Lesson 2—Explore/Explain

What’s Wrong? (Page 1 of 2)

At a Glance

Overview

Students analyze case studies to explore similarities and differences among illnesses. They use this knowledge to develop a definition for illness and consider why depression is an illness of the brain. Finally, students explore how scientists investigate the changes in the way the brain functions during depression by evaluating PET images.

Major Concepts

Mental illnesses, including depression, are illnesses of the brain. Like illnesses that affect other parts of the body, mental illnesses are diagnosed by identifying characteristic symptoms.

Objectives

After completing this lesson, students will

be able to explain that doctors diagnose illnesses based on a set of characteristic symptoms,
be able to define illness,
be able to identify common symptoms of depression, and
understand that changes in brain activity are associated with depression.

Teacher Background

Consult the following sections in Information about Mental Illness and the Brain:

In Advance

Web-Based Activities
Activity	Web Component?
1	Yes
2	No
3	Yes

Photocopies
Activity	Master	Number of copies
1 (Web version)	Master 2.1, Analyzing the Cases Master 2.4, Comparing the Cases: A and B Master 2.5, Comparing the Cases: C and D Master 2.6, Comparing the Cases: E and F	1 copy per team 1 transparency 1 transparency 1 transparency
1 (print version)	Master 2.1, Analyzing the Cases Master 2.2a, Medical Chart A Master 2.2b, Medical Chart B Master 2.2c, Medical Chart C Master 2.2d, Medical Chart D Master 2.2e, Medical Chart E Master 2.2f, Medical Chart F Master 2.3a–k, Doctors’ Reference Manual Master 2.4, Comparing the Cases: A and B Master 2.5, Comparing the Cases: C and D Master 2.6, Comparing the Cases: E and F	1 copy per team 6 copies* 6 copies* 6 copies* 6 copies* 12 copies* 12 copies* 2–3 sets per class 1 transparency 1 transparency 1 transparency
2	Master 2.7, Is It an Illness?	1 transparency
3 (Web version)	None
3 (print version)	Master 2.8, Looking Inside the Brain	1 color transparency†
*These numbers are based on a class of 24 students working in 8 teams of 3 students. Adjust the numbers for your class size. Each student in a team will need a copy of each of the two medical charts. †Alternatively, you could make color photocopies and laminate them. Make enough copies so each team has one copy.

Materials
Activity	Materials
1 (Web version)	computer with an Internet connection and speakers overhead projector transparency pens for each team
1 (print version)	overhead projector transparency pens for each team
2	transparency pen
3 (Web version)	computer with an Internet connection and speakers
3 (print version)	overhead projector transparency pen

Preparation

Activity 1

For classrooms using the Web-based version of Activity 1, verify that the computer lab is reserved for your classes or that the classroom computers are set up for the activities.

Refer to Using the Web Site for details about hardware and software requirements for the Web site. All computers should have a sound card and Macromedia Flash Player. Check that the Internet connection is working properly.

Set the computers to the opening screen for the activity. Log on to the student activities section of the Web site by entering the following URL: http://science.education.nih.gov/supplements/mental/student. Select “Lesson 2—What’s Wrong?” This allows students to begin the activity directly.

For classrooms using the print-based version of Activity 1, cut each medical chart into three parts as indicated. Place the three parts of each medical chart on a table where students can collect them one at a time as needed. Teams will analyze one of Medical Charts A through D first; when they complete that analysis, each team will analyze either Chart E or F. See Steps 3 to 5 in the procedure. Place the copies of Master 2.3, Doctors’ Reference Manual, at stations around the classroom.

Activity 2
No preparation is necessary.

Activity 3

For classrooms using the Web-based version of Activity 3, verify that the computer lab is reserved for your classes or that the classroom computers are set up for the activities.

Refer to Using the Web Site for details about hardware and software requirements for the Web site. All computers used with this module need to have a sound card and Macromedia Flash Player. Check that the Internet connection is working properly.

If using the Web-based version of this activity, set the computers to the opening screen for the activity. Log on to the student activities section of the Web site by entering the following URL into your browser: http://science.education.nih.gov/supplements/mental/student. Select “Lesson 2—What’s Wrong?” Click on "Looking Inside the Brain." This allows students to begin the activity directly.

Procedure

Activity 1: What’s the Health Problem?

For classes using the Web-based version of this activity:

Explain to students that they will play the role of medical interns who are completing a clinical experience with a doctor.

You may want to explain to students that case studies similar to those in this lesson are an important part of doctors’ professional lives. Analyzing cases helps physicians learn about the process of diagnosing and treating patients as well as the characteristics of various diseases.

Organize the class into teams of two to three students. Number the teams 1 through 8 and explain that each team will analyze two cases. Distribute 1 copy of Master 2.1, Analyzing the Cases, to each team and tell students they will work with their team members to complete the chart for each of their cases.

There are six different cases in this activity. The Web program selects two cases for each team to analyze according to the team’s number. Teams will analyze one of Cases A through D first, and then either Case E or F. As long as you have at least four teams, each of the six cases will be viewed by at least one team.

Tell students that when they get to the computers, they will click on their assigned team number and then begin to review the first of their two cases. Inform students that they can get more information following Part 2 and during Part 3 by clicking on the button “Doctors’ Reference Manual.”

Be sure all of the computers have loaded the page for Lesson 2 that includes links for “The Cases” and “Looking Inside the Brain.” See Preparation for Activity 1. The “Doctors’ Reference Manual” will not be available for Part 1, but it will appear when students get to Parts 2 and 3. After students complete a part of the case, they can watch it or a previous part again. The programming does not permit students to watch parts out of sequence. They must watch Part 1 before they can watch Part 2, for example.

Direct teams to computer stations. Circulate around the room to make sure that all groups understand their task.

As teams complete their work, distribute transparency pens and transparencies made from Masters 2.4, 2.5, and 2.6, Comparing the Cases, to the appropriate teams. Ask teams to complete the column for one of the cases they analyzed.

Rotate the transparencies among the teams in round-robin fashion. Teams that receive a transparency with a column already completed by another team should make check marks beside the symptoms, information, and health problems they agree with and add any additional information they have.

If you have more than six teams, some teams (for example, those that take longer to complete their analysis) may not complete any of the columns on the transparencies. They can add their information during the class discussion in Step 6.

Tip from the field test: An alternative to rotating the transparencies among the teams may save time. Make two copies of each transparency so that one team can fill in its information for one of the columns at the same time another team fills in the information for the other column. In Step 6, layer the matching transparencies so that you can display all the information at once.

Some teams are likely to finish analyzing their two cases before other teams are finished. If they have time after completing this step, ask them to view and analyze one to four more cases. Tell them to click on “Next Case” again.

Display the completed transparencies (Masters 2.4, 2.5, and 2.6, Comparing the Cases) one by one and hold a class discussion about each one, during which students respond to the following discussion questions:

What was the first symptom (or health complaint)?
What possible health problems did you list after Part 1?
After watching Part 2, did you rule out any of the possible problems? Why or why not?
Did you add any other possibilities? Why or why not?
After watching Part 3, what did you decide the health problem was?
How did you rule out the other possibilities?
What part of the body is directly affected by this problem?
How much time passed between Part 1, when symptoms were first noticed, and Part 3, when the doctor was ready to diagnose the problem?

Tip from the field test: Don’t let this discussion drag. It isn’t really necessary to record every symptom in the charts. Move on as soon as students recognize that a patient’s symptoms help them narrow down the possible health problems to the most likely problem. The important result of the questioning is that students recognize that doctors use symptoms to determine what a patient’s health problem is and that knowing more information also helps doctors rule out other problems.

The following are examples of how the completed transparencies might appear:

Master 2.4, *Comparing the Cases: A and B*
Part		Case: Alex A.	Case: Alex B.
1	Symptoms and other information	Sore throat	Sore throat
1	Possible health problem(s)	Cold; history test	Cold; history test
2	New symptoms and information in Part 2	Stuffy, runny nose; slightly red throat; very low fever	Red and white patches on tonsils; fever; swollen lymph nodes
2	Possible health problem(s)	Cold; allergies	Cold, strep throat
3	Time passed since Part 1 (when symptoms first appeared)	1 day	1 day
3	Probable health problem	Cold	Strep throat
	Part(s) of the body affected	Throat, nose	Throat

Master 2.5, *Comparing the Cases: C and D*
Part		Case: Abby C.	Case: Abby D.
1	Symptoms and other information	Sore chest; can’t breathe	Sore chest; can’t breathe
1	Possible health problem(s)	Cold; allergies; asthma	Cold; allergies; asthma
2	New symptoms and information in Part 2	Wheezing in lungs; coughing up mucous; low fever	Wheezing in lungs; mom has allergies and uncle has asthma; had bronchitis 4 times in past year
2	Possible health problem(s)	Cold; bronchitis; pneumonia; asthma	Cold; allergies; bronchitis; asthma
3	Time passed since Part 1 (when symptoms first appeared)	2 nights	2 nights
3	Probable health problem	Bronchitis	Asthma
	Part(s) of the body affected	Lungs; bronchial tubes	Lungs; bronchial tubes

Master 2.6, *Comparing the Cases: E and F*
Part		Case: Jenna E.	Case: Jenna F.
1	Symptoms and other information	Not interested in usual activities; sad; poor appetite; grades went down	Not interested in usual activities; sad; poor appetite; grades went down
1	Possible health problem(s)	Nothing; depression; sadness	Nothing; depression; sadness
2	New symptoms and information in Part 2	Grandpa died 2 months ago; grades back up; more interested in usual activities	Grandpa died 2 months ago; not sleeping well; no confidence; often angry at parents; quit band
2	Possible health problem(s)	Nothing; sadness	Depression; sadness
3	Time passed since Part 1 (when symptoms first appeared)	6 weeks	6 weeks
3	Probable health problem	Nothing OR sadness* (but it’s over now)	Depression*
	Part(s) of the body affected	Brain	Brain
*Students may feel that both Cases E and F are examples of sadness, or that both are examples of depression. Either determination is acceptable at this time. In Activity 2, students will compare the cases more carefully using the definition of depression. That exercise will establish that Case E is an example of sadness and Case F is an example of depression.

Content Standard A:
Develop descriptions, explanations, predictions, and models using evidence. Recognize and analyze alternative explanations and predictions.

In the discussion, emphasize to students that they determined the health problem based on the patients’ symptoms. As the cases progressed, the patients displayed additional symptoms that helped the teams rule out some possibilities. The availability of the “Doctors’ Reference Manual” following Parts 2 and 3 also may have led them to suggest other possible health problems that were consistent with the symptoms. Also point out that the time course for each problem varied.

The cases are organized in pairs: A and B, C and D, and E and F. You may want to point out to students that the first scene is identical for each pair. This emphasizes that the same symptoms are often characteristic of more than one illness, at least initially. As doctors continue to gather information about an individual’s symptoms, they can be more sure of their diagnosis.

After all teams report their findings, emphasize again to students that they narrowed down and decided on the probable health problems based on the symptoms that the individuals displayed.

Note that for a few cases, doctors could use distinct medical tests (such as strep tests, blood tests, chest X-ray, or pulmonary function tests) to confirm their diagnoses. But the doctors could be fairly certain of their diagnoses for all of the health problems simply by analyzing the symptoms.

For classes using the print-based version of this activity:

Explain to students that they will play the role of medical interns who are completing a clinical experience with a doctor. They will review medical charts from two of the doctor’s cases.

Organize the class into teams of two to three students. Number the teams 1 through 8 and explain that each team will analyze two medical charts. Distribute one copy of Master 2.1, Analyzing the Cases, to each team and tell students that they will work with their team members to complete the chart for each of their cases.

There are six different cases in this activity. Each team analyzes two of the six cases, as indicated in the tables following Steps 3 and 5. Teams will analyze one of Cases A through D first, and then either Case E or F. As long as you have at least four teams, each of the six cases will be analyzed by at least one team.

Write the team numbers and the medical charts for the first cases assigned to them on the board or a transparency, as indicated in the following table. Point out the location of the medical charts. Make sure students understand that they should collect and analyze just one part of their chart at a time (Part 1, then Part 2, then Part 3).

Team Assignments
Team	Medical chart for first case
1	A
2	B
3	D
4	C
5	B
6	D
7	C
8	A

Tell students that after they collect Part 1 of their medical chart, they should work with their team members to complete the first part of the table on Master 2.1, Analyzing the Cases. After teams finish each part, they should collect the next part and complete the appropriate section of the table.

After students complete Part 1, tell them they can get more information about specific illnesses from Master 2.3, Doctors’ Reference Manual, and indicate where they can find those pages.

As the teams are finishing their analyses of their first cases, write the team numbers and the medical charts for the second cases assigned to them on the board or on a transparency, as indicated in the following table. Make Parts 1, 2, and 3 of the medical charts for the second cases available to students. Tell the teams to complete the other column on Master 2.1, Analyzing the Cases, for this case as they did for their first case. Again, students should collect and analyze one part of the chart at a time.

Team Assignments
Team	Medical chart for second case
1	E
2	F
3	F
4	E
5	E
6	E
7	F
8	F

As teams complete their work, distribute transparency pens and transparencies made from Masters 2.4, 2.5, and 2.6, Comparing the Cases, to the appropriate teams. Ask teams to complete the column for one of the cases they analyzed.

Tip from the field test: An alternative to rotating the transparencies among the teams may save time. Make two copies of each transparency so that one team can fill in their information for one of the columns at the same time that another team fills in the information for the other column. In Step 7, layer the matching transparencies so that you can display all the information at once.

Some teams are likely to finish analyzing their two cases before other teams are done. If they have time after completing Step 6, ask them to read and analyze another case. Give them either Medical Chart E or F, depending on which one they already analyzed.

Display the completed transparencies (Masters 2.4, 2.5, and 2.6, Comparing the Cases) one by one and hold a class discussion about each one, during which students respond to the following discussion questions:

What was the first symptom (or health complaint)?
What possible health problems did you list after Part 1?
After reading Part 2, did you rule out any of the possible problems? Why or why not?
Did you add any other possibilities? Why or why not?
After reading Part 3, what did you decide the health problem was?
How did you rule out the other possibilities?
What part of the body is directly affected by this problem?
How much time passed between Part 1, when symptoms were first noticed, and Part 3, when the doctor was ready to diagnose the problem?

Tip from the field test: Don’t let this discussion drag. It isn’t really necessary that every symptom is recorded in the charts. Move on as soon as students recognize that a patient’s symptoms help them narrow down the possible health problems to the most likely problem. The important result of the questioning is that students recognize that doctors use symptoms to determine what a patient’s health problem is and that knowing more information also helps doctors rule out other problems.

The following are examples of how the completed transparencies might appear:

Master 2.4, *Comparing the Cases: A and B*
Part		Case: Alex A.	Case: Alex B.
1	Symptoms and other information	Sore throat	Sore throat
1	Possible health problem(s)	Cold; history test	Cold; history test
2	New symptoms and information in Part 2	Stuffy, runny nose; slightly red throat; very low fever	Red and white patches on tonsils; fever; swollen lymph nodes
2	Possible health problem(s)	Cold; allergies	Cold, strep throat
3	Time passed since Part 1 (when symptoms first appeared)	1 day	1 day
3	Probable health problem	Cold	Strep throat
	Part(s) of the body affected	Throat, nose	Throat

Master 2.5, *Comparing the Cases: C and D*
Part		Case: Abby C.	Case: Abby D.
1	Symptoms and other information	Sore chest; can’t breathe	Sore chest; can’t breathe
1	Possible health problem(s)	Cold; allergies; asthma	Cold; allergies; asthma
2	New symptoms and information in Part 2	Wheezing in lungs; coughing up mucous; low fever; mom has allergies	Wheezing in lungs; mom has allergies and uncle has asthma; had bronchitis 4 times in past year
2	Possible health problem(s)	Cold; bronchitis; pneumonia; asthma	Cold; allergies; bronchitis; asthma
3	Time passed since Part 1 (when symptoms first appeared)	2 nights	2 nights
3	Probable health problem	Bronchitis	Asthma
	Part(s) of the body affected	Lungs; bronchial tubes	Lungs; bronchial tubes

Master 2.6, *Comparing the Cases: E and F*
Part		Case: Jenna E.	Case: Jenna F.
1	Symptoms and other information	Not interested in usual activities; sad; poor appetite; grades went down	Not interested in usual activities; sad; poor appetite; grades went down
1	Possible health problem(s)	Nothing; depression; sadness	Nothing; depression; sadness
2	New symptoms and information in Part 2	Grandpa died 2 months ago; grades back up; interested in volleyball again	Grandpa died 2 months ago; not sleeping well; no confidence; often angry at parents; quit band
2	Possible health problem(s)	Nothing; sadness	Depression; sadness
3	Time passed since Part 1 (when symptoms first appeared)	6 weeks	6 weeks
3	Probable health problem	Nothing OR sadness* (but it’s over now)	Depression*
	Part(s) of the body affected	Brain	Brain
*Students may feel that both Cases E and F are examples of sadness, or that both are examples of depression. Either determination is acceptable at this time. In Activity 2, students will compare the cases more carefully using the definition of depression. That exercise will establish that Case E is an example of sadness and Case F is an example of depression.

Content Standard A:
Develop descriptions, explanations, predictions, and models using evidence. Recognize and analyze alternative explanations and predictions.

In the discussion, emphasize to students that they determined the health problem based on the patients’ symptoms. As the cases progressed, the patients displayed additional symptoms that helped the teams rule out some possibilities. The availability of Master 2.3, Doctors’ Reference Manual, following Parts 2 and 3 also may have led them to suggest other possible health problems that were consistent with the symptoms. Also point out that the time courses for each problem varied.

The cases are organized in pairs: A and B, C and D, and E and F. You may want to point out to students that the first part of the medical chart is identical for each pair. This emphasizes that the same symptoms are often characteristic of more than one illness, at least initially. As doctors continue to gather information about an individual’s symptoms, they can be more sure of their diagnosis.

After all teams report their findings, emphasize again to students that they narrowed down and decided on the probable health problems based on the symptoms that the individuals displayed.

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The Science of Mental Illness

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