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LESSON PLAN ON DEPRESSIVE NEUROSIS

Name of the student teacher : Ms. Parvathy Santhosh

Subject : Mental Health Nursing

Unit : Unit 4

Topic : Depressive neurosis

Class : Post BSc Nursing –ІІ year.

No. of students : 56

Method of teaching : Lecture Cum Discussion

Teaching aids : Chart, hand outs, OHP

Date and time :

Duration of teaching : 45 min

Venue : : Post BSc Nursing –ІІ year classroom

Previous knowledge of the group : The students will have some previous knowledge about depressive neurosis,its clinical
features and treatment from their general nursing classes.
GENERAL OBJECTIVES: On completion of this class the student will able to develop knowledge on depressive neurosis,
understand the courses, pathology, symptoms and management and apply this knowledge in their nursing care.

SPECIFIC OBJECTIVES: The students are able to

 Define depressive neurosis


 Identify the etiology
 Determine the epidemiology
 Classify the types of depressive neurosis
 Identify the clinical features of depressive neurosis
 Justify the diagnosis
 Recognize the various treatment modalities
 Explain the course and prognosis
 Identify the nursing care aspects in depressive neurosis.
TIME SPECIFIC CONTENT TEACHERS STUDENT AV EVALUATION
OBJECTIVES ACTIVITY ACITIVITY AIDS

Depressive neurosis is commonly called as


Introduces the dysthymic disorder. The term dysthymia means ill Teacher Student Black What do u mean
2min topic with humored and was introduced in the year 1980. begins the listens the board by anxiety
introduction topic with introduction neurosis?
introduction

2 min Define DEFINITION:


depressive Teacher Student OHP What is the
neurosis The revised division of DSM-IV defines depressive defines listens to the definition of
neurosis as the presence of depressed mood that lasts depressive definition depressive
most of the day and is present almost continuously. neurosis and writes neurosis?
notes.
ETIOLOGY:
2 min The exact cause of depressive neurosis is based on Explains the Listens to the OHP What is the
Identify the the following factors. etiology class etiology of
etiology depressive
Biological factors: neurosis?
The biological basis for the symptoms of dysthymic
disorder are same as that of major depressive
neurosis
Sleep studies:
Decreased rapid eye movement(REM) latency and
increased REM density are two state markers of
depression in major depressive disorder that also
occur in a significant proportion of patients with
dysthymic disorder.
Neuro endocrine studies:
The two most studied neuro endocrine axes in major
depressive disorder and dysthymic disorder are the
adrenal axis and the thyroid axis,which have been
tested by using the dexamethasone-supression
test(DST),and the thyrotropin-releasing
hormone(TRH)-stimulation
test,respectively.Although the results of studies are
not absolutely consistent,most indicate that patients
with dysthymic disorder are less likely to have
abnormal results on a DST than are patients with
major depressive disorder.
Psychosocial factors:
Psychodynamic theories about the development of
dysthymic disorder posit that the disorder results
from personality and ego development and
culminates in difficulty adapting to adolescenceand
young adulthood.
Cognitive theory:
The cognitive theory of depression also applies to
dysthymic disorder.It holds that a disparity between
actual and fantasized situations leads to diminished
self-esteem and a sense of helplessness.

EPIDEMIOLOGY:
3 min Determine the
epidemiology Dysthymic disorder is common among the general Explain the Listens the Black What is the
population and affects 5 to 6 percent of all epidemiology class Board epidemiology of
persons.The disorder is more common among women anxiety
younger than 64 years of age than in men of any age neurosis?
and is most common in unmarried young persons and
in those with low income.The disorder is most
common among those with first degree relatives with
major depressive disorder.

TYPES OF DEPRESSIVE NEUROSIS


4 mint Identify the What are the
types 1. Early onset: Identifies cases of dysthymic Lecture types of
disorder when the onset occurs before age of 21 Student depressive
years. listens Black neurosis?
2. Late onset: Identifies cases of dysthymic disorder board
when the onset occurs at the age 21 years or older.
DIAGNOSTIC CRITERIA OF DEPRESSIVE
5minutes Explain the NEUROSIS Explains the Student Black What are the
diagnostic According to DSM-IV-TR,the diagnostic criteria for diagnostic listens Board diagnostic
criteria dysthymic disorder stipulate the presence of a criteria criteria for
depressed mood most of the time for atleast 2 years. depressive
A.Depressed mood for most of the day,for more days neurosis?
than not,as indicated either by subjective account or
observation by others,for atleast 2 years.
B.Presence,while depressed,of two (or more) of the
following:
1.poor appetite or overeating
2.insomnia or hypersomnia
3.low energy or fatigue
4.low self-esteem
5.poor concentration or difficulty making decisions
6.feelings of hopeleeness.
C.During the 2 year period(1 year for children or
adolescents) of the disturbance,the person has never
been without the symptoms in criteria A and B for
more than 2 months at a time.
D.No major depressive episode has been present
during the first 2 years of the disturbance(1 year for
children and adolescents):ie,the disturbance is not
better accounted for by chronic major depressive
disorder,or major depressive disorder,in partial
remission.
E.There has never been a manic episode,a mixed
episode,or a hypomanic episode,and criteria have
never been met for cyclothymic disorder.
F.The disturbance does not occur exclusively during
the course of a chronic psychotic disorder,such as
schizophrenia or delusional disorder.
G.The symptoma are not due to the direct
physiological effects of a substance(eg.,a drug of
abuse,a medication)or a general medical
condition(eg.,hypothyroidism)
H.The symptoms cause clinically significant distress
or impairment in social,occupational,or other
important areas of functioning.

ICD10 CLASSIFICATION OF ANXIETY


NEUROSIS
F34.1 Dysthymia Explains the The students Explain ICD-10
2 Explain the A chronic depression of mood which does not classification listens and ohp classification of
minutes ICD-10 currently fulfill the criteria for recurrent depressive asks doubts anxiety
classification disorder, mild or moderate or severity (F 33.0 or neurosis?
of anxiety F33.1), in terms of either severity or duration of
neurosis individual episodes, although the criteria for mild
depressive episode may have been fulfilled in the
past, particularly at the onset of the disorder.

The essential feature is a very long standing


depression of mood which is never ,or only very
rarely ,severe enough to fulfill the criteria for
recurrent depressive disorder, mild or moderate
severity (F33.0 or F 33.1).It usually begins early in
adult life and lasts for atleast several years
,sometimes indefinitely. When the onset is later in
life, the disorder is often the aftermath of a discrete
depressive episode (F32.-) and associated with
bereavement or other obvious stress.

CLINICAL MANIFESTATIONS

Explains the Affective symptoms: Lecture cum The students What are the
10 min clinical discussion listens and Charts clinical
manifestations Feelingssadness,dejection,helplessness,powerlessness asks doubts manifestations
of depressive Hopelessness,gloomy and pessimistic outlook, of anxiety
neurosis Low self esteem,difficuty experiencing pleasure in neurosis?
activities.

Behavioral :
Slowed physical movements (ie psychomotor
retardation); slumped posture ;slowed speech; limited
verbalizations, possibly consisting of ruminations
about life’s failures or regrets; social isolation with a
focus on the self; increased use of substances
possible; decreased interest in personal hygiene and
grooming.

Cognitive :
Retarded thinking processes ;difficulty concentrating
and directing attention; obsessive and repetitive
thoughts ,generally portraying pessimism and
negativism ;verbalizations and behavior reflecting
suicidal ideation.

Physiological:
Anorexia or over eating ;insomnia or hypersomnia;
sleep disturbances ;amenorrhea ;decreased libido
;head aches ; back aches ;chest pain ;abdominal
pain ; low energy level ;fatigue and listlessness
;feeling best early in the morning and continually
worse as the day progresses.

Course and Prognosis :


Narrate the About 50% of patients with dysthymic disorder
2 course and experience an insidious onset of symptoms before the Explains the Student Black How is the
minutes prognosis age of 25.The prognosis of patients with dysthymic course and listens and board prognosis of
disorder varies.Antidepressants and selective prognosis ask doubts depressive
psychotherapies have positive effects on the course neurosis?
and prognosis of dysthymic disorder.

TREATMENT
Historically,patients with dysthymic disorder either
Recognize the received no treatment or were seen as candidates for
10 various long term,insight oriented Lecture Student Black What are the
minutes treatment psychotherapy.Contemporary data offer the most listens and board various
modality objective support for cognitive therapy,behavior ask doubts treatment
therapy,and pharmacotherapy. modalities in
Cognitive Therapy: depressive
neurosis?
Cognitive therapy is a technique in which patients are
taught new ways of thinking and behaving to replace
faulty negative attitudes about themselves,the
world,and the future.It is a short term therapy
program oriented toward current problems and their
resolution.
Behavior therapy:
Behavior therapy for depressive disorders is based on
the theory that depression is caused by a loss of
positive reinforcement as a result of
separation,death,or sudden environmental
change.The various treatment methods focus on
specific goals to increase activity,to provide pleasant
experiences,and to teach patients how to
relax.Altering personal behavior in depressed
patients is believed to be the most effective way to
change the associated depressed thoughts and
feelings.
Insight Oriented Psychotherapy:
Individual insight oriented psychotherapy is the
common treatment for dysthymic disorder,and many
clinicians consider this as the treatment of choice.The
psychotherapeutic approach attempts to relate the
development and maintenance of depressive
symptoms and maladaptive personality features to
unresolved conflicts from early childhood.
Interpersonal therapy:
In interpersonal therapy for depressive disorders,a
patient’s current interpersonal experiences and ways
of vcoping with stress are examined to reduce
depressive symptoms and to improve self esteem.
Family and Group therapies:
Family therapy may help both the patient and the
patient’s family members deal with the symptoms of
the disorder,especially when a biologically based
subaffective syndromes seems to be present.Group
therapy may help the withdrawn individuals learn
new ways to overcome their interpersonal problems
in social situations.
Pharmacotherapy:
Because of long –standing and commonly held
theoretical beliefs that dysthymic disorder is
primarily a psychologically determined
disorder,many clinicians avoid prescribing anti
depressants for patients;however many studies have
shown the therapeutic success of antidepressants.The
data generally indicate that selective serotonin
reuptake inhibitors(SSRIs)venlafaxine and bupropion
are an effective treatment for patients with dysthymic
disorder.

NURSING MANAGEMENT
Identifies the
8 various nursing Assessment:
minutes diagnosis in Dysthymic disorder is always associated with
depressive moderate depression. Moderate depression occurs OHP
neurosis when the grief is prolonged or exaggerated. All of the Lecture cum Student
feelings associated with grieving are exaggerated out discussion listens and What are the
of proportion, and the individual is unable to function asks doubts main nursing
without assistance. So the assessment includes diagnosis in
identification of the symptoms associated with depressive
dysthymic disorder ie affective ,behavioral ,cognitive neurosis?
and physiological
Nursing Diagnosis:
1.Risk for suicide related to depressed mood
,feelings of worthlessness ,anger turned inward on
the self ,misinterpretations of reality.

Nursing Interventions:
1 Create a safe environment for the client. Remove
all potentially harmful objects from the client’s
access.
2. Formulate a short term verbal or written contract
that the client will not harm self.
3. Maintain close observation of the client.
Depending on the level of suicide precaution, provide
one –one contact.
4. Maintain special care in administration of
medications.
5. Encourage client to express honest feelings,
including anger.

Nursing Diagnosis
2.Dysfunctional grieving related to real or perceived
loss.
Nursing Intervention
1.Assess stage of fixation in grief process.
2.Develop trust ,show empathy,concern ,and
unconditioned positive regard.
3.Explore feelings of anger and help client direct
them toward the intended object or person.
4.Teach normal behaviors associated with grieving.
Nursing Diagnosis
3.Low self esteem related to learned helplessness,
feelings of abandonment by significant others
,impaired cognition fostering negative view of self.

Nursing Interventions:

1. Be accepting of client and spend time with him or


her even though pessimism and negativism may seem
objectionable.
2 .Promote attendance in therapy groups that offer
client simple methods of accomplishment.
3. Encourage client to recognize areas of change and
provide assistance towards this effort.

EVALUATION:
In the final step of the nursing process , a
reassessment is conducted to determine if the nursing
actions have been successful in achieving the
objectives of care.The nurse has to see whether the
self harm to the individual has been avoided, heve
suicidal ideations subsided,is he able to verbalize
feelings associated with each stage of grieving
process,is anger towards the lost object expressed
appropriately

CONCLUSION:
Depressive neurosis is an oldest and still one of the
most frequent diagnosed psychiatric illness.
Dysthymia is most commonly seen as a secondary
complication of other psychiatric disorder .An
effective treatment strategy incoperating
psychotherapies and pharmacotherapies may cure the
condition at the earliest.
SUMMARY AND RECAPTULATION

Depressive neurosis is a common form of neurotic condition. So till now we were disussing the meaning, etiology, epidemiology,
diagnosis, treatment and nursing management of persons with depressive neurosis.

ASSIGNMENT
Write the difference between depressive psychosis and depressive neurosis and submit it on at 9 am in Msc nursing classroom .The
criteria of the evaluation is based on the subject content and neatness.The distribution of the assignment is 2marks –neatness,6-matter
of content,2-bibliography.Refer Bimla Kapoor text book of psychiatry.

STUDENT REFERENCE:
1. Kaplan, Saddock.Synopsis of psychiatry.6th edition.elsievier publications.2006.page no.562-565
2. Mary CT.Psychiatric mental health nursing concepts of care.1994.3rd edition A Davis Company. Page no.491-499.
3. Lalitha K.Mental health and psychiatric nursing M G publications.Pge.346-352

TEACHER REFERENCE:
1. Kaplan, Saddock.Synopsis of psychiatry.6th edition.elsievier publications.2006.page no.562-565.
2. Mary CT.Psychiatric mental health nursing concepts of care.1994.3rd edition A Davis Company. Page no.491-499
3. Lalitha K.Mental health and psychiatric nursing M G publications.Pge.346-352.
LESSON PLAN ON DEPRESSIVE NEUROSIS

SUBJECT: MENTAL HEALTH NURSING


TOPIC : DEPRESSIVE NEUROSIS
COLLEGE: SRI VENKATESWARA INSTITUITE OF NURSING
SCIENCES

SUBMITTED TO SUBMITTED BY

ASSO.PROF.SIMI THOMAS MS PARVATHY SANTHOSH


HEAD OF THE DEPARTMENT MSC NURSING I YEAR
MENTAL HEALTH NURSING MENTAL HEALTH NURSING
THE OXFORD COLLEGE OF NURSING
SUBMITTED ON: 5-1-2011