Emotion, learning and health

Emotion, learning and healthEmotion, learning and health

Preston Lodge High SchoolPreston Lodge High School

2626thth October October

2020thth century trends in life expectancy in Scotland century trends in life expectancy in Scotland and 16 other Western European countriesand 16 other Western European countries

Males

30

40

50

60

70

80

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000Year of birth

Life

exp

ecta

ncy

in y

ears

Scotland

Its all about the brainIts all about the brain

All shapes and sizes!All shapes and sizes!

Aaron Antonovsky 1923-1994Aaron Antonovsky 1923-1994

“.....expresses the extent to which one has a feeling of confidence that the stimuli deriving from one's internal and external environments in the course of living are structured, predictable and explicable, that one has the internal resources to meet the demands posed by these stimuli and, finally, that these demands are seen as challenges, worthy of investment and engagement."

Sense of coherence....Sense of coherence....

For the creation of health....For the creation of health....

....the social and physical environment must ....the social and physical environment must be:be:

ComprehensibleComprehensible ManageableManageable MeaningfulMeaningful

00-046

-1.2

-1

-0.8

-0.6

-0.4

-0.2

0 10 20 30 40 50

Months of Orphanage Rearing

*linear trendline

Evening Cortisol Levels Increase withMonths of Orphanage Rearing *

The Founders’ Network

STRESS AND GRADE OF EMPLOYMENT: MEN

0

2

4

6

8

10

12

14

16

18

2008

-8.3

0

10-1

0.30

12-1

2.30

14-1

4.30

16-1

6.30

18-1

8.30

20-2

0.30

22-2

2.30

nmol

/l Higher GradeLower Grade

Salivary Cortisol

Time of DaySteptoe et al. 2003, Psychosomatic Medicine, 65, 461-470

2020thth century trends in life expectancy in Scotland century trends in life expectancy in Scotland and 16 other Western European countriesand 16 other Western European countries

Males

30

40

50

60

70

80

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000Year of birth

Life

exp

ecta

ncy

in y

ears

Scotland

Attachment theory

“Infants develop the attachment behaviours that optimally enhance their survival in their own characteristic environments.”

Crittenden, 2000

Attachment theoryAttachment theory

AinsworthAinsworth– Deep emotional connection that infant develops with Deep emotional connection that infant develops with

primary caregiverprimary caregiver– Reflects an “internal working model”expressing the Reflects an “internal working model”expressing the

infant’s expectations of parental behaviour in infant’s expectations of parental behaviour in meaningful situationsmeaningful situations

– Basis for development of later relationshipsBasis for development of later relationships Increasingly recognised as determinant of later emotional, Increasingly recognised as determinant of later emotional,

cognitive and social outcomescognitive and social outcomes

“Serve and return”

“The ‘instruction’ to attend to the primary caregiver is genetic, the outcome depends on what happens”

Balbernie, 2001

Engaged to respond to danger

Disengaged...Who needs to bother about differential calculus?

Depcat % smokers Never-smokers Smokers

1 36.8 0.71 1.42

2 35.9 1.00 2.34

3 39.1 1.11 2.25

4 44.1 1.21 2.44

5 46.6 1.13 2.53

6 49.3 1.25 3.07

7 55.5 1.48 3.29

Environmental determinants of Environmental determinants of inflammatory status inflammatory status

CRP (median) mg/dl

affluent

deprived

PP<0.001<0.001

PP<0.001<0.001

PP=0.03=0.03

Quartile of hs-CRP (Range, mg/dL)Quartile of hs-CRP (Range, mg/dL)

P P Trend <0.001Trend <0.001

0.0550.055 0.056–0.1140.056–0.114 0.115–0.2100.115–0.210 0.2110.211

Rel

ativ

e R

isk

of

MI

Rel

ativ

e R

isk

of

MI

Ridker. N Engl J Med. 1997;336:973–979.

0

1

2

3

1 2 3 4

hs-CRP and Risk of Future MI hs-CRP and Risk of Future MI in Apparently Healthy Men in Apparently Healthy Men

Inflammation in plaquesInflammation in plaques

Inflammatory cellsInflammatory cells

MMPs, IL-6, MMPs, IL-6, IL-15, IL-18, CRPIL-15, IL-18, CRP

LumenLumen

CoreCore

CapCap

Thin Thin Fibrous CapFibrous Cap

InflammatoryInflammatoryCellsCells

SMCSMC apoptosisapoptosis

DegradedDegradedmatrixmatrix

UnstableUnstable

cytokinescytokines MMPMMP

0

1

2

3

4

5

0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5

Q1 : <0.66 mg/l

Q5: > 4.18 mg/l

Years in study

% diabetic

CRP and cumulative risk of type 2 diabetes

Freeman et al. Diabetes 2002,51;1596

Adipocyte programmingAdipocyte programming insulin resistance, inflammation and ALPinsulin resistance, inflammation and ALP

Adipose stores

NEFAs

liver

CRPSAA

IL-6/IL-6sR

TNF-TNF-sR-I

triglyceride

Low HDLsmall LDL

AtherogenicLipoproteinPhenotype

Pro-inflammatorystate

skeletal muscleInsulin resistance

The Stroop Testa test of ‘response inhibition’

Say the colournames of the shapes

Say the word namesSay the names of the colours that the words are printed in

Shapes Words

pSoBid: Stroop test

0

20

40

60

80

100

120

35-44 45-54 55-64

MD

LD

p<0.001

Age (years)

Co

lou

r-w

ord

sc

ore

pSoBid: Verbal Learning

0

2

4

6

8

10

12

14

35-44 45-54 55-64

MD

LD

p<0.001

Age (years)

Wo

rd

reca

ll

The Trails Test:a test of “executive function”

Trails “A” Trails “B”

pSoBid: Trails B

0

20

40

60

80

100

120

35-44 45-54 55-64

MD

LD

p<0.001

Age (years)

Sec

on

ds

pSoBid: Choice reaction time

0

200

400

600

800

1000

1200

35-44 45-54 55-64

MD

LD

p<0.001

mill

isec

on

ds

Age (years)

pSoBid: psychological state

0

5

10

15

20

25

30

35

GHQ SoC RSE BHS GSE

LD

MD

All p<0.001

GHQ = General Health Questionnaire; SoC = Sense of Coherence; RSE = Rosenberg Self-Esteem Scale;BHS = Beck Hopelessness Scale; GSE = Generalised Self-Efficacy Scale

The Dunedin cohortThe Dunedin cohort 1000 children recruited in late 1972/31000 children recruited in late 1972/3 At age 3, “at risk” children identified on the basis of chaotic At age 3, “at risk” children identified on the basis of chaotic

circumstances, emotional behaviour, negativity and poor circumstances, emotional behaviour, negativity and poor attentivenessattentiveness

As adults, those “at risk” were more likely to :As adults, those “at risk” were more likely to :– be unemployedbe unemployed– have criminal convictions (especially for violence) have criminal convictions (especially for violence) – been pregnant as a teenagerbeen pregnant as a teenager– have a substance abuse problemhave a substance abuse problem– exhibit signs of insulin resistance and metabolic syndromeexhibit signs of insulin resistance and metabolic syndrome

Opportunity to escape Opportunity to escape poverty, decent housing, poverty, decent housing,

social networks, self esteem social networks, self esteem and sense of controland sense of control

Consistent parenting, safe, Consistent parenting, safe, nurturing early years, nurturing early years, supportive educationsupportive education

Health related Health related behavioursbehaviours

Opportunity to escape Opportunity to escape poverty, decent housing, poverty, decent housing,

social networks, self esteem social networks, self esteem and sense of controland sense of control

Consistent parenting, safe, Consistent parenting, safe, nurturing early years, nurturing early years, supportive educationsupportive education

Health related Health related behavioursbehaviours

Comprehensible

Manageable

Meaningful

How many new neurons?How many new neurons?

>9,000 per day – 250,000 per month in the young adult rat (Cameron & McKay, 2001)

Adult neurogenesis in the hippocampus

?

2020thth century trends in life expectancy in Scotland century trends in life expectancy in Scotland and 16 other Western European countriesand 16 other Western European countries

Males

30

40

50

60

70

80

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000Year of birth

Life

exp

ecta

ncy

in y

ears

Scotland

Fit or fat?Fit or fat?