Module 4 Discussing Treatment Making Recommendations

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Module Description and Content Goals:

Given topics on depression and treatment explanation to patients; texts that are varied and of a specialized and medical nature, which include information presented from dialogues and other sources (e.g. photographs, drawings, reference text /research information), the participant will use English with 70 % accuracy to:

1. Identify and pronounce correctly vocabulary related to depression and its treatment. (Vocabulary)2. Identify and use gerunds.(Grammar)3. Identify and use phrasal verbs and adjectives followed by prepositions. (Grammar, Speaking)4. Listen for main ideas and details. (Listening)5. Identify and use expressions to give advice. (Vocabulary, Speaking and Writing)6. Identify and use the modal verbs of advisability. (Grammar, Speaking, Writing)7. Make recommendations about lifestyle changes. (Speaking, Writing)8. Identify lay terms that are used for some common medical terms. (Vocabulary)9. Identify and describe various depression treatments. (Reading)10. Identify dysthymia, its signs, symptoms and treatments. (Reading)

Module 4 STUDENT HANDOUT H4:1

WORDS AND EXPRESSIONS TO KNOW:

A. The following words will be used in the dialogue you are about to hear. Read the words and make sure you understand all of them.

antidepressants urinary retention muscle spasms drowsy side effects blurred vision treatment chronic migraines tension headaches tremors weird

sacrificepain killers pain relievers attainable goals counselor confused fulfilling lifemagic cure

B. The following expressions will be used in the dialogue you are about to hear. Read them and then do the exercise that follows. After completing Exercise D, go back to B and write the meaning of the expressions in the chart.

Expressions: MeaningTo suffer from depressionWe could start you off with some antidepressant medication.Pills that will lift you up a bitI am not really good at (See D Grammar Note I and II)I have a lot on my plate as it is.To kill two birds with one stoneYour energy level will perk up.To be aware of side effectsTo watch out for side effectsIt may take up to 4 weeks before the medicine will kick in.If things are not settling down and you are not feeling your usual self within that time…To be in a better moodTo give up smoking, wine (or some other bad habit)I can’t remember off the top of my head.Pick up literature on the way outTo get rid of headachesYou will start feeling better in no time.Easier said than done.To be dependent upon drugsA happy camper

C. Complete the sentences from the conversation you are about to hear using the words andexpressions above:

1. This medication does have some _______________ ___________________ I want you ____________________

________. The pills will help you fall asleep, but they could leave you feeling ________________________ and confused in the

morning. You may also have ____________________ vision, dry mouth, _______________________ spasms and increased urinary

________________________.

2. I want you to know that it may take up to four weeks before the medicine ________________ ______ and your symptoms start

to improve.

3. I expect you to start feeling better sooner, but if things are not ______________________ ____________ and you’re not

feeling your ________________ ___________ within that time, you should call the office and schedule another appointment.

4. Unfortunately, there is no ____________________ ______________ for this condition.

5. Will you be able to ________________ your wine _________ at night?

6. Hopefully, once you’re in a better ________________ and your sleep patterns improve, you will start feeling better in all aspects

of your life: your energy level will _________________ _______, you’ll be able to concentrate better, you will be more productive

and enjoy a happier, more fulfilling life again.

7. Based on what you‘re telling me and on the questionnaire I gave you, I think you’re _____________________ ____________

depression.

8. I am not really _____________ ______ taking pills, doctor. I am very busy and have a lot on _______ ______________ as it is.

I won’t remember to take them.

9. We could _______________ you ______ with some antidepressant medication, you know, pills that will ______________ you

__________ a bit.

10. I think these are all the major side effects, at least the ones that I can remember ________ __________________ of my head.

11. I often take painkillers to ____________ ____________ _____ my headaches.

12. I like the second option a lot, and in combination with the pills, you will start feeling better ______ ________ _____________.

13. The counselor could help you deal with your feelings in a constructive way, and hopefully very soon you won’t be

________________________ ____________ the drugs. You will be a ___________________ ______________________ again,

the Ms. Sandler I’ve always known!

D. GRAMMAR NOTE I: GerundsA gerund is the –ing form of a verb. E.g. working, being, seeingIt can be used as a noun and, thus, as a subject or an object in a sentence.

E.g. I enjoy helping people. (object of the verb enjoy ) I like working at the hospital. (object of the verb work) Doing medical research can be really rewarding because it can help save people’s life. (subject) I am interested in becoming a nurse. (object of a preposition in).

GRAMMAR NOTE II: to be good at

Gerunds or nouns are used after the preposition in the expression to be good at to be good at + Gerund (verb+ing) to be good at + Noun

E.g. I am not good at taking pills. I am good at Math. I am very good at taking care of the sick people. Remember that at is the only preposition that can be used in this expression.

Write three things you are good at and three things you are not good at in the following chart. Then tell your partner about your abilities.

Things I am good at Things I am not good at

1. 1.

2. 2.

3. 3.

GRAMMAR NOTE III: Phrasal Verbs

Such expressions as to pick up, to give up and to kick in are called phrasal verbs. Phrasal verbs are frequently used in informal, non-technical speech. Such words consist of a verb and a particle (a small word such as up, off, in, etc.) that together have a special meaning. E.g. give up something means “abandon, quit”, put up with something or somebody means “to tolerate, to accept a bad situation or person without complaining”.

Phrasal verbs can be separable and inseparable.

If a phrasal verb is inseparable, the particle has only one position in the sentence. It immediately follows the verb. E.g. I am suffering from migraines. Watch out for the side effects when you take antidepressants. I don’t feel good today. I think I am coming down with cold. Separable phrasal verbs can be separated by a noun or a pronoun. If a pronoun is used, it must separate the parts of the verb (come between the verb and the particle). A noun can either follow the particle or come between the verb and the particle. E.g.

I can’t give up this habit. I can’t give it up.I can’t give this habit up. I can’t give up it. – INCORRECT.

You are about to hear a dialogue which has a lot of phrasal verbs. Pay attention to how these structures are used. While listening to this conversation, pay attention to the phrasal verbs used in it. Write them here. The first one ha been done for you.

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Modules 4 STUDENT HANDOUT H4:2

LISTENING:

A. Listening for Main Ideas. Dr. Howell is explaining to Ms. Sandler her condition and treatment. Listen to their conversation and answer the following questions:

1. What two treatment options does Dr. Howell suggest?

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2. Why doesn’t Ms. Sandler like the first option?

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3. Why does the physician say that by taking Elavil they will kill two birds with one stone?

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4. What side effects should Ms. Sandler watch out for taking Elavil?

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5. Why does Dr. Howell encourage his client to be patient?

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6. Why won’t the second option be as easy as the first one?

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B. Listen to the conversation again. Some of the words are missing. During each pause, fill in the blanks with the words or phrases from the list.

fall asleep easier said than done fulfilling spasms confused increased side effectssuffer from antidepressant lift you up good at on my plate 25mg perk uprestless settling down kicks in weird optimistic productive retention

magic cure off the top of my head chronic tension pain killers give up sacrificein no time pain relievers stressors counselor happy camper tremors be aware of

Dr. Howell: Well, Ms. Sandler, based on what you‘re telling me and based on the questionnaire I gave you, I think you’re

____________________ ________ depression. There are a couple of options we can use here. We could start you

off with some ____________________________ pills, you know, pills that will ____________________________ a bit.

Ms. Sandler: I am not really ____________________ taking pills, doctor. I am very busy and have a lot ______________

as it is. I won’t remember to take them.

Dr. Howell: Well, you won’t have to take too many pills throughout the day. There will be only two tablets, ___________

each. You will take one in the morning and one at night – at breakfast and before you go to bed, so it shouldn’t be

difficult. You want to get better, right? These pills may actually make you less forgetful and may help you organize your

life. They will also help you ____________________________. So, in reality we’re killing two birds with one stone here.

Ms. Sandler: Twice a day is not that bad I guess. I think I can do that.

Dr. Howell: Good. Hopefully, once you’re in a better mood and your sleep patterns improve, you will start feeling better

in all aspects of your life: your energy level will ______________________, you’ll be able to concentrate better, you will

be more __________________________ and enjoy a happier, more ______________________ life again.

Ms. Sandler: What kind of pills are you talking about? Are there any _______________________ I should watch out for?

Dr. Howell: That’s an excellent question, Ms. Sandler. The medication is called Elavil. Yes, it does have some side effects

that I want you to ___________________________. The pills will help you fall asleep, but they could leave you feeling

drowsy and _____________________ in the morning. You may also have blurred vision, dry mouth, muscle __________

and ________________________ urinary retention.

Ms. Sandler: Muscle spasms and urinary retention? I am not sure I know what you are talking about.

Dr. Howell: Well, muscle spasms or ______________________ are when you have ________________________ muscle

movements in your eyes, tongue, jaw or neck, uncontrollable shaking, you know. Urinary ______________________ is

inability to empty your bladder completely. These are the most common side effects, but it doesn’t mean you will

develop all of them. I want you to call the office if you have any strange or __________________ symptoms.

Ms. Sandler: And how long would you like me to take this medication?

Dr. Howell: I want you to know that it may take up to 4 weeks before this medicine _____________________ and your

symptoms start to improve. I expect you to start feeling better sooner, but if things are not ________________________

and you are not feeling your usual self within that time, you should call the office and schedule another appointment.

Ms. Sandler: Four weeks is a long time. Well, I guess it took me a while to get so bad, it will take some time to get better

now.

Dr. Howell: Yes, Ms. Sandler. Unfortunately, there is no ____________________________ for this condition. You have

to be patient. I do believe you will see changes a lot sooner. Let’s be __________________________ here. Another

important thing I need to tell you about is alcohol. I know that you like to have a little wine before you go to bed, but I

am afraid you won’t be able to do it any longer. It can cause dangerous side effects when taken together with Elavil. Will

you be able to _________________ your wine ________________ at night?

Ms. Sandler: Well, I was only having a little wine at night because I thought it would help me sleep better. If the pill does

the job, I won’t need the wine. I don’t have to have it, so it’s not a ____________________________.

Dr. Howell: Great. That’s good to hear. I think these are all the major side effects, at least the ones that I can remember

_____________________________________… You can read about the rest if you pick up the literature from the nurse’s

station on the way out. The nurse will also give you some Elavil samples so you could start the treatment. That’s about

all I wanted to tell you about this drug. Do you have any questions?

Ms. Sandler: Yes, Dr. Howell. I often take ________________________________ to get rid of my headaches. Will it be

OK to take both of these pills together?

Dr. Howell: That’s another great question. I have one more wonderful thing about this drug to share. Elavil is known to

treat _____________________ migraines and ______________________ headaches, so you may not need to take any

________________________________ after all. Let’s see how you will do with this treatment.

Ms. Sandler: You’ve mentioned at the beginning that we have two options treating my condition. I know the first one,

but what’s the second option?

Dr. Howell: Yes, there is another way to treat your problem that I wanted to talk to you about. It won’t be as easy and

simple as taking a pill; it does require some work. However, I like the second option a lot, and in combination with the

medication, you will start feeling better ______________________________.

Ms. Sandler: How much work are you talking about?

Dr. Howell: There are a few things about your lifestyle we should address. You could really help yourself if you change

the way you think, eat and react to the _____________________________ in your life.

Ms. Sandler: If I could do that, I wouldn’t have gotten here in the first place.

Dr. Howell: I know … __________________________________________. How would you feel about seeing a

________________________________? He could help you deal with your feelings in a constructive way, and hopefully

very soon you won’t be dependent upon the drugs. You will be a _____________________________________ again,

the Ms. Sandler I’ve always known!

Compare your notes with a partner. Listen to the conversation again. During each pause, repeat the phrase or

sentence you just heard. Then read the dialogue with your partner using proper pronunciation and intonation.

Module 4 STUDENT HANDOUT H4:3

SPEAKING and WRITING: Making Recommendations

A. Use the following expressions to give advice:

1. You should/You ought to + VERB 10. Have you thought about + GERUND/NOUN

2. You had better + VERB 11. How about + GERUND/NOUN

3. Try to + VERB 12. What about + GERUND/NOUN

4. I recommend you to + VERB

5. I advise you to + VERB

6. Maybe you could + VERB

7. Why don’t you + VERB

8. One thing you could do is + VERB

9. It might be a good idea to + VERB

B. Grammar Note: Modals of advisability SHOULD/OUGHT TO/HAD BETTER

SHOULD/OUGHT TO/HAD BETTER have basically the same meaning. They mean: “This is a good idea. This is a good

advice.”

Affirmative forms: SHOULD + Verb (Notice: no “to”)

OUGHT TO + Verb

HAD BETTER +Verb

HAD BETTER usually implies a warning about possible bad consequences and it is usually contracted in speaking.

E.g. I don’t feel good today. I think I am coming down with something. – You’d better call in sick and stay home. (If

you don’t, you will get worse and infect the whole office).

Negative forms: SHOULDN’T + Verb

HAD BETTER NOT + Verb

OUGHT TO is usually not used in the negative.

E.g. You shouldn’t make any major decisions until the depression is lifted.

You’d better not use sugar for coffee or tea if you have diabetes.

C. Ms. Sandler is going to see a counselor, Mr. Briggs. The following are the lifestyle changes the counselor is

going to recommend to the depressed patient:

1. Reduce stress by getting adequate sleep, rest and recreation.

2. Eat a well-balanced healthy diet that is low in fat, high in fiber and rich in vitamins and minerals.

3. Avoid being alone too much. Share your feelings with family members and friends.

4. Change your negative thinking to positive. For instance, use the word “stop” when your thinking is negative or

make a list of five positive things about yourself.

5. Take up a new hobby or engage in a new activity.

6. Try to get a regular physical exercise.

7. Set goals that are attainable. List things that need to be done. Break large ones into smaller ones and set

priorities.

8. Be patient with yourself. Don’t expect to get well overnight.

9. Be kind to yourself. Respect who you are.

10. Increase social and spiritual support.

11. Postpone making any major life decisions until the depression is lifted.

D. Choose six most important recommendations and make sentences using the expressions of

advice. Expand each recommendation by explaining what you mean and providing examples. Try to use as

many expressions of advice as you can. Follow the example:

E.g. 1. You should avoid being alone so much. One thing you could do is telephone one friend or family member a

day to discuss how your day has been and other social things. How about going out for dinner with your son or your

friends rather than eating some fast food that you pick up on the way home from work?

2. In order not to be overwhelmed during the day, I advise you to list things that need to be done. Then you

could break them down into smaller ones and set the priorities.

1. ___________________________________________________________________________________________

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2. ___________________________________________________________________________________________

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3. ___________________________________________________________________________________________

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4. ___________________________________________________________________________________________

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5. ___________________________________________________________________________________________

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6. ___________________________________________________________________________________________

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E. Role-play the dialogue between Ms. Sandler and the counselor. Use the recommendations listed above. Use

the expressions of giving advice.

Module 4 STUDENT HANDOUT H4:4

COMMUNICATION TIP: Most patients do not have medical knowledge. Explanations should be given in language the patient will understand, avoiding medical jargon. Using lay terms – words familiar to people without medical knowledge – can help patients understand explanations. Here is the list of common lay terms for conditions, medications and parts of the body.

A. Listen to these words and then repeat them.

Medical Term Lay Termhypertension high blood pressureinsomnia trouble with sleepingantidepressants medication to improve your mooddiuretics water pillsoral contraceptives birth control pillsbenign not due to cancer or infectionmalignant due to cancermyocardial infarction heart attack cerebrovascular accident strokefractured neck of femur broken hiparrhythmia palpitations; abnormal heart rhythmdysarthria slurred speechdyslexia difficulty in using and comprehending written languagedismenorrhea difficult or painful monthly flow (menses or menstruation)dyspareunia painful intercoursedyspepsia difficulty in digestion, indigestiondysphagia difficulty swallowingdysphasia impairment of speech caused by a brain lesiondyspnea difficult or uncomfortable breathingdysthymia a less severe type of depression that involves long-term,

chronic symptoms that do not disable but keep an individual from functioning well or feeling good.

dystrophy faulty muscular development caused by lack of nourishment

dysuria difficult or painful urinationhyperglycemia conditions of excessive blood sugar in the bloodhypoglycemia conditions of deficient blood sugar in the bloodpolydipsia excessive thirstpolyphagia extreme hungerpolyuria frequent urinationumbilicus belly button, navelpatella kneecapmandible jawthorax chest abdomen belly, tummy

nocturia excessive urination during nighthematuria presence of blood in the urinehematemesis vomiting of bloodangina chest pain

B. Match the medical terms with the ordinary English words. The first one is done for you.

1. Dyspnea _____ a. stroke

2. Patella _____ b. a less severe type of depression

3. Nocturia _____ c. high blood pressure

4. Hypoglycemia _____ d. tummy

5. Myocardial infraction _____ e. jaw

6. Diuretics _____ f. not due to cancer or infection

7. Polydipsia _____ g. painful menses

8. Umbilicus _____ h. excessive hunger

9. Dyspepsia _____ i. kneecap

10. Benign _____ j. heart attack

11. Polyphagia _____ k. low blood sugar

12. Abdomen _____ l. water pills

13. Dysmenorrhea _____ m. excessive thirst

14. Cerebrovascular accident _____ n. excessive urination at night

15. Dysthymia _____ o. indigestion

16. Hypertension _____ p. belly button

17. Mandible _____ q. difficult breathing

Module 4 STUDENT HANDOUT H4:5

READING: Read the text about various treatments available for depression and then answer the questions that follow.

Treatments for Depression

Depression's forms and symptoms vary from person to person, and so does its treatment. What works for one person may not work for another. Clinical depression is highly treatable and more than 80 percent of people who are treated show improvement.

Carl Purcell/Three Lion/Getty Images

Electroconvulsive therapy is often misunderstood. This patient was treated at Hillside Mental Hospital circa 1955.

Effective and common treatments for major and chronic depression are antidepressant medications to relieve symptoms and psychotherapy to learn effective coping methods, or a combination of the two.

Antidepressant medications help to normalize levels of mood-regulating chemicals in the brain, specifically neurotransmitters called serotonin, norepinephrine and dopamine.

The newest types of antidepressants are selective serotonin reuptake inhibitors (SSRIs), known commercially as Prozac, Paxil and Zoloft, among others. Also commonly prescribed are serotonin and norepinephrine reuptake inhibitors (SNRIs), known to us as Effexor and Cymbalta. SSRIs and SNRIs generally have fewer side effects than the more established tricyclics and monoamine oxidase inhibitors (MAOIs), which are known to have food and drug interactions.

One type of antidepressant may work better than another from person to person, and doctors encourage patients to try different forms until the right one is found.

Antidepressants are taken regularly for at least four weeks (in some cases eight weeks) before improvement is noticed, and it usually takes six to 12 months for complete therapeutic effect. In cases of severe or chronic depression, long-term treatment may be needed.

Psychotherapy is typically used in conjunction with medication, although for mild cases of depression, it may be best used solo. In psychotherapy, also known also as talk therapy, people speak with a mental health professional about ways to deal with their depression and symptoms, thoughts of suicide and other problems. There are two main types of psychotherapy: cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT). CBT teaches people new ways of thinking and behaving, whereas IBT helps people understand and work on personal relationships that may be contributing to their depression.

One of the most misunderstood therapies used to treat severe depression is Electroconvulsive Therapy (ECT). ECT is used when medications and psychotherapy are not effective, usually in suicidal patients, patients who experience treatment-resistant depression or patients who suffer from depression and mania. Formerly known as shock therapy, ECT has improved since the 1940s and 1950s when stories of misuse and controversy were in the media. During treatment, a patient is given a muscle relaxant and anesthesia. Electrodes are affixed at specific placements on the head and are used to deliver electrical impulses of about 30 seconds, causing a seizure within the brain. ECT is usually given three times per week for several sessions.

For people looking for more natural remedies, St. John's Wort and other alternatives such as acupuncture, herbal remedies, biofeedback, massage and yoga have been gaining increased attention in the last several years. In recent scientific studies, St. John's Wort proved effective for mild depression, but acted no better than a placebo when treating major depression.

Exercise and Mental HealthWe all know that exercise will help keep us healthy. It keeps blood pressure low and diabetes and other diseases at bay. Did you know that it can also help improve symptoms of depression and other mood disorders?

By incorporating 30 minutes of physical activity into your day, three to five days a week, you can improve your mood and reduce anxiety. While it's not a cure, research suggests that exercise raises levels of mood-enhancing neurotransmitters in the brain, releases endorphins and reduces levels of the stress hormone, cortisol.

Source: National Institute of Mental Health at http://health.howstuffworks.com/depression.htm ,Colenso, Maria. "How Depression Works." 12 May 2008.

1. Name the three mood-regulating chemicals in the brain.

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2. Name the four types of antidepressants. Which ones have fewer side effects?

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3. What is psychotherapy? Name the two types of psychotherapy.

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4. What is the difference between cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT)?

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5. When is Electroconvulsive Therapy used and why is it misunderstood?

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6. Why can exercise improve your mood and reduce anxiety?

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Photo compliments of Microsoft clipart

Module 4 STUDENT HANDOUT H4:6

READING: Read the text about dysthymia, a milder form of depression, and answer the questions that follow.

Dysthymia

Dysthymia (the Greek roots of the word mean “bad state of mind” or “ill humor”) is a disorder with similar but longer-lasting and milder symptoms than clinical depression. By the standard psychiatric definition, this disorder lasts for at least two years, but is less disabling than major depression; for example, victims are usually able to go on working and do not need to be hospitalized.

About three percent of the population will suffer from dysthymia at some time - a rate slightly lower than the rate of major depression. Like major depression, dysthymia occurs twice as often in women as it does in men. It is also more common among the poor and the unmarried. The symptoms usually appear in adolescence or young adulthood but in some cases do not emerge until middle age.

The warning signs of dysthymia are: poor school/work performance; social withdrawal; shyness; irritable hostility conflicts with family and friends; physiological abnormalities; sleep irregularities; parents with major depression.At least three-quarters of people with dysthymia have some other psychiatric or medical disorder as well.

Dysthymia can be controlled by therapy and medications. Psychotherapy or cognitive therapy (also known as “talk therapy”) is used to alter people’s self-defeating thoughts. Behavioral therapy may help people learn how to act in a more “positive approach” to life and to communicate better with friends, family, and co-workers. Tricyclic antidepressants, the standard treatment for major depression, may be prescribed to treat dysthymia.

In many cases, the symptoms are hard to recognize and classify, and the response to treatment is unpredictable. Most people with dysthymia see only their family doctor, who may misdiagnose them, especially if the main complaints are physical. Many people do not think of themselves as depressed, and are relieved to be told they have a treatable illness. Unfortunately, mental health professionals are usually consulted only when major depression develops, although

dysthymia alone may lead to alcoholism or suicide. Even when it is recognized, dysthymia is difficult to treat. The longer a depression lasts the slower the recovery.

Source: http://www.howstuffworks.com/framed.htm?parent=depression.htm&url=http://www.mentalhealthamerica.net/go/depression

1. What is dysthymia?

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2. How common is it?

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3. What are the warning signs of dysthymia?

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4. What are the treatments available for dysthymia?

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5. Why is dysthymia often misdiagnosed?

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