pilot study consisting of 30 physicians which resulted in an Odds Ratio of 1.8. Considering 95% confidence and 95% power, two tailed test, and utilizing G-Power software, 161 cases were computed and regarding a dropout rate of 45% the total sample size increased to at least 234 cases. Data were collected using a voluntary self-administered, anonymous questionnaire that originally developed by John Mastrojohn and Agnes Csikos in 2010 (13) and we confirmed and retained its validity and reliability after translation to Farsi in this survey. A translation – back translation process was used to translate the measure; two English language specialists and two native English speaking persons respectively involved in the translation and back translation processes. In addition to apply the translated questionnaire in the study population on 15 persons, a linguistic edit of the measure was done. The content validity of the questionnaire was evaluated based on opinions of an expert panel consisted of eight specialists in the fields of Health service research. After conducting some modifications and corrections the content validity was approved. In addition, we assessed the reliability of questionnaire totally using Cronbach’s Alpha coefficient. The Cronbach†™s Alpha values were calculated for all 22 items (0.92.) and showed reasonable reliability (internal consistency). Questionnaires were distributed prior to the sessions and internship workshops. A total of 38.3% (215 of 560) of participants completed the survey. Participation was voluntary and no incentives were offered. Completion of the anonymous questionnaire was taken as consent to participate in the study. Questionnaire includes a letter explaining its general purpose and providing assurances of the confidentiality of individual answers. Questionnaire contains 22 questions about care of terminally ill patients, 2 questions about personal (age and sex) and 5 questions in relation to organizational characteristics. All returned questionnaires were checked manually for completeness before they were forwarded to electronic data computer. Frequencies and percentages were calculated to compare results and Cross-tabulations using Kendall’s tau-b to test for significance were conducted to compare within-sample bivariate associations between demographic and practice variables with belief and attitudinal variables. Most of these tests were not statistically significant, with the exception of those reported here. All study data were analyzed using SPSS version 16.0.Only quantitative results are discussed in this article. Ethical consideration for this study and the study protocol were approved by the Ethics Committee of Tabriz University of Medical Sciences (TUMS), which was in compliance with Helsinki Declaration. Results: In this study, 215 questionnaires were completed from 560 (overall response rate of 38.3%). Of all participants, 60% were males. In terms of their graduated universities, (76.2%) of the respondents were graduated students of Tabriz medical university. Every physician had visited 24.63 (16.57) patients every day and the average length of service was 5.23 (4.53) years. The physicians identified their degrees as 60.7% generalist and 39.3% specialist. Socio-demographic and organizational characteristics of participations are shown in table 1. According to the table 1 more than eighty percent of physicians have had at last 1-3 EOL patients. It is considerable that 72% of mentioned patients received medical care in the hospital, 23% at home and 4.7% in other settings. Further investigation did not show any statically significant differences between gender groups, specialty or generalists in the number of their daily visiting patients, however differences about their terminal illness patients were statically meaningful (p Physicians’ believes about the most appropriate type of care for end of life patients illustrated in Table2 The responses of physicians about opinion on current cares for end of life patients in our country were as following: 1.9 percent indicated the best, 15.8 percent sufficient with deficiencies, 59.5 percent insufficient, and finally 22.8 percent there is not any care. In other words nearly all of the physicians evaluated these services as insufficient. Furthermore their response to :In your opinion, the best setting for care of terminally ill patients is usually approximately were:20 percent hospital, 62 percent the patients home, 18 percent a nursing home, that obviously is in contrast with their practices that indicate more than 72.4 percent of end of life patients were cared in hospital. Furthermore the differences among two groups of physicians about Best Setting for care of terminally ill patients were statically significant (p Physicians beliefs about the ability of end of life patients to maintain dignity until death showed in the Table 3: Further investigation about mentioned differences in last table didn’t show any significant relationship among specialty, age, gender, work place and graduating groups of physicians. Nearly one percent of physicians stated that they were quite knowledgeable about hospice care and 57.1 percent did not posses any familiarity with this type of care. In other way, 97.2 percent of physicians indicated that they would not participate in educational course about hospice care. Hence 82.2 percent of them were interested in participating in educational course on hospice care. Table 4 shows familiarity of physicians with hospice care and their interest in participating in educational course. Table 4: physicians’ familiarity, behavioral with hospice care and educational course Investigation on significant relationship between physicians’ knowledge about hospice and demographic characteristics were meaningful only in Age groups, where differences in physicians on searching workshop in different groups were significant only in work place (p=0.025). DISCUSSION: There are numbers of important implications of this study. First, the study demonstrates that familiarity of Iranian physicians with end of life cares was low in spite of frequent contact with those patients. Second, there isnt any kind of structured or organized system to deliver services for end of life patients. Third, there isnt any developed educational plan neither in medical school curriculums nor continuity medical education programs. In this study the participation rate was 38.3% which was lower than that of similar studies in Hungary (54%) , United States (48%) and Pakistan (63.6%)(13, 14). This differences could be attributed to methods of sampling and low level of Iranian physicians’ knowledge about end of life cares . Most of the Iranian physicians (72%) in the current study claim that they didnt have any knowledge about hospice care, which is similar to Pakistani doctors (57.1%) who stated that they had heard about a hospice (14). In contrast to the most of U.S. physicians who were quite knowledgeable most of the Hungarian physicians had only a basic knowledge (13). However there is a high level of interest in the physicians of U.S., Hungary, Iran (82%), and Pakistan to participate in continuing medical education to learn more about hospice care. These findings are consistent with previous studies that indicate physicians’ common interest in continuing medical education for end-of-life care(7, 13-17). In this study 72% of EOL patients received medical care in the hospital and 23% at home, whereas other studies are focusing to physicians’ awareness of patients’ preferred place for dyeing(18, 19). However 27% of Iranian physicians mentioned that the preferred place of providing terminal care is hospital, the reasons for this obvious conflict are related to lack of delivering any end of life care in health system in hospital or home. Furthermore 82% of physicians demonstrated that level of present end of life care in Iran is insufficient and 22% believed that there is not any structured service for end of life patients. This finding is in accordance with other study results and reports, thereforeIran was categorized in second group on Palliative Care Development in the world (20). Iranian physicians believed that combination of curative and palliative care is most appropriate approach for terminally ill patients (61.7%) which matches with U.S. physicians and contrasts with most of Hungarian physicians that supported a palliative care only approach for terminally ill patients (13). This may be attributed to the current practice of aggressive curative treatment until the last day s of life in Iran and Hungary. Iranian Physicians’ beliefs about the ability of End of life patient to maintain personal dignity were differed from those of other countries(13, 19) especially for this opinion Most or all end of life patients are not able to maintain personal dignity it was 18% in our study but in the mentioned countries it was 9% and 5 %. These differences could be attributed to difference of social contexts and family structures in these three countries. Most of the Iranian physicians in the current study claim that they would not participate in educational course about hospice care neither would they do in collage curriculums nor in continuity medical education programs. These results are in contrast to most of the U.S. and Hungarian physicians (13) but are in accordance with previous studies on Iranian nurses (8). Intense interest of Iranian physicians to participate in continuing medical education for end-of-life care is clear evidence for this finding. Conclusions: A growing trend of chronic, non-communicable diseases especially cancers in Iran, has led to new condition of needs for providing care to EOL patients. Furthermore our findings clearly indicate unacceptable level of knowledge and attitudes of physicians about delivering services for EOL patients. Physicians of our study were interested in participating in continuing education programs about EOL patient. In response to these realities, designing the specific care for EOL patients, is inevitable and should be starting as soon as possible. Furthermore the education of physicians about EOL care should be included in the formal curriculums of medical schools and continuous medical education programs.

The Rastafarian Religion :: essays research papers

While some will call Rastafarianism a religion, others will say that Rastafarianism is a kind of spiritual consciousness because the Rastas lack a great deal of what is central for other religions while still retaining a belief in a God. There aren't too many organised Rasta 'churches', and the closest thing you would come to a church will probably be Rasta organisations like 'The Twelve Tribes of Israel', the 'Nyabinghi Order' and especially the 'Bobo Dreads'. Rastafarianism also lacks a confession of fate, which most other religious systems will have. So the question will remain open if this is a religion or a spiritual consciousness where everyone calling him/herself a Rasta will be more or less free to believe in what they like. As already mentioned, Rastafarianism is not just a religion or spiritual consciousness, but also a way of life. This encompasses among other things food, called Ital food. Rastas are supposed to be vegetarians, while some eat fish, the Ital food consists only of vegetables and spices, not including salt, which for health reasons are not used in cooking. The food is very healthy, as health is also generally very important to Rastas. You will seldom see an unhealthy Rasta. Rastas also smoke ganja, or marijuana as it's more commonly known, but this is not something you have to do. The smoking of ganja is founded on Bible passages describing how ganja was used in ancient times by people like King Solomon, and the Rastas see it as a way to ease the way to commune with Jah. But there are even a small number of Rastas who do not smoke it on the grounds that easy ways out to reach a 'communion' with Jah should not be sought. The Rasta way of life also encompasses a social side, where the lives and rights of everyone, but especially of the poor, are taken into account. They believe that everyone deserves and has the right to freedom, and more than anything else a belief in equal rights for everyone. The question of dreadlocks or no dreadlocks is not so important, even if most Rastas will have them. Even one of today's reggae groups sing a song that's called, 'You don't haffi (have to have) dread to be Rasta' (Morgan Heritage). It's more to do with how you behave, act and what you believe in, than how you look. Even the language of the Rastas has changed the Jamaican Patois language, where many of the expressions unique to Jamaica originated in Rastafarianism, like 'I and I', meaning we.

Things I’ve learned

I've learned One of the first things that I have learned since Eve been In this class was how to be better at communication. Often at times we as people seem to only think about ourselves, It's not a good thing but we are human. In the world of business I am my own brand but I'm not the most important piece in the puzzle.Teamwork is the key because the same people that I see going up the ladder will most likely be he same people I see coming down. With that being said, I will try my best not to burn any bridges because you never know who or what that you might need In life. The second thing that I have learned since being in this class is emotional Intelligence. A lot of people claim to have emotional intelligence but lack the confidence within themselves to properly express it and in this line of business find It crucial.With limited knowledge of self and emotional intelligence one can ender their success. With emotional intelligence a person can communicate effectively because with out communication you can't be an effective player in this game of life. The third thing I've learned was the Dry. Phil test. It was important because it was Like looking In the mirror and being critical of myself to put things In 1 OFF learned since being in this class is trust and how to effectively complete proposals.

Anime VS American Animation Essays - Shnen Manga, Osamu Tezuka

Anime VS American Animation Essays - Shnen Manga, Osamu Tezuka Anime VS American Animation by Marker Apenname Thesis Statement This is my thesis statement while American animation and Japanese animation both have their virtues, the style of American animation, in general, has a significant amount of higher quality. Where to Begin? Where to be Going? To begin with, one of the major problems that has hindered American animation is budget and time constraints. On the other hand, in Japan, anime has been allowed to flourish all over. When it comes to animation, it seems that Hollywood simply does not take it seriously and would rather throw its millions into "live action" films and TV shows. There is only one company in Hollywood which devotes a significant amount of its resources to advancing our heritage in animation, and that's Disney. Comparatively, its Japanese cousin has hundreds. This is a real shame considering that animation itself was originally pioneered by us. The American form of animation has not had its techniques advanced through as many stages or been perfected as much as Japanese anime has. This would lead some to the conclusion that Japanese animation is inherently better than American animation; a false conclusion that I will dissect piece by piece as we go on. Still, there are some examples where the qualit y of American animation really shines through for what it was meant to be. Take another perspective, and you'll see that the cut-throat constraints which American animation producers face can actually help the quality of their animation, because they are always forced to work under the constant threat of being "canned". Any animation project cannot be a flop or else (as in showbiz terms) so-and-so "will never work in this town again!" Compare this to all that garbage floating around in Japan. However, to gain the popularity and respect that the form deserves, we need to make some big changes. Fortunately, it seems that some of the big-shots up there have finally started to take notice of what has caused the likes of Disney to become very successful and make billions of dollars for years. Of course, it will be a while before animators are given the freedom and creativity that have made the Japanese successful for the last decade. But we cannot simply play catch-up by copying their in ferior anime style (even though that's what they did to us a long time ago). Then we would be giving away our pride selling out one of the few proud things that we can say was made in America. No, we must do things our own way! A Little History Few people, including those obsessed anime fans, have a clear understanding of how Japanese animation came to be or how it relates to the American form of animation. So, let's take a little look at its history. First, let's figure out what element of Japan's society has caused the proliferation of anime. Well, in Japan there is a distinctive connection between the animation industry and the comic book (called "manga") industry. In fact, many animes are based off of manga. The actual word "manga" was coined in 1814 and roughly translates into "humorous pictures", but cartoonish art had existed in Japanese culture for centuries prior to that. The crude drawings were used by the Japanese leaders and social elite, usually for political purposes. One of the earliest known collections of these drawings were drawn by a Buddhist monk named Toba in the 12th century. The need for these drawings was probably brought about by a certain trait in Japanese culture, which modern-day psychologis ts might call an "attention deficit disorder". The solution for this was to entice their people with certain visual stimuli. This became a useful tool for those in power, since they could use it to leverage control over the public. The effect could be described similarly to the "media saturation" which has plagued America in recent times. Flash forward to 1989 only 12% of published material in Japan were books, whereas the majority (38%) were manga! If this does not show anything about Japanese society and literacy, then I don't know what does. All of this may suggest that the Japanese had a unique style of their

20 Analytical Essay Topics What to Discuss in the Lyric Poetry of Paul Celan

20 Analytical Essay Topics What to Discuss in the Lyric Poetry of Paul Celan If you are facing a literary analysis writing assignment on the lyric poetry of Paul Celan, the first place you need to start is with a topic. Below are 20 topics you might want to use: The Role That Survivors Guilt Plays in the Arts and How the Different Manifestation of Guilt in Different People Influence the Language Used and Communication Used Analysis of a Poem of Your Choosing The Role Played by the Poet’s Depression and Whether That Depression Helped or Hindered His Poems. How Poetry Is Self-Expression How Poetry Can Heal Entire Nations or Peoples The Reason the Poet Used Neologisms with Surreal Imagery in order to Cultivate a Powerful Image in the Minds of the Readers Analysis of a Made Up Word of Your Choosing How the Poet’s Poems Bury Emotional Content Related to the Unspeakable Horrors He Experienced and Witnessed during the Holocaust How Meaning Is Lost in the Translation The Use of Surreal Metaphors How Cenal’s Poems Differ from Traditional Poetic Style How Psychological Survival Skills Used in the Labor Camp Result in Feelings and Events Being Dissociated beyond Consciousness The Importance of Not Using Standard Poetry Techniques How Poetic Influence Is Measured How German Is a Unique, Scientific, and Technically Literal Language such That It Afforded the Poet More Flexibility in Creating His Own Vocabulary in the Language Can Poetry Come from a Happy Life What Defines Poetry as â€Å"Good† How Conjectural Meanings Played a Role in His Word Poetry as Self-Therapy The Way in Which the Disconnect from the German Language and the Relation It Had to the Death Of His Parents Played in His Using His Own German Vocabulary as a Means of Control over the Enemy and Therapy Aren’t those cool topics? Of course, they are because they open the deep background of Celan’s poetry. These topics are based on the facts about Paul Celan’s lyric poetry. However, if you have troubles conducting the analysis, visit our guide on analytical writing. Below is a sample essay on one of those 20 topics: Sample Analytical Essay: â€Å"The Way in Which the Disconnect from the German Language and the Relation It Had to the Death of His Parents Played in His Using His Own German Vocabulary as a Means of Control over the Enemy and Therapy† Survival’s guilt is a powerful psychological effect that often accompanies survivors of mass atrocities and war, including the labor camps and concentration camps so prevalent during the Second World War. For the poet Paul Celan, this took combined with the survival skills learned during his two years in the labor camps are responsible for pushing forward his need to seek therapy in whatever form was best suited for his situation. That form was the specific changing of the German vocabulary and use of the German language as the mother tongue for his poems. It was in 1942 that Paul Celan left his mother and father to go into hiding. They opted not to follow in spite of the inherent risks of remaining at home. It was on this night that both were arrested, deported, and ended up dying in concentration camps. His father died of disease but his mother was shot and killed when she was no longer physically able to work. He was taken to a labor camp where he worked for two years before escaping. As part of his time there, Paul Celan developed survival skills the same as everyone else. These skills enabled him to compartmentalize his feelings, to place sympathy and empathy on the same playing field so as to avoid a break down. This skill also allowed him to ignore the unbearable sounds, smells, and sights through disassociation, wherein the individual remains in a trance-life state which is beyond that of consciousness. This is a complex psychological state of being, one which must be dealt with after the fact. The manner in which Paul Celan dealt with it was through his poetry. Working through the survivor’s guilt and attempting to move beyond the disassociation and survival skills developed, the poet began to write his own works. While fluent in three languages and familiar with six, he learned German, a trait common among those who are dealing with mass atrocities; he learned his enemy and studied it deeply. During this time he opted to write all of his poetry in the German language. This language was the language of the people who murdered his mother, who took away his father, who put him in a camp himself, and more. But in writing in their language, the poet was able to gain some semblance of power back over his enemy who had taken so much from him. He was able to learn their ways, their meanings, and to not just write in their language but to change it. Paul Celan was popular for the vocabulary he created for the sake of his poetry. He was popular for making new words, for using traditional German prefixes and postfixes and making words which are similar to commonly used phrases, but are slightly different. Indeed, part of the ability and ease with which this was done reflects upon the German language itself, a very practical language full of literal terms and very few figurative turns of phrase. But in addition to the Greek and Latin roots so prevalent in the German language, the poet opted to do this because it offered a mild form of therapy, a way of taking back the control that was lost to him at the hands of the Nazis. For a people whose entire goal in the war was to preserve their motherland and mother tongue, to make sure that their purity went on to create the master race, the manner in which the poet spliced their mother tongue into pieces and infiltrated the pure language they held so dear was a way to re-gain control over what they did, to show them that they had not achieved a victory over him, and to get back at them in the same invasive and deeply inappropriate fashion that they had done to him. He violated the sanctity of their native tongue as a way of violating one of the things they held most dear as a people and in this way achieved revenge for their violation of the sanctity of his family unit. References: Celan, Paul, and Michael Hamburger.  Poems Of Paul Celan. New York: Persea Books, 1989. Print. Celan, Paul, and Pierre Joris.  Paul Celan. Berkeley: University of California Press, 2005. Print. Celan, Paul, Barbara Wiedemann, and Nelly Sachs.  Paul Celan, Nelly Sachs. Riverdale-on-Hudson, N.Y.: Sheep Meadow Press, 1995. Print. Celan, Paul, Ilana Shmueli, and Susan H Gillespie.  The Correspondence Of Paul Celan Ilana Shmueli. Riverdale-on-Hudson, N.Y.: Sheep Meadow Press, 2010. Print. Celan, Paul, Werner Hamacher, and Winfried Menninghaus.  Paul Celan. Frankfurt am Main: Suhrkamp, 1988. Print. Ives, Margaret C., Haskell M. Block, and Paul Celan. The Poetry Of Paul Celan.  The Modern Language Review  89.2 (1994): 530. Web. Meyerhofer, Nicholas J., Clarise Samuels, and Paul Celan. Holocaust Visions: Surrealism And Existentialism In The Poetry Of Paul Celan.  German Studies Review  18.2 (1995): 364. Web.

Discuss Carson's view in the context of the history of management Essay

Discuss Carson's view in the context of the history of management theory and evaluate the relevance of McGregor's theories t - Essay Example The theories were based on a number of assumptions which a manager can use to motivate his employees (Koontz and Weihrich 2007). Managers who apply theory X in their management practices believe that employees do not like work. People are generally lazy and do not like responsibility. They avoid work and lack ambition and as a result, managers have to direct them and force them to work. On the other hand, managers who apply theory Y believe that employees are self -motivated, like work and are responsible. However, according to Carson (2005), â€Å"McGregor did not originate these ideas; he just made them easy for practitioners to use and implement in their work environments.† This paper discusses Carson’s view in the context of the history of management and also evaluates the relevance of McGregor’s theories to the contemporary leisure industry. Early foundations of theory Y The foundations of theory Y can be traced back to as early as 1690. The initial ideas of the theory were introduced by Locke in the year 1690 and Smith 1776. The philosophy by Locke was law based. The four ideas in his philosophy were; law based on purpose rather than arbitrary, government deriving powers from its citizens, freedom to pursue personal objectives as a natural right, as well as use of private property in search of happiness as a legally protected and natural right. These ideas have a connection with theory Y in that they all focus on an individual (Carson 2005). It is important to note that theory Y and theory X focus on individual behavior and their motives to work. Locke suggested that power, legal matters and liberty are influential at personal pursuance of goals and objectives. People need to be given the freedom to do their own things. He argued that individuals use their own properties in order to pursue happiness and objectives and they should not be dictated on how to achieve that fate. This is the same manner with which McGregor placed his theory . He argued that managers do not have to put much pressure on employees for them to perform. Instead, they should have faith in them. Each individual employee should be given a responsibility and the employer should trust him or her with it. Employers and managers should give employees freedom to carry out their duties (Lussier and Achua 2010). Smith presented an idea similar to that by Locke in that it focused on freedom. His liberal economics were developed in a period when there was less government control and interjection. The government interjection was similar to the assumption in McGregor’s theory X that people do not like work, have little ambition and tend to avoid responsibility. Smith advocated for a free market that gives an opportunity for competition. For a free market to be achieved, people should be accorded the liberty to make decisions on their own (Lusch and Vargo 2006). This was a foundational idea to the assumption by McGregor in his theory Y which indica ted that managers do not have to input external control or threat of punishment to make employees work towards achieving the organizational objectives. He suggested that man has the ability to exercise self- control as well as self- direction towards achieving the goals to a service in which they are committed (Carson 2005). Further foundation to McGregor’s theory was developed when Owen in the year 1857 expressed his beliefs that workers are a valuable asset to an organization. He felt that managers should realize the value in

(adults with schizoaffective disorder) Term Paper

(adults with schizoaffective disorder) - Term Paper Example The second and third aspects of the paper will also discuss how a family member saw this spectrum and how it is affects African-Americans. The theoretical orientation that has been chosen for this report is the cognitive theories. According to the Better Health Channel (2011) schizo-affective disorder is a combination of â€Å"schizophrenia and a mood disorder† (par. 1). There are two sub-types that have been identified: Schizo-affective bipolar type and schizo-affective depression type. The symptoms of schizo-affective disorder can include three types: Psychotic symptoms include losing touch with reality, chaotic speech, blank facial expression, hallucinations, disorganized thoughts and the inability to move. Manic symptoms can include rapid thoughts and/or speech, quick changes in mood, impulsive behaviors and exaggerated self-esteem. Depressive symptoms that can include low self-esteem, suicidal thoughts, loss of motivation and/or loss of interest, difficulty concentrating, insomnia and loss of appetite. Unfortunately, the causes of schizo-affective disorder is not known (Better Health Channel, 2011). Also, s chizo-affective disorder is difficult to diagnose because clients are usually having the same challenges when they are diagnosed with schizophrenia or bipolar disorder. Generally, the diagnosis of schizo-affective disorder will be used if the individual has both schizophrenia and a mood disorder that is present for at least two weeks (Better Health Channel, 2011). This is one of the reasons that many researchers state that socio-affective disorder is part of a schizophrenia spectrum. The cognitive theories are important to this disorder because there are several areas of cognitive dysfunction. Green (2006) identified several key concepts in cognitive functioning. These concepts include: â€Å"speed of processing, attention/vigilance, working memory, visual learning and memory, reasoning and problem solving, and social