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CHAPTER I

• The nervous system

Lesson 1

• The brain
Lesson 2

• Neurological disorders
Lesson 3

• Self-evaluation (check appendix)

Lesson 4

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 The nervous system

Pre-reading activities:

1. Which of the following words do you think will occur in the text?

Myelin, axon, motor, sensory, fibre, embryo, impulse, conduction, central, reflex, vertebrate

2. Read the first sentence of the text and revise your decisions if necessary.

Reading passage:

1- Even the simplest animal – a protozoon (single-celled organism, plural protozoa) made of
a single cell – responds to stimulus (s.th that causes s.th. else to happen) by withdrawing
itself. In more advanced creatures some of the cells in the outer layer of the body are adapted
to receive stimuli and transmit them to other cells adapted for movement. Cells that transmit
impulses (small amount of energy that moves) to other cells are called nerve cells or
neurones. In all higher animals the neurones are gathered together to form an anatomical unit,
the nervous system, derived entirely from the outermost layer of the embryo (ectoderm),
which also forms the outer coat of the skin.

2- In the embryo of a vertebrate (such as man) the future neurones are gathered in the mid-line
of the surface of the back. This strip, running the length of the embryo, is first depressed to
form a groove (low area in a surface) and then submerged, as the tissues of the back close
over it, to form a tube. Later this neural tube is surrounded by the skull and vertebrae, to form
the brain and spinal cord, together making the central nervous system.

3- A neurone consists of a cell-body with several thread-like projections or processes. There

are generally several branched processes, dendrites (protoplasmic process that conduct
impulses toward the body of a neuron), and a single long process, the axon, which is the
main conducting fibre. An axon may be very long – extending, for instance, from a cell-body
in the spinal cord at the small of the back to a muscle in the foot. Similarly, sensory processes
extend from the periphery to their parent cells in the nerve roots. The nerves of the body are
simply bundles of conducting fibres, each with its parent cell in the central nervous system.
Each fibre has a coat of myelin, a fatty insulating substance. The myelin sheath (protective
covering) accelerates conduction and is essential to repair if the fibre is damaged. Fibres
within the central nervous system have rudimentary (not very developed, simple or basic)
myelin sheaths and no power of healing.

4- Twelve pairs of cranial nerves spring from the under surface of the brain and 31 pairs of
spinal nerves from the spinal cord. Their parent cells are only the outer links of complex
chains of neurones within the central nervous system. A group of muscle cells is activated by
a single motor neurone in the spinal cord, but this neurone may receive impulses through its
dendrites from hundreds of other neurones, of which some stimulate and other inhibit. Only a
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few of these, in the upper part of the brain, are involved in conscious activities or sensation.
The rest operate reflex actions.
From: Peter Wingate, The Penguin Medical Encyclopaedia, 1976.

Reading comprehension questions

1. Are the following statements true or false? Justify from the text.

(a) Neurones transmit impulses to other cells. (true) L. 4

(b) Processes are of two types. (true) L. 2 parag. 3

(c) Twelve cranial nerves spring from the brain. (false) L.1 parag. 4

(d) Dendrites are the main conducting fibres. (false) L.

2. Replace the underlined words below with expressions from the passage:
(a) The nervous system is made up of ( consists of) the central nervous system and the peripheral
nervous system.

(b) There are hundreds of nerves whose fibres convey (transmit) messages to and from all parts of the
body.

(c) In higher animals (advanced creatures) some of the cells in the outside layer (outer) of the body
receive stimuli and relay (transmit) them to and from all parts of the body.

(d) A neurone consists of (is made up of) a cell-body with several thread-like projections (processes).

(e) There are several branched processes (dendrites) and a single long process (axon).

3. Write sentences like (a) in the previous activity using the expressions make up / is
made up of, consists of, is composed of and the following cues.

(a) the central nervous system (b) a protozoon (c) neurones (d) the ectoderm

4. Make six pairs of words having a similar meaning from the following list:

Simple, several, convey, form, animal, creature, chain, comprise, various, rudimentary, conduct
simple = rudimentary / several = various / form = comprise/ convey = conduct / animal = creature
/ links = chain

5. Use the words from the previous activity to fill in the blanks:

(a) Electrical nerve impulses in the cells of the retina are conveyed to “relay sensations” in the brain.

(b) The sensory fibres carry impulses from various types of sensory receptors to the spinal cord.

(c) Fibres within the CNS have rudimentary myelin sheaths.

(d) The parent cells of the cranial nerves are only the outer links of complex chains of neurones.

6. Label the diagram using information from the text as well as your own knowledge:

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Vocabulary practice

I. Match the following terms with their meanings or associated terms below:

plexus - convulsions– astrocyte- afferent nerves- efferent nerves- meninges

1. A large, interlacing network of nerves. plexus

2. Neurological cell that transports water and salts between capillaries and nerve cells. astrocyte

3. A type of seizure consisting of a series of involuntary contractions of the voluntary muscles.

convulsions

4. Motor nerves that carry messages away from the brain and spinal cord to muscles and glands.
efferent nerves

5. Sensory nerves that carry messages towards the brain and spinal cord from receptors. afferent
nerves

6. Three protective membranes surrounding the brain and the spinal cord. meninges

Listening

I. Listen to a conversation between a professor and a medical student. Choose the

correct answers.

1. What is the conversation mainly about?

a) The types and functions of the synapses x

b) Common nervous system ailments
c) Ways to test neuron performance
d) How the nervous system grows

2. What does the woman fail to answer correctly?

a) How synapses transfer information

b) The number of synapses in the average brain x
c) What the connections between neurons are called
d) The different kinds of synapses

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II. Listen again and complete the conversation:

Professor: Very good. And what 1. Types of signals do synapses send?

Student: They send 2.chemical or electrical signals to another cell.

Professor: Right again. So tell me, about how many synapses are there in the 3.average brain?

Student: Hmm… 4.that’s a tough one. I would guess about 100 billion.

Professor: Not quite. 5. It’s actually many times that- 100 to 500 trillion.

Student: Wow, that’s a lot of synapses!

Professor: Indeed. All that 6. Information exchange is what makes the brain so powerful.

The brain
Reading passage:
1- The largest of the five subdivisions of the brain is the cerebrum. This consists of two egg-shaped
hemispheres, partially separated in the middle, known as the right and left cerebral hemispheres. They
make up the bulk of the brain. The surface of the cerebral hemispheres is known as the cerebral cortex,
and consists of up to six layers of nerve cells. The right cerebral cortex exercises control on the left
side of the face and body, and the left cerebral cortex exercises control on the right side of the face and
body, but both of the cerebral cortices are aware of what each is doing, by means of interconnecting
fibres across the midline.

2- The frontal lobes of the cerebrum contain the nerve cells which control all power of movement in
the body muscles. At the front is the great silent area or “seat of the mind” which houses memory,
intellect and emotion, and applies all of these to determine the attitude and conduct of the individual in
a given situation.

3- At the lower end of the frontal lobes is the area known as Broca’s area, which governs the
mechanisms of speech by control of the vocal folds, lips and tongue. The speech area is better
developed on the left frontal lobe, especially in right-handed persons.

4- The parietal lobe lies just behind the frontal lobe. It receives feeling and sensation messages from
the opposite side of the face and body. The sensations by which people become aware of external
surroundings – touch, pain, temperature, pressure –are analysed and compared in the postcentral gyrus
of the parietal lobe.

5- Since the sensory system is principally designed to warn against external danger, however, the
sensation messages are decoded lower down in the brain system at the thalamus which lies just above
the midbrain.

6- At the rear of the cerebrum, behind the parietal lobe, lies the occipital lobe. The two occipital lobes
are connected to the optic nerves which emerge from the light sensitive areas at the back of the eyes.

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These lobes therefore receive all visual images observed by the eyes, and correlate and interpret the
information so received.

7- Below the frontal and parietal lobes of the cerebrum lie the temporal lobes, one in each hemisphere.
The temporal lobe receives information about hearing sensations from the inner ear of the brain. It
interprets the pitch and intensity of sounds, analyses the nature of sounds, and compares and contrasts
them with past experience.

Reading comprehension questions

1. Make complete sentences by matching the information in column A with that in column B.

1. the temporal lobe Lie(s) (a) just above the midbrain

2. the occipital lobe (b) at the lower end of the frontal lobes
3. the thalamus (c) below the frontal and parietal lobes
4. the parietal lobe (d) at the front of the frontal lobe
5. Broca’s area (e) just behind the frontal lobe
6. the silent area (f) at the rear of the cerebrum, behind the parietal lobe

2. Complete the chart below by ticking the appropriate box.

Frontal Parietal Occipital Temporal

1. pain
2. movement of muscles
3. hearing
4. attitude
5. vocal cords
6. balance
7. conduct
8. visual images
9. feelings / sensations

3. Make 11 pairs of opposites from the following box

Below, low, inner, compare, front, local, together, intellect, above, contrast, separately, send,
general, behind, high, back, receive, completely, feeling, partially, in front of, outer
___________________________________________________________________________

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4. Label these diagrams using words from the text and your own knowledge

Follow up activity

Use your knowledge of brain anatomy and the functions of different parts of the nervous
system to locate what area that is damaged based on behavioural symptoms.

1) Since your grandfather’s stroke he no longer pays attention to the left side of his world.
He ignores people and objects on his left as well as the left side of his body. He doesn’t
comb the left half of his hair, shave the left side of his face, or put his left arm in the
sleeve of his shirt.
2) Since suffering brain damage, this patient speaks with great difficulty, only getting out
a word or two at a time.
3) A person is accidentally shot in the head behind the ear. The bullet enters the brain.
Breathing and heart beat stop almost immediately. Where is the bullet?
4) Playing football this fall, Jose received an exceptionally hard blow to the back of his
head and neck. Since then, he has been suffering from insomnia. Even sleeping pills
don't seem to work.
5) Following a head injury Bret can no longer plan, organize or follow through with tasks.
He no longer behaves appropriately in class and was eventually asked to leave school
after several emotional outbursts.
6) Stephanie has a brain tumor. The primary changes in her behaviour are a decrease in
her primitive auditory reflexes (she doesn’t react when a car's horn startles her) and a
decrease in her primitive visual reflexes (her eyes move more slowly to new visual
stimuli).

Classroom discussion:

Based on the “old school”, lesion-based, Wernicke-Geschwind Model of language

function, what parts of the brain will be active in each condition:

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a. See a blank screen
b. See words
c. Read words out loud
d. Generate nouns based on words seen

Now, to check your predictions, watch carefully the video entitled “Language processing
in the Brain”, which depicts the early use of positron emission tomography (PET) to
study cognitive functions in the human brain.
http://www.learner.org/vod/vod_window.html?pid=1615
___________________________________________________________________________
___________________________________________________________________________

Writing

1. Read the following case report. Notice particularly the order in which the data are
presented.

A 43-year-old man had headaches that usually started with a feeling of blood rushing to the
right eye quickly followed by severe pain. The headache usually lasted 20 minutes to two
hours and, if excruciating, was vomiting. Diurnal or nocturnal attacks have occurred about
twice each day for four to eight weeks every year since 2013. Personal and family histories
were non-contributory. Findings from general examination, EEG, skull X-ray film, and
nuclide brain scan were unremarkable.

__________________________________________________________________________________

__________________________________________________________________________________

2. Write out the following case report, placing the data in the correct order.

As a rule, when the headaches reached peak intensity, the patient would notice paresthesias of
the right hand and foot that would last for about three minutes. They occurred three times per
week for about two months every year and were always located around the left eye. Findings
from general examination and routine laboratory tests, skull X-ray film, and nuclide brain
scan showed no abnormalities. The headaches lasted 20 to 45 minutes and were usually
accompanied by nasal congestion and lacrimation on the left. A 44-year-old man had severe
headaches since 2005. No family history of migraine was found.

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

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3. Write a case report from the following notes:

 Male, 49/ severe headaches since 2016.

 2*/wk about 4 mos every year/around left eye
 Duration 30 min.
 Generally when excruciating, patient noticed paresthesias r; hand and foot for about 2
min.
 Migraine runs in the family
 Gen exam, lab tests, skull X-ray, nuclide brain scan = normal.

Neurological disorders
PREREADING:
Put the words between parentheses in the right form:
Epilepsy has been defined as “a disorder of the brain characterized by an enduring 1. (dispose)
_______________ to generate epileptic seizures, and by the neurobiological, 2.(cognate)
___________ , psychological and social consequences of this condition. The definition of epilepsy
requires the 3. (occur)____________ of at least one epileptic seizure”. An epileptic seizure is defined
as “a 4. (transience)____________ occurrence of signs and/or symptoms due to abnormal
5.(excess)_____________ or synchronous neuronal activity in the brain”.
Reading passage: read the text and answer the questions:

1-Epileptic conditions are multifactorial functioning brain is capable of having a

disorders, and it is useful to discuss three seizure; however, seizures occur more easily in
important factors. The first factor is some people than in others. The ease with
predisposition, or threshold. Anyone with a which a seizure can be provoked is referred to

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as a threshold. Individual differences in
threshold are largely attributable to genetic
variations but could also be acquired, such as
certain types of perinatal injuries, which can
alter threshold.
2-The second important factor for epilepsy is
the epileptogenic abnormality itself. Epilepsies
attributable to identifiable brain defects are
referred to as symptomatic epilepsies.
Symptomatic epilepsies can be caused by a
variety of disorders, including brain
malformations, infections, vascular
disturbances, neoplasms, scars from trauma,
including strokes, and disorders of cerebral
metabolism. Treatment for symptomatic
epilepsy is most effective if it is directed at the
underlying cause. Some forms of epilepsy are
unassociated with identifiable structural lesions
or diseases and are usually unassociated with
other neurological or mental deficits. These are
genetically transmitted, generally easily treated
with medications without sequelae, and
referred to as idiopathic epilepsies.
3-The third important factor is the precipitating
condition, which determines when seizures
occur. Common precipitating factors include
fever for children with febrile seizures, alcohol
and sedative drug withdrawal, sleep
1. Fill in the blanks with information from the text:
deprivation, stimulant drugs and — in some
patients — stress. Reflex seizures are
precipitated by specific sensory stimuli. The
most common are photosensitive seizures
induced by flickering light, but in most patients
specific precipitating factors are not apparent,
and may not exist at all.
4- There are a number of idiopathic epilepsy
syndromes characterized by onset at a certain
age, and specific seizure types. Those that
begin in infancy and childhood, such as benign
familial neonatal seizures, benign childhood
epilepsy with centrotemporal spikes, and
childhood absence epilepsy, usually remit
spontaneously, while those that begin in
adolescence, the juvenile idiopathic epilepsies,
are often lifelong. Most of these are easily
treated with antiepileptic drugs (AEDs).
5-The goal of treatment should be the
maintenance of a normal lifestyle, preferably
free of seizures and with minimal side-effects
of the medication. Up to 70% of people with
epilepsy could become seizure free with AED
treatment. In 25–30% of people with epilepsy
the seizures cannot be controlled with drugs.
Epilepsy surgery is a safe and effective
alternative treatment in selected cases.

Factors related to epilepsy Cause(s) or origin(s)

1. predisposition ______________________
2. the epileptogenic ______________________
abnormality
3.______________________ ______________________

2. Fill in with information from the text:

 Epileptic conditions are multifactorial disorders: the most 3 important ones are
__________________, ____________________ and ___________________.
 There are a number of idiopathic epilepsy syndromes: (a) __________________, (b),
___________________ and (c)__________________.

3. Are the following statements true or false? Justify your answer from the text

(a) Effective treatment deletes epileptic seizures. __________________________________________

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(b) Epilepsy is only genetic. ___________________________________________________________

(c) The juvenile idiopathic epilepsies usually remit spontaneously._____________________________

4. Find words in the text closest in meaning to:

(a) Change §1 ________________ (b) original §2 _________________ (c) clear §3 ______________

Language practice:

I. Put the words between parentheses in the right form then write what the following
abbreviations stand for:

There are many causes of dementia. Alzheimer’s disease (AD) is the most common,
1.(account)__________ for one half to three quarters of all cases. Vascular dementia (VaD) is
diagnosed when the brain’s supply of oxygenated blood is 2.(repeat) _________ disrupted by strokes
or other blood vessel pathology, leading to a 3.(signify) ___________ damage to brain tissue and
function. Perhaps vascular damage is no more than an 4.(accelerate) __________ factor for the onset
of clinically significant symptoms in people with AD. The main risk factor for most forms of dementia
is advanced age, with 5.(prevalent) __________ roughly doubling every five years over the age of 65.
There are a few rare causes of dementia that may be treated effectively by medical or
6.(surgery)__________ intervention. For the most part, altering the progressive course of the disorder
is unfortunately not possible. 7.(Symptom)______________ treatments and support can, however,
transform the outcome for people with dementia and their caregivers. For carers and, arguably, for
people with dementia, it is the 8.(behave) ____________ and psychological symptoms of dementia
(BPSD) that are most important. Behavioural problems may include agitation, aggression, calling out
repeatedly and sleep 9.(disturb) __________ (day–night reversal). They are a common reason for
10.(institution) _____________ as the family’s coping reserves become exhausted.

(AD)____________________(VaD)_____________________(BPSD)________________________

II. Put the words between parentheses into the right tense and/or form:

Multiple sclerosis (MS) is an inflammatory demyelinating condition of the central nervous system
(CNS) that 1. (generally/ consider)_______________ to be autoimmune in nature. In people with
MS, the immune trigger is unknown, but the targets 2. (be) ___________myelinated CNS tracts. In
regions of inflammation, breakdown of the blood–brain barrier occurs and 3. (destroy)___________
of myelin ensues, with axonal damage, gliosis and the formation of sclerotic plaques. Plaques (MS
lesions) may form in the CNS white (or grey) matter in any location thus, clinical presentations may
be diverse. Continuing lesion formation in MS often leads to physical 4. (able) _____________and
cognitive decline. Uncertainty over the cause or development of MS implies that prevention is not
currently a realistic option. Furthermore, there are no 5. (cure)___________ treatments available for
MS. A number of disease modifying drugs 6. (develop) ______________ in the past 20 years,
however, which reduce the number of attacks in the relapsing/remitting form of the disease. Although
these drugs 7. (introduce)________________ in the developing regions, their high cost means many
patients are unable to have access to them.

III. Fill in the blanks with the correct prefix or suffix.

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 1. An epileptic seizure is an ___ controlled chaotic electrical activity in the brain. It alters
conscious______ and may bring on ____ voluntary movements. Epilepsy may be the result of
chemical ____balance but more often the cause is ____known.

2. In a grand mal epileptic seizure, the victim falls to the ground ___ conscious and makes twitching
movements which may last for several minutes. In a petit mal seizure, the victim may be ___ aware of
things around him for up to thirty seconds but rarely loses conscious_____.

3. In temporal lobe epilepsy, a seizure may result in the victim having ____ rational feelings of anger
or fear.

4. Parkinson's disease is a ____ generative condition of the brain causing weakness and stiff______
of the muscle.

5. People with dementia lose their memory of recent events and become ______ interested in their
appearance. In the later stages of dementia, patients may become _____ continent.

6. Some drugs can slow the progress of Alzheimer's disease but it is _____curable.

Vocabulary practice

I. Match each condition with its definition:

1. Cerebral contusion A. transient, temporary (usually clearing within 24 hours)

dysfunction caused by mechanical force to the brain.
2. Cerebral concussion

3. Cerebrovascular accident B.The sudden death of brain cells in a localized area due to inadequate
blood flow also known as a stroke.

C. Bruising of brain tissue as a result of direct trauma to the head;

neurological deficits persist longer than 24 hours.

II. Fill in the blanks with words from your own. The first letter is given to you.

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 Cerebrovascular accident: Also knwon as a s________ or
cerebral i__________, is the result of a localized area of
ischemia and ultimately infraction or n__________ in the
brain. there are 3 types:

2.Embolic: an
1. Thrombotic: caused by blood 3. Hemorrhagic: bursting forth
e________ (a clot that
c_______ in the arteries leading to the of blood from a cerebral
breaks of from an area
brain resulting in o__________. Before a__________. it is often
of the body) travels to
total blacking occurs, a patient may f_________ and results from
the cerebral arteries
experince symptoms (neurological advanced age, a____________,
and occludes a small
disfunctions) which are known as or high blood pressure, all of
v________. iI occurs
t__________i___________a_________. which result in d_________ of
very s_____________.
It is medically treated with cerebral blood vessels.
a_______________.

III. Match the following terms with their descriptions below. The terms in bold should
give you a clue to the pathological condition described.
Spina bifidia cystic – hydrocephalus – bell’s palsy – Huntington’s chorea- myasthenia gravis

(a)Disease characterized by quick involuntary movements, speech disturbances, and mental deteriora
tion due to degenerative changes in the cerebral cortex and basal ganglia.

(b) Cerebrospinal fluid accumulates in the head in this condition.

(c) Unilateral facial paralysis characterizes this condition.

(d) The spinal column is imperfectly joined (a split in a vertebra occurs), and part of the meninges
and spinal cord is herniated out of the spinal cavity in this congenital condition.

(e) This neuromuscular disorder is marked by loss of muscle strength because of the inability of a
neurotransmitter to transmit impulses from nerve cells to muscle cells.

IV. Give the meanings for the following abbreviations:

1. PET scan _______________________________________________________________________

2. MRI of the brain _________________________________________________________________

3. TIA ___________________________________________________________________________

4. CNS ___________________________________________________________________________

5. LP _____________________________________________________________________________

6. CVA ___________________________________________________________________________

7. EEG ____________________________________________________________________________

Listening

~ 15 ~
I. Listen to a conversation between a professor and a medical student. Choose the
correct answers.
1. What is the conversation mainly about?

a) Types of neurological disorders

b) Treatments for Alzheimer’s disease
c) Common neurological diagnosis errors
d) Differences between the central and peripheral nervous systems.

2. What can be caused by inner ear or nervous system problems?

a) Seizures
b) Paralysis
c) Vertigo
d) Alzheimer’s

II. Listen again and complete the conversation:

Doctor: 1. _______________ ________________ _____________ neurological disorders. What are

some signs of trouble in the nervous system?

Student: Well, I know that vertigo is a big sign.

Doctor: Hmm, that’s not always true, you know.

Student: I’m 2.____________ _______________ ______________ _____________ ____________.

Doctor: Let me explain. Vertigo can be an indicator of a problem with the brain. But it’s often
3.__________ ____________ ______________ inner ear problems.

Student: Oh, I see. So you’re thinking of something 4. ___________ ___________ ____________

____________ seizures or paralysis.

Doctor: Yes exactly. Those 5. ______________ _________ ____________ a problem with the
nervous system. But please explain what those are.

Student: Sure. 6. _____________ _____________ ____________ a patient loses the ability to move
muscles, and seizures result in uncontrolled muscle movement.

Translate into English

1) cette patiente souffre de sclérose en plaques depuis juillet. La gaine de myéline est endommagée, ce
qui entraine une paralysie progressive de ses membres.

2) Il était neurologue depuis 6 ans lorsqu’il a commence a se plaindre de pertes d’équilibre, de

conscience et de mémoire. S’il avait su, il aurait choisi gynécologie

__________________________________________________________________________________

__________________________________________________________________________________

Chapter 2: DERMATOLOGY

~ 16 ~
 • Structure and functions of the skin and the related
structures
Lesson1

• Pathological conditions of the skin

Lesson 2

The skin and its related accessories

~ 17 ~
Pre-reading: Before you read, talk about these questions:

 What are the different parts of the integument? What are the layers of the skin? What are the
main functions of the skin?

1- The integument provides the following functions: (1) physical protection from chemicals and
abrasives, (2) excretion (in the form of secretion of sweat and oils), (3) nutrition (synthesis of vitamin
D3), (4) thermoregulation, (5) reception of sensory information and, (6) it participates in immune
protection when the integument has been broken and exposed to microorganisms.

2- The integument consists of two parts, (i) the cutaneous membrane (the skin) and (ii) accessory
structures (hair follicles, nails, exocrine glands, ect.). The cutaneous membrane is composed of two
layers; the superficial (outer) a vascular layer is called the epidermis, while the deep (inner)
vascular layer is called the dermis.

3- The epidermis is formed from keratinized stratified squamous epithelial tissue. Keratin provides
weatherproofing for the skin and also provides part of the physical barrier that protects the underlying
tissue. The epidermis is continually renewed through division of cells found in the deepest stratum
(stratum germinativum {SG}). The SG also contains melanocytes. These cells manufacture the
pigment melanin, which gives skin its range of colors. The melanin also helps protect the skin against
UV radiation. The number of melanocytes varies little from person to person. Differences in skin color
are mainly due to the genetically predetermined amount of melanin produced by each person.

4- The deep layer of the skin, the dermis, is composed of connective tissue with an abundance of
collagen fibers and elastic fibers. The connective tissue of the dermis is very vascular and contains a
variety of nerve fibers (both sensory and motor). These nerve endings include, pain, light touch,
pressure, heat and cold receptors. Except for hairs and nails, which project above the surface of the
epidermis, the other accessory structures are located within the dermis.

5- The accessory structures of the integument (hair follicles and nails) grow in cycles. In many
animals, hair plays a part in thermoregulation, however, in humans the role of hair has been reduced to
mainly protecting the entrance to the nose from airborne debris and protecting the head from UV
radiation. Small muscles, located in the dermis, attach to hair follicles and when they contract they can
change the position of the hair. These muscles are called arrector pili muscles, which are supplied by
motor nerve fibers of the parasympathetic nervous system (PNS). When these muscles contract, as
part of the thermoregulation response, they produce a small bump on the skin next to each hair. These
little bumps can be seen and felt and are called "goose pimples" or "goose flesh".

6- Nails play a role in stabilizing the tips of the digits during mechanical stress. The exocrine glands
can be divided into sebaceous glands (oil glands) and sweat glands. Sebaceous glands help water proof
the skin. The lipids in the secretions may also have antibacterial properties. Secretions from sweat
glands play a role in the thermoregulation.

7- Unlike the epidermis, the dermis is vascular and has rich network of arteries, veins and capillaries
that supply oxygen and nutrients to the structures and tissues of both the dermis and the epidermis.
The main tissue in the dermis is dense irregular connective tissue.

8- The layer below the dermis is called the hypodermis or sebaceous layer. Like the dermis, the
hypodermis is vascular and consists of a combination of dense irregular connective tissue and adipose
tissue.
Reading comprehension questions
~ 18 ~
1. Fill in the table with reference to the text:

organ(s) or part function(s)

skin Epidermis 1)_____________________________________________
2)_____________________________________________
3)_____________________________________________

Dermis _______________________________________________

accessories hair 1) _____________________________________________

2)_____________________________________________

Nails _______________________________________________

exocrine glands 1)______________________________________________

2)_______________________________________________
3)_______________________________________________

2. The following statements are false correct them with reference to the text.

a. The skin colour depends on the number of melanocytes.

___________________________________________________________________________

b. "Goose flesh" is part of the protection against UVs function of the skin.
___________________________________________________________________________

3. Complete the following diagram with reference to the text and your own knowledge:

4. Fill in the following table

~ 19 ~
 adjective noun verb
Stratified
waterproof
division
connective

5. Complete the following sentences from the text (do not look back at the text). What do
you notice?

"The integument provides… physical protection (1) ___________chemicals and abrasives"

"The melanin also helps protect the skin (2) __________ UV radiation."

 _____________________________________________________________________

Listening:

1. Listen to a conversation between a doctor and a patient. Mark the following

statements as true (T) or false (F).

1. The man condition's is common in teenagers. (…..)

2. The woman believes the man washes his face too often. (…..)
3. The woman writes the man a prescription. (…..)

2. Listen again and complete the conversation

Speaking
With a partner, act out the roles below based on the previous task. Then switch roles
~ 20 ~
Students A: you are a doctor talk to student B about:
 Skin condition
 The severity of the condition
 Treatment options/measures
Student B: you are a patient. Talk to student A
about a skin condition.

Language practice: Latin plural

Although there are some exceptions, the following
intuitive rules can be helpful with plural terms:

Singular Plural Example

-us -i Bronchus – bronchi

-um -a Acetabulum – acetabula

-a -ae Vena – venae

-ma -mata or -mas Sarcoma - sarcomata/sarcomas

-is -es Metastasis – metastases

-is -ides Arthritis – arthritides
-x -ces Pneumothorax – pneumothoraces

-cyx -cyges - Coccyx – coccyges

-ion -ia Criterion – criteria

These simple exercises have been created to encourage you to become familiar with
Latin and Greek plural

1. There are two mistakes in the following paragraphs. Find them and correct them:
a) The spleen is probably the least-studied abdominal viscera. Multiple metastasis are
relatively uncommon.
b) Two thrombus were removed through mechanical aspiration. Although a third thrombi
was detected, it was not removed.
c) Both superior and inferior veni cavi were occluded.
2. There is one mistake in the following sentences. Find them and correct them:
a) The only diagnostic criteria was fever.
b) Several metastasis were found in the liver.
c) Both humerus were shorter than normal.

3. Are there any mistakes in the following lines?

a) Each leg has two menisci.
b) Two iliofemoral thromboses were identified.
c) The patient's right knee had got lesions in its two meniscus.
Skin Pathologies

~ 21 ~
Reading
Practice pronunciation of medical terms by reading the following medical reports aloud. Then
answer the following questions.

A 29-year-old married white woman was referred for surgical treatment of a nevus of the right
lower lip. The patient has had a small nevus located at the vermilion border of her lower lip
all of her life, but recently it has enlarged and has become irritated with crusting and bleeding
due to local trauma.
The lesion was evaluated initially about 1 month ago during a period of trauma, but it could
not be removed at that time because the patient had a prominent upper respiratory infection.
Subsequently, there has been healing of the local inflammatory component, and the nevus is
clear at this time.
Examination reveals a brownish lesion with a flat, irregular border that is fairly
circumscribed, measuring 0.5 cm in the greatest diameter, and located just at the edge of the
vermilion border on the right side of the lower lip.

1. What is a nevus?
______________________________________________

2. Locate the vermilion border on your lip. Where is it located?

_______________________________________________

3. Was the lesion limited to a certain area?

________________________________________________

4. The pathologist has ruled out melanoma. What does this

mean?
___________________________________________________

5. Is melanoma a dangerous condition? If so, explain why.

Patient is a 24-year-old white woman who has experienced intermittent psoriasis in various
stages of severity since her early teens. Since May, her condition has become more
troublesome because of an increase of symptoms after being exposed to the sun. Her past
history indicates she had chronic sinusitis of 3 years’ duration. Her Bartholin gland was
excised in 20XX. She has had pruritus of the scalp and abdominal regions. There is no FH of
psoriasis. An uncle has had diabetes mellitus since age 43. Patient has occasional abdominal
pains accompanied by diaphoresis and/or syncope. PE showed the patient to have psoriatic
involvement of the scalp, external ears, trunk, and, to a lesser degree, legs. There are many
scattered erythematous (light ruby), thickened plaques covered by thick, yellowish white
scales. A few areas on the legs and arms show multiple, sclerosed, brown macules and
papules.

~ 22 ~
 1. What causes psoriasis?
______________________________________________

2. On what parts of the body does psoriasis typically occur?

______________________________________________

3. How is psoriasis treated?

_______________________________________________

4. What is a histiocytoma?
_______________________________________________

Vocabulary practice:
I. Use adip/o or lip/o (fat) to build words that mean:
1. Tumor consisting of fat__________________
2. Hernia containing fat___________________
3. Resembling fat________________________
4. Fat cell_______________________________
Use dermat/o (skin) to build words that mean:
5. Inflammation of the skin____________________
6. Instrument to incise the skin_________________
Use onych/o (nail) to build words that mean:
7. Tumor of the nails________________________
8. Softening of the nails_____________________
9. Abnormal condition of the nails caused by a fungus_______________

II. Common skin lesions:

• Skin lesions are classified by size, firmness, shape, colour, and the presence/absence of fluid. (pus)
• Rash: temporary skin eruption (erupt= break out). For a rash, consider: the distribution (widespread
or localized) and the grouping (scattered or in clusters)

Medical term Common word Features

Macule Spot Not raised
Papule Spot Raised
Nodule Lump Large papule
Vesicle Small blister Filled with fluid
Bulla Blister A large vesicle
Pustule - Filled with pus
Naevus Birthmark A coloured skin lesion present at birth
Verruca Wart A nodule produced by HPV
furuncle Boil A large pustule or skin abscess

A. Complete the description of herpes zoster (shingles) by replacing the medical word in
parenthesis with ordinary English words.

(1)_______________ (herpes zoster) usually starts with pain. Then red (2) __________ (macules)
appear that develop into groups of (3) ___________________ (vesicles) over a particular area on one
side of the body. In most patients, new (4) _____________ (lesions) continue to appear for 3 or 5
days. The (5) ______________ (vesicles) become (6) _________ ___________ (pustular) and then
form (7) _______________ (crusts). I severe cases there may be (8) ______________ (cicatrices).

~ 23 ~
B. Label the following skin lesions on the lines provided, using the terms listed below.

Bulla / macule / pustule / vesicle / excoriations / nodule / tumor / wheal / fissure

papule / ulcer

~ 24 ~
 C. Match the medical terms below with the definitions in the numbered list.

scabies / tinea / urticaria / verruca / debridement / furuncle / vitiligo

1. ____________________ is a rounded epidermal growth caused by a virus.

2. ____________________ is localized loss of skin pigmentation characterized by appearance
of milk-white patches.
3. ____________________ is a fungal skin disease, commonly called ringworm, whose name
indicates the body part affected.
4. ____________________ is an abscess that originates in a hair follicle; also called boil.
5. ____________________ is an allergic reaction of the skin characterized by eruption of pale
red elevated patches that are intensely itchy; also called hives.
6. ____________________ refers to removal of foreign material and dead or damaged tissue,
especially in a wound.
7. ____________________ is a contagious skin disease transmitted by the itch mite.

D. Complete the notes for the rash in the photograph, and suggest a diagnosis

location and distribution:________ diagnosis:

grouping: ____________________ __________
type of lesion: ________________ __________
colour: ______________________

location and distribution:________ diagnosis:

grouping: ____________________ __________
type of lesion: ________________ __________
colour: ______________________

location and distribution:________ diagnosis:

grouping: ____________________ __________
type of lesion: ________________ __________
colour: ______________________

~ 25 ~
Writing:

A medical referral letter is sent from one physician to another when referring a patient for care.
Most often the letter is sent from the patient's general practitioner to a specialist with a request for
diagnosis or treatment of a patient. Details are given about the patient's presenting complaint,
medical history, family history, clinical findings, test results, and prior treatment so that the
consultant has as much information as possible to provide the appropriate care.

 Imagine for a moment that you are a consultant dermatologist and you receive the
following consultation request letter:

Dr. A. Smith River

City Medical Centre
222 River Road, River City
Dear Doctor,
Re: Williams, Pat
DOB: 19 June 1956
123 5th Avenue, Springfield

Please see Pat for assessment. Pat is a pleasant 51 year-old with a family
history of basal cell carcinoma and has recently had an open sore that bleeds and
remains open for a few weeks, only to heal up and then bleed again.

A. Smith

I. . How would you feel after reading this letter? What would be your impression of the
referring physician? What are the risks of such poor communication?

Poor communication in the consultation and referral process can lead to: 1) poor continuity of care, 2)
delayed diagnoses, 3) polypharmacy, 4) unnecessary testing and 5) repetition of investigations. All of
these can reduce quality of care while increasing health care costs and litigation risk.

~ 26 ~
 II. What information would you like to have seen included in the letter? How should
the information be presented?

__________________________________________________________________________________

A good referral letter should include:

1) Initial statement outlining reason for referral: A single sentence introduction including gender,
age, and problem/reason for consultation. You may use these expressions:

“I am referring to you a patient of mine, (name, age) for suspected (illness).”

« Thank you for seeing [patient’s name] for evaluation and consideration for a (illness). »

2) History of the presenting problem: a description of the chief complaint, associated symptoms and
relevant collateral history.

3) Past history: summary of medical, surgical, and, if relevant, of obstetrical histories.

4) Psychosocial history: relevant family, work and travel histories.

5) Medications: an up to-date medication list which includes over-the-counter and herbal products.

6) Allergies: the presence (or absence) of allergies and intolerances.

7) Physical findings and Investigations: relevant clinical findings and all laboratory/imaging
investigations done and indicate if any others have been initiated.

8) Closure and expectation(s): Specific expectations regarding return of the patient (opinion only or
transfer). You may use:

« Thank you in advance for attending my patient.

I look forward to receiving your report. »

I. Use the following information to write a letter of referral for further investigation
and definitive diagnosis to the dermatologist, Dr Jason Roberts, at Newtown
Hospital, 111 High Street, Newtown (Be careful some information are irrelevant)

Patient: Alicia Gonzoles Medication: self-medicated with OTC

DOB: 02/06/1956 Chinese herbal product
Social history: Divorced, 2 children, non- Laboratory findings: within limits except
smoker, social drinker for elevated alkaline phosphatase (100).
Allergies: Codeine, dust mites Asked for another liver enzymes count in 2
FHx: Mother – hypertension; asthmatic; weeks.
Father – peptic ulcer Tentative diagnosis: Onychomycosis 1-5
PMHx: Childhood asthma; hypertension bilaterally
and breast CA, mastectomy

~ 27 ~
~ 28 ~
 Chapter3: Deontology

• Deontoligical issues (1):

Utilitarianism/ Kantian deontology + Passive
voice
Lesson1

• Deontoligical issues (2):

Abortion, Blood transfer, Euthanasia, type 2
conditional
Lesson 2

_______________

~ 29 ~
 Deontological issues
Pre-reading

Have you done the right thing?

You have been temporarily assigned to work alone at a remote medical outpost nobody is monitoring
you. The local population will not remember the decisions you make.
1) Your patient has an incurable illness. She has said goodbye to her family. She is in great pain.
She wants to be painlessly euthanized. You do it.
2) You have blood to save Alfred or George, but not both. Alfred is younger and healthier. He has
a larger, happier family. You give the blood to Alfred.
3) As above, but this time it is George’s blood. You promised to set it aside for him in case he
needed it. You promised you would NEVER give it to anyone else. You give it to George.

Reading:

Read the following text and decide if you have been mainly utilitarian or deontologist.

1- Ethics is a crucial branch in medicine that guides good medical practice. It deals with the
moral dilemmas arising due to conflicts in duties and the faced consequences. They are based
on six principles, i.e., autonomy, beneficence, nonmaleficence, justice, veracity, and fidelity.

2- While these definitions are clear, exceptions arise during clinical practice. For example, the
practice of fundamental principles of autonomy and informed consent may be breached in the
care of newborn, mentally handicapped or patients in the permanent vegetative state. In
practical ethics, two arms of thoughts exist in decision-making: Utilitarian and
deontological. In utilitarian ethics, outcomes justify the means or ways to achieve it, whereas
in deontological ethics, duties/obligations are of prime importance.

3- In the utilitarian approach, decisions are chosen based on the greatest amount of benefit
obtained for the greatest number of individuals. This is also known as the consequentialist
approach since the outcomes determine the morality of the intervention. This approach could
lead to harm to some individuals while the net outcome is maximum benefit. A few examples
of utilitarian approach in medical care include setting a target by hospitals for resuscitation of
premature newborns (gestational age) or treatment of burns patients (degree of injury) based
on the availability of time and resources.

4- There are two variants of utilitarianism: Act utilitarianism and rule utilitarianism. Act
utilitarianism deals with decisions undertaken for each individual case analyzing the benefits
and harms promoting overall better consequences. Every action/decision arrived for each
patient is confronted with the measurement of balance of the benefits and harms, without
examining the past experience or evidence. This method would lead to enormous wastage of

~ 30 ~
time and energy in decision-making and are prone to bias. In rule utilitarianism, no prediction
or calculation of benefits or harms is performed. These decisions are guided by preformed
rules based on evidence and hence provide better guidance than act utilitarianism in decision-
making. According to rule utilitarianism, morally right decision is an action complying moral
codes/rules leading to better consequences.

5- In contrast to the utilitarian concept, deontology is ethics of duty where the morality of an
action depends on the nature of the action, i.e., harm is unacceptable irrespective of its
consequences. This concept was introduced by a philosopher, Immanuel Kant and hence
widely referred as Kantian deontology. The decisions of deontology may be appropriate for
an individual but does not necessarily produce a good outcome for the society.

6- The deontological ideologists (doctors and other medical staffs) are usually driven to
utilitarian approach by public health professionals, hospital managers, and politicians
(utilitarian ideologists). From a utilitarian perspective, health care system resources, energy,
money, and time are finite and are to be appropriately accommodated to achieve the best
heath care for the society. While achieving good for the greatest number, few harm
(iatrogenic) is acceptable by utilitarian ideologists. For example, few cases of vaccine-induced
paralytic polio after oral polio vaccination. From a deontological perspective, utilitarians
generalize the rules while there may be exceptional cases where they may not apply.

7- Traditional moral analytical studies revealed that deontological and utilitarian inclinations
are mutually exclusive while recent studies revealed that an inclination toward an ideology
may occur due to the absence of inclination to another. These studies also reported the
association of deontological inclinations with empathy, religiosity, and perspective-taking,
while moral concern and reduction in the cognitive load are associated with utilitarian
inclinations.

8- In conclusion, both utilitarian and deontological perspectives have their own importance in
medical ethics. In the current scenario, we get to see utilitarian perspective countermanding
the deontological perspective and hence most ethical and moral dilemmas. A balance between
these two perspectives would bring better harmony and justice to medical practice.

Reading comprehension questions

1. Fill in the blanks with information from the text:

principle Advantage(s) criticism

Act ___________________ ____________________ ________________________
utilitarianism
rule ___________________ ____________________ ________________________
utilitarianism
Kantian ___________________ ____________________ ________________________
deontology

~ 31 ~
2. Ethics are based on 4 fundamental principles: autonomy, beneficence, nonmaleficence, and
justice. Explain each of these principles with words from your own.

___________________________________________________________________________
___________________________________________________________________________

3. Are the following statements true or false? Justify your answer from the text

a) Act utilitarianism is cost effective. __________________________________________

b) Public health professionals tend to be deontological.____________________________
c) A doctor has to be either utilitarian or deontological.___________________________

4. Find words in the text closest in meaning to:

a) Major §2: _________________

b) Teach §5: _________________
c) Limited §6: ________________

5. What do the underlined words refer to?

a) They §1: ___________________

b) Another §7: _________________

6. Fill in the table:

Verb Noun Adjective

Comply
Exclusive
exception

Language

I. Put the verbs between parenthesis in the right tense and/or form:

The principle of autonomy views the rights of an individual to self-determination. This 1.(root)
_____________ in society's respect for individuals' ability to make informed decisions about personal
matters. Autonomy 2. (become) ____________ more important as social values have shifted to define
medical quality in terms of outcomes that 3. (be) __________ important to the patient rather than
medical professionals. The increasing importance of autonomy can 4. (see) _____________ as a social
reaction to a "paternalistic" tradition within healthcare. Respect for autonomy is the basis for informed
consent and advance directives.

The definition of Autonomy is the ability of an individual to make a rational, un-influenced decision.
Therefore, it can 5. (say) ________ that autonomy is a general indicator of health. The progression of
many terminal diseases 6. (characterize) ______________ by loss of autonomy, in various manners.
For example, dementia almost always 7. (result) __________ in the loss of autonomy. This has
implications for the consideration of medical ethics: "is the aim of health care to do good, and benefit
from it?"; or "is the aim of health care to do good to others, and 8. (have) _________ them, and
society, benefit from this?".

~ 32 ~
Writing
Scientific writing should be energetic and clear, smoothly propelling the reader forward. One way to
energize your sentences is to use the parts of speech that express energy and action, ie, verbs. But you
should also use verbs effectively, which means :

 Choose ACTIVE voice over passive voice.

 Choose STRONG and ACTION-FILLED verbs over weaker, more static verbs. In scientific
writing, weak verbs are the overused verbs such as ‘be,’ ‘do,’ ‘make,’ ‘cause,’ ‘occur,’
‘perform,’ and ‘conduct.’ (Later on, you will notice that such weak verbs are often substituting
for a stronger verb, which is actually hidden within a noun.)

Consider the following sentence:

 The diagnosis of Sjögren syndrome was made, and treatment with X (1.5 mg daily) was
started.(16 words)

Grammatically, nothing is wrong with the sentence; however, its weak verbs and passive voice make it
heavy and dull. We can energize the sentence by revising it in 2 steps:

Step 1 Delete the weak verb and replace it with the real verb, which is probably hidden within a
noun in the sentence. In the sample sentence, the weak verb is ‘made,’ and the real verb is ‘diagnose,’
hidden in the noun ‘diagnosis.’ So, the step 1 revision becomes:

 Sjögren syndrome was diagnosed, and treatment with X (1.5 mg daily) was started. (13
words)

The sentence is already improved over the original, but with the two passive verbs, it is still rather
heavy. So we can revise it in a second step:

Step 2 Replace the passive voice with the active voice (inserting a subject such as ‘we,’ ‘I,’ or ‘the
authors,’ if necessary).

So the step 2 revision becomes:

We diagnosed Sjögren syndrome and started treatment with X (1.5 mg daily). (12 words)

 With its strong verbs in active voice, the sentence has more energy. Its fewer words
means that it is also lighter, and its S+V+O order moves the message forward in a
natural way.

~ 33 ~
I. Energize the following sentences by revising with strong verbs and active voice.

1. Measurements of the extent of the corneal displacement were performed 5 times.

__________________________________________________________________________________
2. A diagnosis of left oculomotor nerve palsy was made.
__________________________________________________________________________________
3. Three months postinjection, the tumors were collected and the weights were measured.
__________________________________________________________________________________
4. X had a significant correlation with Y.
__________________________________________________________________________________
5. To assess intraobserver agreement, the same measurements were performed again on another day.
__________________________________________________________________________________
6. Evaluation of response to the chemotherapy was performed by using magnetic resonance imaging
(MRI) or computed tomography (CT) with contrast enhancement.
__________________________________________________________________________________
7. In the X+ group, the total number of adherent tumor cells in the sinusoids was at a peak at 20 min
postinjection and decreased thereafter (Fig. 2).
__________________________________________________________________________________
8. Although administration of antibiotics was performed and TAC was discontinued, CRP continued
to decrease.
__________________________________________________________________________________

~ 34 ~
 Deontological issues (2)
Pre-reading: group discussion

Is it wrong to abort a foetus if:

• Pregnancy is unintended, the result of failed contraception during voluntary intercourse.

• The foetus is at 10 weeks of development and developing normally.

• The pregnancy poses no health risks to the mother.

• It is not in the mother’s interest to have a child (financially, emotionally, etc.).

Reading

What if you were the treating doctor in the story of this newspaper article would you take the same
decision?

~ 35 ~
Reading comprehension

1. Complete the following paragraph with words from the text:

The newspaper article is about the case of ___________ who were born ____________ and in
need of _______ __________. The parents opposed the transfusion and claimed they had the
right of ____________ ___________. The doctors ____________ the parents decision and
said that the babies didn’t express their wishes to make __________ of themselves.

2. Say whether the following statements are true (T) or false (F) and justify your answer
from the text.

a) The sextuplets were born at week 35 of the pregnancy. (...)

_____________________________________________________________________
b) The parents regretted their decision to refuse blood transfusion. (...)
_____________________________________________________________________
c) The parents were permanently denied the custody of their children. (...)
_____________________________________________________________________

3. Complete the following sentences according to your understanding of the text. (Be
careful to tenses)

a) The two babies wouldn’t have died if they___________________________________

b) The remaining four babies could have died if _______________________________
c) If I were in the parent’s shoes, ____________________________________________

4. Find words closest in meaning to

Principal (§5) ______________________ surpass (§7) _________________________

Language: Type 2 conditional

The type 2 conditional refers to an unlikely or hypothetical condition and its probable result. These
sentences are not based on the actual situation. In type 2 conditional sentences, the time is now or any
time and the situation is hypothetical.

Example:

 If I could choose the sex of my baby, I would leave it up to chance for the first baby and then
choose the gender of the second child. (in reality it’s not possible or very unlikely for me to
choose the sex of my baby)

 If I were you, I would give up smoking. (subjunctive mood)

In a Type 2 conditional sentence, the tense in the 'if' clause is the simple past, and the tense in the
main clause is the present conditional (or the present continuous conditional).

~ 36 ~
  Now discuss these dilemmas using the second conditional structure

Writing

What do you think about euthanasia? Is it permissible? Is it a right? Is it a duty? Whose right or duty?

Write a short five-paragraph essay in which you give arguments for or against euthanasia.

Arguments For Euthanasia

1. “It is a human right born of self-determination” .There is a basic right of an individual to

control the time and manner of his or her death. Choice is essential within liberal democracies.

2. Individuals have a right to die with dignity.

3. “It would produce more good than harm, mainly through pain relief”. Quality of life
considerations.

~ 37 ~
4. “There is no substantive distinction between active euthanasia and the withdrawal of life-
sustaining medical interventions”. Rejecting killing/letting die distinction.

5. Economic and human resources considerations: it is costly to provide long-term medical

treatment; keeping people alive can be a burden.

Arguments against Euthanasia:

1. Most deaths are not painful. (Empirical argument)

2. It contradicts the role of physicians (appeal to Hippocratic Oath).

3. “Maintaining the distinction between active and passive euthanasia”. Upholding

killing/letting die distinction.

4. Legalizing euthanasia would have adverse effects, including (i) abuse, (ii) medicine in not
exact science (miraculous recoveries), (iii) puts pressure on patients to request it (consent under
pressure), (iv) undermines doctor/patient trust, and (v) slippery slope (Emanuel, p. 798).

5. Euthanasia is suicide and suicide is impermissible; or euthanasia is murder and murder is

impermissible.

~ 38 ~
 Chapter 4: Psychiatry

• Mental health
Lesson 1

• Mood disorders
Lesson 2

• Anxiety disorders
Lesson 3

~ 39 ~
 MENTAL HEALTH
1. Give the terms for the following definitions

1) A physician specializing in treating mental illness: ______________________

2) A nonphysician trained in treatment of mental illness : ___________________
3) A therapist who practices psychoanalysis: _____________________________

2. Circle the correct alternative then answer the comprehension questions.

Mental health is a relative state of mind in 1. (what/which/whom) the person who is healthy
is able to cope 2. (with/to/for) and adjust to the recurrent stresses of everyday living in an
acceptable way. Mental disorders are disturbances of emotional stability, as manifested in
maladaptive behaviour and 3. (impaired/impairing/impairment) functioning. This may be
caused by genetic, physical, chemical, biological, psychological, or social and cultural factors.
Many of us use defense mechanisms 4. (as/on/in) a normal day-to-day basis when dealing
with areas of conflict in our lives. It is when the defense mechanisms become a way of
dealing with life that they may be indicative of the need for psychological or psychiatric help.
Psychology is the study of behaviour and the processes of the mind, 5. (specially / especielly/
especially) as they relate to the individual’s social and physical environment. A psychologist
is a professional who specializes in the study of the structure and function of the brain and
related mental processes. A psychologist is not a 6. (physicist / physician/ physisian), but
one who earns either a master’s or doctoral degree in some area of psychology. A clinical
psychologist provides testing and counselling services to patients with mental and emotional
disorders. Psychiatry is the branch of medicine that deals with the causes, treatment, and
prevention of mental, emotional, and behavioural disorders.
A psychiatrist is a medical doctor who specializes in diagnosing, preventing, and treating
mental disorders—an education1al process that involves several additional years beyond
medical school. Psychiatrists may specialize in various areas of practice in the field of
psychiatry. If a psychiatrist chooses to specialize in psychoanalysis, he or she would be
known as a 7. (psychoanalyst/ psychoanalist) and would complete additional special training
in psychotherapeutic techniques. Psychoanalysis involves the use of free association, dream
interpretation, and the analysis of defense mechanisms. The psychoanalyst applies the
techniques of psychoanalytic theory to help the patient become aware of repressed emotional
conflicts and seeks ways to help the individual to bring the conflicts to a conscious level so
that they 8. (can/will/must) be resolved.

 What is a defense mechanism? Can you give examples?

______________________________________________________________________________
______________________________________________________________________________
 What are the differences between a psychologist, a psychiatrist and a psychoanalyst?
_______________________________________________________________________________
______________________________________________________________________________
 How does psychoanalysis operate?
________________________________________________________________________________
_________________________________________________________________________________

~ 40 ~
3. Defense Mechanisms
The body’s unconscious reaction used to protect itself from conflicts or anxieties is known as a
defense mechanism. Some defense mechanisms are designed to lessen or deal with anxiety or conflict,
allowing normal function to continue. Others are designed to conceal the anxiety or conflict.

 Rely on the examples given for each defense mechanism in order to define it.

Defense mechanisms/ examples Definition

1. A refusal to admit or acknowledge the reality

of something, thus avoiding emotional conflict or
Compensation
anxiety.
An individual may compensate for a deficiency in
physical size by excelling in academics
2. An ego defense mechanism whereby an
individual unconsciously identifies with another
Denial
person or with some object. The individual
assumes the supposed feelings and/or
A child may deny that he or she is being abused by characteristics of the other personality or object.
a parent.

Introjection 3. An effort to overcome, or make up for, real

or imagined inadequacies
A child develops his or her conscience by internalizing
what the parents believe is right and wrong. The child
may say to a friend while playing,

“Don’t hit people. Nice people don’t do that.”

4. An involuntary blocking of unpleasant

feelings and experiences from one’s conscious
Projection
mind.

A worker who dislikes his or her boss accuses the

boss of disliking him or her.

5. The voluntary blocking of unpleasant feelings

and experiences from one’s mind.
Repression

An individual involved in a tragic automobile

accident may have no memory of the sequence of
events.

6. The act of transferring one’s own unacceptable

thoughts or feelings to someone else.
Suppression

An individual faced with a frustrating or painful

situation may consciously choose not to confront
the situation.

~ 41 ~
Reading: A brief history of psychiatry

1. As you read, fill in the table on the following page with reference to the text:

1- Psychiatry got its name as a medical specialty in the early 1800s. For the first century of its
existence, the field concerned itself with severely disordered individuals confined to asylums or
hospitals. These patients were generally psychotic, severely depressed or manic, or suffered
conditions we would now recognize as medical: dementia, brain tumors, seizures, etc. As was true of
much of medicine at the time, treatment was rudimentary, often harsh, and generally ineffective.

2- Around the turn of the 20th century, the neurologist Sigmund Freud published theories on the
unconscious roots of some of these less severe disorders, which he termed psycho-neuroses. These
disorders impaired relationships and work, or produced odd symptoms that could not be explained
medically. Freud developed psychoanalysis to treat these "neurotic" patients. Psychoanalysis thus
became the first treatment for psychiatric outpatients. It also created a split in the field, which
continues to this day, between biological psychiatry and psychotherapy.

3- By the late 1950s and early 1960s, new medications began to change the face of psychiatry.
Thorazine and other first generation anti-psychotics profoundly improved institutionalized psychotic
patients, as did newly developed antidepressants for the severely depressed. State mental hospitals
rapidly emptied as medicated patients returned to the community (the "deinstitutionalization
movement"). Although a well-funded community mental health system never materialized as
promised, psychiatric patients with varying levels of symptoms and dysfunction were now treated as
outpatients.

4- In 1980, the Diagnostic and Statistical Manual (DSM) of Mental Disorders, published by the
American Psychiatric Association, was radically revised. Unlike the prior two editions which
included psychoanalytic language, DSM-III was symptom-based and "atheoretical". Patients were
thereafter diagnosed by "meeting criteria" for one or more defined disorders. One result of was that
psychoanalysis and psychodynamic therapies were increasingly seen as nonspecific and unscientific,
whereas pharmaceutical research took off in search of drugs that could improve discrete symptoms.

5- The push for pharmaceutical innovation paid off. A new class of antidepressants called SSRIs
("selective serotonin reuptake inhibitors") were better tolerated and medically safer than prior
antidepressants. The first of these, Prozac, was released in 1987. Shortly thereafter, new anti-
psychotics were released: "atypical neuroleptics" such as Risperdal and Zyprexa. Psychiatry was
increasingly seen as a mainstream medical specialty and public research money strongly shifted
toward neuroscience and pharmaceutical research.

6- Meanwhile, clinical psychologists championed the use of cognitive and cognitive-behavioural

psychotherapies. They empirically validated the use of cognitive-behavioral therapy (CBT) for
depression, anxiety, and other named disorders. This empiricism meshed well with the "evidence
based medicine" movement starting in the 1990s, to the further detriment of analytic and dynamic
therapies.

7- Notwithstanding the Decade of the Brain and lavish public and private investment, pharmaceutical
innovation dried up in the 2000s. No new classes of medication or blockbuster psychiatric drugs were
discovered. Moreover, previously unrecognized or under-appreciated side-effects of widely used
medications hit the headlines. SSRIs were implicated in increased suicidal behaviour, and some
patients reported severe "discontinuation syndromes" when stopping treatment. Atypical neuroleptics
were associated with a "metabolic syndrome" of weight gain, increased diabetes risk, and other
medical complications. Adding insult to injury, the millions spent on basic brain research led to no
advancement in our understanding of psychiatric etiology, nor to novel biological treatments. And to

~ 42 ~
top it off, pharmaceutical companies were fined repeatedly and for huge sums for promoting powerful,
expensive psychiatric medications for unapproved uses.

8- Psychiatry's reputation suffered for it. Office-based psychiatrists are now too often viewed as mere
technicians, attacking emotional symptoms with one prescription after another. Getting to know the
person behind the symptoms is left to non-psychiatric therapists, obscuring the often close connection
between medication response and psychology.

9- The future of psychiatry can be neither "brainless" nor "mindless." History points to many
conditions once thought to be "mental" that are now known to be medical (e.g., general paresis,
cretinism, senility, seizures, etc.). The distinction between medical and psychological will likely
become less sharp in the years ahead, as certain genetic or other biological differences will be linked
to psychological vulnerabilities. Nonetheless, the uneasy tension between biological and
psychological psychiatry will not end soon, and we are better off embracing it instead of choosing
sides.

Reading comprehension questions

Period Event(s)
1800 Treated disorders:___________________________________________________
Patients were mainly: ________________________________________________
Type of treatment:___________________________________________________

The turn of the (+): _______________________________________________________________

20th century (-): ________________________________________________________________

50s and 60s The emergence of:___________________________________________________

Movement: ________________________________________________________

1980 Revision of the __________, which used to ___________________, to become

more ______________________________________________________________

1987 ___________________________________________________________________

90s Movement: ____________________________

 Which promoted ______________________________________________
2000s __________________________________________________________________
__________________________________________________________________

2. Are the following statements true (T) or false (F)? Justify from the text.

a) The revision of the DSM has benefited the general public view on psychiatry. (…)

__________________________________________________________________________________

b) Risperdal and Zyprexa are strong antidepressants. (...)

_________________________________________________________________________________

~ 43 ~
3. Answer the following questions with reference to the text:

a) When did the split between biological psychiatry and psychotherapy originate?
___________________________________________________________________________
___________________________________________________________________________
b) What is the author's position regarding this split?
___________________________________________________________________________
c) Psychiatry has known a dark era: when was that and why? (Identify 3 reasons)

__________________________________________________________________________________
__________________________________________________________________________________

4. What does the following sentence from parag. 9 mean? “The future of psychiatry can
be neither "brainless" nor "mindless."”
_________________________________________________________________________________

5. Find words in the text closest in meaning to:

Distinct §4:_________________________ simple §8:____________________________

Vocabulary practice

1. Select from the following terms to complete the sentences below.

anxiety disorder / dissociative disorder / eating disorder / mood disorder / personality disorder /
sexual disorder / somatoform disorder

1. Disturbance of memory and identity that hides the anxiety of unconscious conflicts is
___________________________ .
2. Troubled feelings, unpleasant tension, distress, and avoidance behavior describe a/an
___________________________ .
3. Bulimia nervosa is an example of a/an ___________________________.
4. A disorder involving paraphilias is a/an ___________________________.
5. An illness marked by prolonged emotions (mania and depression) is a/an
___________________________ .
6. A mental disorder in which physical symptoms cannot be explained by an actual physical disorder
is a/an ___________________________.
7. A lifelong personality pattern that is inflexible and causes distress, conflict, and impairment of
social functioning is a/an ___________________________.

2. Identify the personality disorder based on its description as given.

1. Flamboyant, theatrical, emotionally immature _______________________

2. No loyalty or concern for others; does not tolerate frustration and blames others when he or she is at
fault _______________________
3. Fantasies of success and power and a grandiose sense of self-importance
_______________________
4. Pervasive, unwarranted suspiciousness and mistrust of people _______________________
5. Emotionally cold, aloof, indifferent to praise or criticism or to the feelings of others
_______________________
6. Instability in personal relationships and sense of self; alternating over involvement with and
rejection of people _______________________
~ 44 ~
3. What do the following abbreviations stand for?
ADHD_________________________________________
DT____________________________________________
IQ_____________________________________________
STM___________________________________________
CA____________________________________________
MA____________________________________________

Listening: Mental state examination

Listen to a doctor, Dr Vine, talking about one of the patients as part of the mental state
examination. Take notes under the three headings: appearance, behaviour, and speech
Appearance Behavior speech
________________________ _________________________ __________________________
________________________ _________________________ __________________________
________________________ _________________________ __________________________

What other details would you want to know about for the examination under the
headings: mood, risk, anxiety?
___________________________________________________________________________
_________________________________________________________________________

Complete these patients' statements using a suitable word of your own. Then categorize
the statements according to whether you would associate them with anxiety or elation

Language spot: Phrasal verbs separable / inseparable

An understanding of phrasal verbs is another feature of colloquial English that will help you interpret
and understand the patient.
EXAMPLES
Inseparable phrasal verb Separable phrasal verb
I got into washing my hands again and again. I couldn't fix it, which got me into a rage.

~ 45 ~
1. Work in pairs. Add the appropriate particle to each pair of sentences.
At down into off on over

1)
a. I feel as if everyone is getting_______ me all the time
b. With so little information it's difficult to get _________ the diagnosis in this case.
2)
a. Sometimes work and the weather get me _______________.
b. Can you try and get some food _____________ you today?
3)
a. My father got __________ his depression very quickly.
b. He got the procedure ___________ to the patient.
4)
a. I get __________ a violent temper quiet easily and I know I shouldn't.
b. His depression got me _________ a bad mood too.
5)
a. It helps to try to talk about it so you can get it __________ your chest.
b. I find it very difficult to get __________ to sleep most nights.
6)
a. Everybody is getting ________ my nerves at the moment.
b. He gets _________ with everybody in the psychiatric ward.

Use these words to rewrite the relevant sentences in the previous activity where possible.

Annoying (*2) / depressed me / explained / eat some food/ release it / mastered

Verbs with prepositions

2. Add a word from each list below to complete sentences1 -8.You may have to change
the form of the verb

Benefit / blame / come / cope / depend/ face / prescribe / think /worry

About / for/ from / from / of / on / with / with / with

1) Sometimes, I feel I can't __________ adequately _________ the baby as I'm on my own with
no support.
2) I never __________ myself unnecessarily _________ things that go wrong.
3) The baby __________ _______ me for everything and sometimes it all gets on top of me.
4) I get down at times and sometimes feel a bit panicky and I don't know where it ___________
________.
5) My friend said you could ___________ me ___________ something to stop my mood
fluctuations.
6) No, I can safely say I haven't __________ _________ harming myself or the baby at all.
7) I am ___________ _________ so many things to do on my own that I don't know which way
to turn at times.
8) I ____________ __________ the baby a lot, especially about her health.
9) Would I __________ _________ seeing a counsellor, do you think?

~ 46 ~
 Anxiety disorders

 Look at the following pictures and identify the related phobias. What other
phobias do you know?

Cyberphobia - zoophobia - haemophobia - claustrophobia - xenophobia - agoraphobia - aracnophobia

Reading: Sigmund Freud took a strong interest in anxiety throughout his professional life.

1. His thinking about the subject changed significantly as his theories evolved. By the end of his life,
anxiety had become central to his theory of the development and functioning of the mind.

2. First phase: the toxic theory

“Anxiety arises from a transformation of the accumulated tension.”S I G M U N D F R E U D

Freud’s earliest theory of anxiety goes back to the mid-1890s, predating even his use of the term
‘psychoanalysis’ itself. At this early stage he didn’t consider anxiety to be related to thoughts or ideas,
but he did observe that it was closely linked to sexuality, defining it as sexual excitation that has
been transformed.

At this time, Freud’s argument was that when the path to satisfaction is blocked (for instance, in coitus
interruptus, when sexual intercourse ends before ejaculation), the resulting build-up of unsatisfied
libido takes on a toxic character, finding an outlet in anxiety.

3. Second phase: anxiety as a result of repression

“Anxiety arises out of libido by the process of repression.”S I G M U N D F R E U D

Freud’s views on anxiety shifted as he developed his theory of repression, which describes how the
ideas connected to sexual urges are repelled from consciousness when they come into conflict with
‘civilised’ social norms. In other words, Freud claimed that the process of becoming social beings
requires us to give up some of our sexual impulses.

~ 47 ~
His earlier ‘toxic theory’ of anxiety as transformed sexual excitation was preserved, but with an
important modification: while his earlier views assumed the cause of anxiety to be external blocks to
sexual release, the theory of repression shifted the emphasis to internal ones or psychological
inhibitions.

4. Final phase: anxiety as a signal

“The ego is the actual seat of anxiety.”S I G M U N D F R E U D

In the late 1920s, Freud introduced a very different theory of anxiety, abandoning his earlier view of
anxiety as transformed libido. He made an important distinction between a more primary automatic
anxiety, triggered by a traumatic situation in which the helpless ego is overwhelmed, and signal
anxiety, which can be activated in the ego response to situations of danger as a kind of warning that
a traumatic situation is imminent, so that defensive measures can be put into place to avoid it. These
‘danger situations’ tend to gravitate around the threats that arise from the prospect of being helpless
and at the mercy of others: threats of losing a loved one or of being attacked etc. Ultimately, Freud
claimed, these threats are manifestations of a more fundamental threat, the threat of castration.

This new perspective led Freud to a complete reversal of his former position: whereas before he had
posited anxiety as a result of repression, he now understood it as preceding repression and giving rise
to it. This final phase gives anxiety a much more central place in the workings of the psyche: instead
of being a kind of side-effect of repression, it was now possible to think of the very contours of the
mind itself as a means of avoiding anxiety.

Reading comprehension questions:

1. Fill in the following diagram with reference to the text:

Mid 1890s 2nd phase _____

automatic
Anxiety definition: anxiety
transformation of def:_____________
accumulated ________________ origin______________
tension

signal anxiety

origin:________ origin:__________ origin__________

___ __________ _______________

2. Fill in the following paragraph with words from the text:

Freud’s understanding of anxiety evolved ______________ During his life. In the first phase, he defined
anxiety as an ___________ for an unsatisfied libido. In the second phase, the origin of this unsatisfaction
shifted from being external to rather internal psychological _______________. In the final phase, Freud
_____________ his theory of transformed libido. He thought of anxiety as being ___________ by imminent
traumatic situation. He attributed all threats to a more ______________ threat of castration.

~ 48 ~
3. Are the following statements true (T) or false (F). Justify with details from the text:

a) Freud started to use the term “psychoanalysis” before he become interested in anxiety.
b) During the first and the second phases, the origin of anxiety didn’t change radically.
c) In the final phase, Freud maintained that repression is what gives rise to anxiety.

4. Find in the text words closest in meaning to:

a) An increase (§2)
b) Kept away (§3)
c) About to happen (§4)

Vocabulary practice

1. Read the scenario carefully and select the most appropriate answer for each question:

Johnny Burrows, a 48-year-old, is a patient of the psychiatrist Dr. Ryan. Mr. Burrows was
diagnosed with a phobic disorder nine months ago. Most recently, he has experienced an
increase in the recurrence of the phobic disorder. Mr. Burrow’s wife has many questions for the
health care worker about this disorder.

1. The health care worker will base her responses to Mrs. Burrows’ questions about phobic
disorders on which of the following facts? Phobic disorder is described as a/an:
a. anxiety disorder characterized by recurrent obsessions or compulsions that are severe enough to be
time consuming and/or cause obvious distress.
b. anxiety disorder characterized by an obsessive, irrational, and intense fear of a specific object, of an
activity, or of a physical situation.
c. disorder characterized by gross distortion of reality, disturbances of language and communication,
withdrawal from social interactions, and the disorganization and fragmentation of thought, perception,
and emotional reaction.
d. a disorder in which the individual represses anxiety experienced by emotional conflicts by
converting the anxious feelings into physical symptoms that have no organic basis.

2. When Mrs. Burrows asks the health care worker about the symptoms normally seen
in patients experiencing a phobic disorder, the health care worker’s best response(s)
would be:
a. faintness, fatigue, palpitations, perspiration, nausea, tremor, and panic.
b. hallucinations, delusions, disorganized speed, flattened affect, and catatonic behaviour.
c. exaggerated feeling of sadness, discouragement, hopelessness, worthlessness, and guilt.
d. paralysis, pain, loss of sensation, or some other form of dysfunction of the nervous system.

3. The health care worker explains to Mrs. Burrows that the typical treatment used to
treat phobia disorder is:
a. behaviour therapy
b. electroconvulsive therapy
c. administration of antipsychotic agents
d. play therapy

~ 49 ~
4. Mrs. Burrows asks the health care worker to explain what “Nyctophobia” means. The
health care worker would explain to her that Nyctophobia is a/an:
a. fear of being in an open, crowded, or public place (such as a field, congested street, or busy
department store) where escape may be difficult.
b. persistent, irrational fear of animals—particularly dogs, snakes, insects, and mice.
c. obsessive, irrational fear of darkness.
d. fear of high places that result in extreme anxiety.

2. Match each of the following psychiatric symptoms with its best meaning from the list
below.
anxiety / apathy / compulsion / delusion / dissociation / hallucination / mania / obsession

1. State of excessive excitability; agitation ________________________________________

2. Uncontrollable urge to perform an act repeatedly _________________________________
3. Persistent idea, emotion, or urge _____________________________________________
4. Feelings of apprehension, uneasiness, dread ___________________________________
5. Anxiety becomes a bodily symptom that has no organic basis_______________________
6. Absence of emotions; lack of motivation or emotional involvement___________________
7. Fixed false belief that cannot be changed by logical reasoning or evidence___________
8. False or unreal sensory perception __________________________________________

3. What do the following abbreviations stand for?

PTSD _____________________________________
GAD______________________________________
PDD______________________________________
DSM______________________________________
CBT______________________________________
OCD______________________________________

Language practice:
Supply with the right verb form (-ed form or -ing form)

Many psychoactive drugs used today operate by 1.(affect)________ levels and activities of
neurotransmitters such as serotonin, norepinephrine, and dopamine in the brain. Examples are
fluoxetine (Prozac) and 2.(relate)________ compounds, which are 3.(prescribe)_______ to alter
mood. Prozac increases serotonin’s activity by blocking its reuptake—that is, it blocks transporters
that carry serotonin back into the 4. (secrete)__________ cell at the synapse. Like other selective
serotonin reuptake inhibitors (SSRIs), Prozac prolongs the neurotransmitter’s activity at the synapse,
5.(produce)__________ a mood 6.(elevate) ________ effect. Prozac is used to treat depression,
anxiety, and symptoms of obsessive–compulsive disorder. Other psychoactive drugs are less selective
than Prozac. Venlafaxine (Effexor) blocks reuptake of serotonin and norepinephrine and is used to
treat depression and 7. (generalize)___________ anxiety disorder. Bupropion (Zyban) inhibits
reuptake of norepinephrine and dopamine and is prescribed for depression and 8.(smoke)_________
cessation. Another class of antidepressants, the monoamine oxidase inhibitors (MAOIs), prevents an
enzyme from 9.(break)__________ down serotonin in the synapse. Like SSRIs, MAOIs increase the
amount of serotonin available in the synapse. As with any drug, care must be 10.(take)_______ when
using St. John’s wort, especially if it is combined with other antidepressant medications, and health
care providers should always be informed of any drugs, 11.(include)____________ herbal
preparations, that a person is taking.

~ 50 ~
 MOOD DISORDERS
1. Can you name these people? Can you guess what they do have in common?

2. All of the above suffered from a depressive illness. Can famous people help
remove the stigma of mental illness or do they confirm people’s beliefs? Are
public attitudes changing or have they been the same for a long time?

3. Read the text and choose the most suitable title:

a) Depression: a symptom or a condition

b) The changing face of depression
c) Depression: causes and treatment

1- Depression is a common yet complex mental health condition affecting more than 16 million adults
and 3 million adolescents in the US each year. People with depression feel sad, empty, or hopeless
much of the time. It’s more than a case of the blues; depression looms like a storm cloud that won’t let
sunshine peak through. It saps the joy of being with friends and family. People can lose interest in
hobbies and other pleasurable activities, and they may have trouble eating or sleeping.

2- Sometimes people don’t acknowledge or recognize depression in themselves or others, so they fail
to seek help from a health care professional. But without treatment, depression can linger for weeks or
months–sometimes years–and can lead to worsening symptoms. Depression can wreck lives,
friendships, and marriages and pose problems at school or work. Some people may turn to alcohol or
drugs to ease their pain or consider some form of self-harm or suicide as an escape.

3- The exact causes of depression are unclear. Experts think there may be multiple factors involved.
Many times, it’s the intermingling of two or more of these factors that bring on depression or make it
worse. Depression causes include:

~ 51 ~
Your genes: Depression can be hereditary. Certain gene mutations may impede the ability of nerve
cells in the brain to communicate effectively.

Changes in brain chemistry: Depression is often described as a chemical imbalance in the brain, but
it’s not quite as simple as being too low or too high in one chemical or another. There are many ways
brain chemistry is linked to depression. For example, overproduction of the stress hormone cortisol
has also been linked to depression. In addition, there’s a connection between serotonin and depression.
Some depressed people have reduced transmission of this important chemical messenger in the brain.

Personality: A person’s temperament and upbringing are among the psychological and social factors
that may influence how he or she reacts to stressful situations and views the world. As a result, some
people may be more vulnerable to depression.

Environment: Stressful life events, such as a childhood trauma, relationship conflicts, and loss, may
alter brain function in ways that make a person susceptible to depression.

Medical conditions, medications: Depression often goes hand-in-hand with certain chronic
conditions (diabetes, cancer, heart disease, Parkinson’s disease...). Certain medicines are also tied to
depression (heart drugs such as beta-blockers and calcium-channel blockers; cholesterol-lowering
statins; female hormones; anticonvulsants...)

Substance abuse: Alcohol and drug use can bring on depression (and people who are depressed often
use alcohol and drugs to cope with their depression).

4- A depression diagnosis is typically based on a patient’s personal and family history of depression
and reported symptoms. Patients may be asked to take a questionnaire to gauge the severity of their
symptoms. A physical exam and lab tests can rule out other medical conditions, such as a thyroid
disorder, that can cause the same symptoms as depression.

5- To be diagnosed with major depression, a person must experience symptoms on most days over at
least a two-week period. Sometimes depression persists for two or more years. Depending on
symptoms and their severity, your doctor may refer you to a psychiatrist, psychologist, or other mental
health professional for treatment. Depression is managed mainly through psychotherapy and
medication. The choice of treatment depends on the type of depression and its severity.

~ 52 ~
6- Also known as talk therapy or counselling, psychotherapy may be the first line of treatment for
people with mild depression. It can be combined with antidepressant medications for moderate to
severe cases. There are several types of counselling for depression.

7- One of the most common forms is called cognitive behavioural therapy. CBT focuses on helping
patients identify and change negative thinking and behaviours that cause or worsen their depression.
Another type, called interpersonal therapy, seeks to improve a depressed person’s relationships with
others.

Comprehension questions
 Answer the following questions with reference to the text:

 What is depression? How different is it from feeling of sadness?

___________________________________________________________________________
 Should depression be taken seriously? What are the risks if left untreated?
___________________________________________________________________________
 What are the chemical components involved in depression?
___________________________________________________________________________
 How is depression diagnosed? How is it treated?
___________________________________________________________________________

 Are the following statements true (T) or false (F)?

 Lab tests are needed to diagnose depression.

 Talk therapy is a sufficient treatment for depression.
 CBT seeks to improve the relationships of the depressed with others

 Find words in text closest in meaning to:

Remain §2: _________________ Combination §3: _______________Measure §4:_______________

Vocabulary practice

1. Fill in the blanks with words from the box (Types of depression)

Bipolar depression / Seasonal affective disorder or SAD/ Major depressive disorder / Medication-
or alcohol-induced depression / Postpartum depression / Premenstrual dysphoric disorder or
PMDD / Depression due to an illness / Disruptive mood dysregulation disorder / Persistent
depressive disorder

a) ____________________ is another name for classic depression, the type that thrusts people into a
dark mood. To be diagnosed with it, you must have its symptoms nearly daily for at least two weeks.

~ 53 ~
b) _____________________is a common, long-lasting form of depression characterized by low mood.
People have symptoms for two years or more, but they aren’t as disturbing as in major depression.
c) ______________________ severe depression in the week before a woman’s monthly period begins.
d) ___________________________is a mood change caused by the use or abuse of alcohol, certain
medications, and illicit drugs. Also called substance-induced depression.
e) _______________________can occur alongside heart disease, cancer, multiple sclerosis,
and HIV/AIDS. It’s normal for these diagnoses to be emotional, but if mood changes linger for more
than a couple of weeks, you might have depression.
f) ________________________is a childhood condition that results in irritable and angry mood;
frequent, severe temper tantrums; and an inability to function in school.
g) ________________________, also known as manic-depressive illness, is characterized by
unusually wide swings in mood and energy, including periods of depression.
h) _______________________occurs after childbirth. Women may experience extreme sadness and
have difficulty caring for themselves or their new babies. Men can have it too.
I) _________________________: This type of recurring depression commonly strikes in a seasonal
pattern, usually during the fall or winter, and disappears in the spring or summer.

2. Match the following prefixes and suffixes with their meanings and give examples.

Prefixes Meaning
a-, an-  Down __________________________________
cata-  Abnormal _______________________________
hypo-  Deficient, less than _______________________
para-  No, not _________________________________

Suffixes Meaning
-genic  Mind ___________________________________
-leptic  Feeling, bearing __________________________
-mania  Fear (irrational and often disabling)___________
-phobia  Obsessive preoccupation ___________________
-phoria  To seize hold of ___________________________
-thymia  Produced by _____________________________

Combining Forms Meaning

Anxi/o  Sleep ___________________________________
Aut/o  Treatment _______________________________
Hallucin/o  Attraction to, love_________________________
Hypn/o  Uneasy, anxious, distressed _________________
Iatr/o  Self ____________________________________
Phren/o  Hallucination, to wander in the mind __________
Schiz/o  Split ____________________________________
Phil/o  Nerve ___________________________________

~ 54 ~
3. Circle the term that best completes the meaning of the sentence.

1. Robin fluctuated between bouts of depression and mania and finally was diagnosed as having a
(xenophobic, histrionic, bipolar) disorder.
2. When Sam was admitted to the hospital after his automobile accident, his physicians were told of
his alcoholism. They needed to know Sam’s history so that they could prevent (dementia, dysthymia,
delirium tremens).
3. Hanna was afraid of everyone she met. She had the (paranoid, narcissistic, schizoid) delusion that
everyone was out to get her.
4. Ever since she was trapped in an elevator for 3 hours, Lil experienced a (social phobia, panic
attack, somatoform disorder) marked by palpitations, sweating, and trembling when she was unable
to get out of an enclosed space.
5. The few survivors of the nightclub fire were diagnosed with (OCD, dissociative fugue,
posttraumatic stress disorder). They regularly experienced insomnia, nightmares, and feelings of
helplessness.
6. Bill felt depressed during the months of November through February. In March his (OCD,
ADHD,SAD) changed and his mood was characterized by (hypomania, dysphoria, paranoia).
7. An ( antipsychotic, anxiolytic) drug is also known as a tranquilizer.

4. What do the following abbreviations stand for?

SAD___________________________________________
ECT___________________________________________
SSRIs__________________________________________
MDD__________________________________________
Language practice: tenses review

Complete the text with the correct form of the verb in brackets.

Dear Coleen,
I ____________1 (be married) for 53 years, and for the past three years my husband _________2
(have) dementia. He _________3 (keep) accusing me of having affairs with his friends. He
__________ 4 (have) a carer who__________5 (come) around to _________6 (wash) and
__________ 7 (dress) him, and now my husband __________8 (think) I _________9 (sleep) with him.
Our children ___________10 (say) it’s time he_____________11 (go into) a home, but I can’t do
that—we ____________12 (marry) in sickness and health. But, I __________13 (know) how much
more I can take.

Coleen says …

Until you __________14 (live) with a loved one with dementia, it is impossible to know or explain
how hard it is. I __________15 (go through) it with my mother and it ________16 (be) devastating.
What you have to keep in mind is that it is not your husband who ____________17 (accuse) you of
affairs, it’s his illness __________18 (drive) him to say it. My mum was the most laid-back woman in
the world, but Alzheimer’s ___________19 (turn) her into a violent, aggressive person who I
______________20 (not recognise) at all. She ____________21 (call) me every name under the sun.
I had to keep ____________22 (come) home after visiting her and telling myself it was the illness and
not how she really __________23 (feel). You mustn’t be afraid to get support. I am sure your children
are only suggesting a home for your husband as they __________24 (be) worried about you. Maybe
there _____________25 (be) other ways they can help. Age UK __________29 (have) good
information and links to support groups. _________30 (get) in touch with the Alzheimer’s Society
______________31 (help) me. You have to try hard not to take it personally and to remember that
your husband does love you and he _____32 (love) you throughout your married life.

~ 55 ~
Appendix

Reading passage:

1- Giving birth is always a trying experience for everyone involved. Still, the pressure and
anxiety around the event is even more intense when the health of the child is at risk. One
extreme example of this was with a baby boy four years ago named Noah Wall who was born
with a severe birth defect caused by hydrocephalus. As a result of the disorder, he came out of
his mother’s womb with a swollen head and almost no brain.

2- Hydrocephalus is a condition that occurs when fluid builds up in the skull and causes the
brain to swell. Brain damage can occur as a result of the fluid build-up which can lead to
developmental, physical, and intellectual impairments. It can be fatal if it’s left untreated.
Treatment may not reverse brain damage that’s already occurred. The goal is mainly to
prevent further brain damage.

3- Shelly discovered three months into her pregnancy that her unborn son had a catalogue of
health problems. These included spina bifida - a condition which prevents the spine from
developing properly - rare chromosome abnormalities along with hydrocephalus. Doctors
warned Shelly that Noah wouldn’t survive long after he was born and that even if he did, his
quality of life would be incredibly low. They even advised her to terminate the pregnancy
rather than risk having a child who would either not survive or live the rest of its life in pain.
Still, Shelly wanted to see her child into the world no matter what the risk was.

4- Noah's prognosis was so poor that his family were forced to make plans for his funeral.
However, incredibly, Noah survived his knotty birth, and was rushed into his first major
surgery moments later. The open wound on his lower back - characteristic of spina bifida -
was sewn up. Then a shunt was installed in his skull, to drain the excess fluid from his brain.

5- As expected, Noah was born with 98% of his brain nonfunctional as a result of fluid
damage. But what happened next was a miracle. Despite his seemingly irreversible condition,
Noah’s brain gradually started to grow itself back. Although his developmental process took
longer than with a child without his health issues, he was still able to learn how to talk and at
age four had a brain that was practically the same as other children his age. A brain scan
showed that his brain had expanded to 80% of a normal brain - an incredible result that no
doctor expected.

6- While he still faces extreme health complications as a result of spina bifida, Noah’s is a one
in a million situation that will be used around the country as a teaching case. Now, after a
series of painful and difficult operations on his hips, he’s even contemplating the possibility
one day of walking. He is also the subject of a BBC documentary about his incredible
recovery called The Boy With No Brain.

7- Stories like these remind us not to be cynical and to open our hearts and minds to the
possibilities of the world. Though Shelly’s decision to follow through with her pregnancy was
an enormous risk, doing so paid off immensely and resulted in an inspirational story for
millions around the world—and in granting a little boy a chance at a full life.

~ 56 ~
I/ READING COMPREHENSION: (10 marks)
1) Complete the following table with information from the text. (3.5 marks)

Noah’s birth Prognosis at birth Treatment Recent prognosis

defects
1.___________ ____________________ _____________________ _________________
____________ ____________________ _____________________ _________________

2.___________ ____________________ _____________________ _________________

____________ ____________________ _____________________ _________________

2) Say whether the following statements are true (T) or false (F) and justify from
the text. (3 marks)
a) The doctors were cynical about the foetus prognosis.
( ) ____________________________________________________
b) At age four, Noah’s brain is exactly the same of any child of his age.
( ) ____________________________________________________

c) Surprisingly, Noah was born with 98% of his brain damaged.

( ) ____________________________________________________

3) Find in the text words closest in meaning to: (1.5 mark)

a) Accumulation: (§ 2) _______________________
b) Complicated: (§4) _________________________
c) Basically: (§5) ___________________________

4) What do the underlined words in the text refer to? (1 mark)

a) Its: (§3) ____________________
b) Itself: (§5) __________________

5) How would you describe the author’s tone in the last paragraph? Circle the right
option. (1 mark)
a) Resigned
b) Confident
c) Moved

~ 57 ~
II/ LANGUAGE: (10 marks)
1) Express the following sentences differently starting as given. (3 marks)
a) The doctor will have to examine you again.
 You _________________________________________________________
b) “You will be discharged tomorrow.”
 The doctor said that _____________________________________________
c) The doctor regretted not prescribing this drug.
 The doctor: “ I _____________________________________” (use a modal)

2) Put the words between brackets into the correct tense and/or form. (Use the table
below) (3 marks)
Expectant mothers undergo a variety of biological changes during pregnancy, and
researchers 1.[have] evidence that there are alterations to brain structure. In a Nature
Neuroscience paper, which 2.[recently/ publish], a team of researchers compared
MRI brain scans of 25 first-time mothers before and after they 3.[give] birth. The
researchers found post-partum 4.[reduction] of gray matter in regions of the brain
involved with social cognition and found that these same regions activated when the
mother looked at photos of her child. And mothers that displayed the most significant
brain changes tended to score 5.[high] on tests that measured their emotional
6.[attach] to their children.

1. 2. 3. 4. 5. 6.

3) Circle the word which does not belong to the list (2 marks)
a) Euphoria / mania / elation / echolalia
b) Naevus / bulla / verruca / papule
c) Perception / mood/ thought/ cognition
d) Laceration / cut / bruise / graze

4) Fill in the blanks with words from your own (each space stands for a letter) (2
marks)

Eczema is a general term that describes several different skin - - - - - - . The skin is inflamed, red,
scaly, and - - - - -. Eczema is a common skin condition, and can occur in adults or children. The
condition is not - - - - - - - - - - . The cause of atopic eczema is not known, but the condition often
affects people with a family history of - - - - - - - - -.

~ 58 ~