Content warning: addiction, mental-health in-patient facilities, PTSD, animal experimentation, suicide and self-harm
The Nottingham Young Quakers headed into this year’s Pint of Science energised by the triumph that was the Quaker Bake Off. To summarise: Quakers of all ages came together to make sure we didn’t run out of cake; the courgette and lemon cake in particular was praised for being delicious and moist; and it’s hard to overstate my satisfaction with the £151 we raised for Care International!
Anyway, look at me still talking when there’s science to do! Sitting down to write this I’m quite overwhelmed by all the things we learned, but I shall try to convey to you the key points, for the good of all of us.
The first evening was entitled Learn to Behave and opened with Prof Maddie Groom talking about ADHD. She recommended the Horizon documentary ADHD and Me with Rory Bremner as an excellent introduction to the subject and having watched it myself I have to agree, although I did find some of the language used problematic (such as ‘normal’ and ‘healthy’ as opposed to ‘typical’ or ‘non-ADHD’). Unfortunately it is no longer available on iPlayer but there are a few clips available to view here. ADHD is characterised by a triad of symptoms comprised of inattention, hyperactivity, and impulsivity. Most people possess these traits to some extent, but diagnosis of ADHD depends on the degree to which the individual is impaired by them. There is a common misconception that ADHD is a new condition, however there is evidence of attempts to define the condition that we now know as ADHD as early as 1775 (as discussed in the Rory Bremner programme).
Prof Groom conducted an exercise (a simple Go/NoGo task) with the audience where we had to clap when we saw a letter K on the screen and not clap when we saw a letter X (or maybe it was the other way around). This demonstrated that some of the audience found it easier than others (Abi) to control the impulse to clap as soon as a letter appeared. Prof Groom explained how similar tests had been used to asses the ‘wandering minds’ of people with ADHD. She showed us some slides (unfortunately I did not get any good pictures, but the points of data made a beautiful line) illustrating how children with ADHD who were on medication and children without ADHD were able to switch off their ‘mind-wandering’ for little to no reward, in contrast to children with ADHD who were not on medication who were only able to do this for a strong incentive.
Finally Prof Groom spoke about developments in helping people with ADHD to concentrate, and specifically EEG feedback. This uses an EEG (a test that detects electrical activity in the brain) to determine how hard a person is concentrating and then feeds this back to the person. Ironically enough, I seem to have missed the part where she explained how this results in a change of behaviour, but it might have been as simple as making someone aware of when they’re concentrating or not concentrating so they can try to concentrate more. Prof Groom described this work as very promising, but there is still research to be done in order to provide the evidence that it is an effective treatment.
The second scientist of the night was Dr Maria Kontogianni, who was a fantastic speaker and had the audience in hysterics for most of her talk. Other than the rivalry between Nottingham University and Nottingham Trent University, she spoke about why humans seek relationships. Dr Kontogianni explained that this was because of three needs: the needs to affiliate, to be intimate, and to belong. She added that these could be fulfilled through platonic and familial relationships as well as romantic and/or sexual relationships.
Dr Kontogianni then spoke in a little more depth on the subject of intimate partner relationships. She noted that being ‘in love’ for more than a few months would be unsustainable because of the sheer amount of stress that it places on the body! Dr Kontogianni also introduced us to Sternberg’s triangular theory of love, which describes three components of love: passion, intimacy and commitment. For a successful relationship all three components must be strong but they must also be in balance. Dr Kontogianni noted that many people give up too easily when things become difficult in relationships, where as in fact it is natural for the strength of these components to vary over time.
At the end of this talk an audience member asked Dr Kontogianni whether it was possible to love more than one person at once, and her answer was a resounding yes! When she elaborated it became clear that she was focussing more on infidelity and the difficulties that such relationships bring but her initial reaction at least is good news for those who support consensual non-monogamy.
Dr Kontogianni’s talk was followed by a much-needed break, in which the NYQs tried their hand at a number of activities. One involved saying out loud the colour of some words on a screen, with the added complication being that the words themselves were the names of different colours. Out of a field of around thirty competitors I managed the fifth best time whilst another NYQ (Abi) claimed first place with a time of just 9.37 seconds!
There was also a game of Mr and Mrs, which sounded pretty heteronormative but in the end was anything but! The two pairs of contestants were Dr Kontogianni and her same-sex partner, and NYQ best-friends Abi and Laura. Our team thrashed the competition with an impressive four out of five correct answers, scooping a Pint of Science goody bag each as a prize!
After the break Prof Charlotte Bonardi discussed the concept of addiction as a learned behaviour. Her main focus was on Pavlovian conditioning and how things which are bad for us (such as cigarettes or alcohol) become associated with a pleasant experience. This also has implications for relapse, as if a person finds themselves in a situation that they associate with the thing that they are trying to give up it can be difficult to resist.
Prof Bonardi showed us some interesting research involving images of cigarettes, some randomly generated images, and pressing of keys on a keyboard. Unfortunately the notes that I took on this talk lack sufficient detail so I will try to explain from memory, with the caveat that this may be completely wrong. As far as I recall, participants (who were smokers) had to press a key when an image of cigarettes or an associated randomly generated image appeared and not press a key when another randomly generated image appeared, and this produced a strong correlation of some kind. The participants were then told not to press the key when the image of cigarettes was accompanied by another randomly generated image, and according to my notes ‘responding reduced significantly’. I’m not doing a very good job of explaining it but it was fascinating, although Prof Bonardi has not identified any practical applications of this research at this time.
The second evening was entitled Mental Healthy and we started with Prof Peter Liddle talking to us about schizophrenia. He spoke about how the way we have managed patients with this condition in the past and how we approach it today. Prof Liddle recalled visiting an asylum in 1976 where 20% of the patients with a schizophrenia diagnosis were age disorientated; that is, although they were aware that they had resided in the institution for many years they reported their own age to be within 5 years of their age at the time of admission. By the late 1990s there had been a shift towards community management and age disorientation in this population almost vanished. The hypothesis was that this was the results of being able to interact with the wider world.
The symptoms of schizophrenia include reality distortion, disorganised mental activity and impoverished mental activity, and scans have shown that patients with schizophrenia have enlarged ventricles in their brains. There are at least 100 known causes of the condition including 18-19 different genes and it appears that none of these are sufficient to cause schizophrenia on their own, only in combination with others. Prof Liddle is of the opinion that a new name is needed for the condition to reflect the diverse causes and communicate the different ways it affects a person’s processing without the baggage associated with the label of schizophrenia.
Treating schizophrenia is also a complex task. One factor associated with reality distortion appears to be excess dopamine and therefore dopamine blockers can be used, which help relieve this symptom but also impair motivation and learning, leaving the patient in a zombie-like state. Nevertheless, for some people they are still helpful, although the doses currently prescribed are orders of magnitude smaller than those used in the 1980s. Prof Liddle noted that the brain is very plastic and that you can in fact teach an old dog new tricks. As an example, he cited the Knowledge, the world-famous assessment undertaken by taxi drivers in London. Drivers who had acquired the Knowledge were found to have a larger hypocampus due to having more connections between the same number of cells.
Overall, what appears to be the best approach for patients with schizophrenia is far more compassionate than our approach to managing mental health in the past. Prof Liddle recommends practicing the things the patient needs to do, physical and mental activity, and a genuinely stimulating environment, far from the sterile asylums of the 1970s.
Prof Liddle was followed by Ms Harriet Day who explored why PTSD is more common in female than males, in rats as well as humans! Her research involved playing one of two tones and giving rats an electric shock following one but not the other. After one day, males did not distinguish between the two tones but after three days they displayed fear by freezing more for the tone associated with the shock. The females showed the opposite effect, quickly distinguishing between the two tones but over time starting to show fear of both tones. When they changed which tone was associated with the electric shock the males were slower to learn than the females. The researchers concluded that the male rats had learnt that the tone with no shock associated meant ‘safe’ whilst the females attached no meaning to this tone.
Ms Day concluded by talking about the differences in experiences of PTSD in male and female humans, which is believed to have some evolutionary source but has since been reinforced by messages in the media. Research has shown that male humans with PTSD are less able to distinguish between potentially triggering stimuli, and research on female humans is currently ongoing.
The last talk of the night – and, indeed, NYQ’s time at Pint of Science – was on the topic of self-harm in young people. It is here that my notes let me down again as it was billed to be delivered by Prof Ellen Townsend however I have noted the name Emma Neilsen, suggesting to me that one was in fact presenting the work of the other, although which way around this was I could not say. (After submitting this article, Abi informed me that this talk was delivered by Prof Townsend and included research by Ms Neilsen.) The speaker opened by discussing some of the language we use around self-harm, with ‘died by suicide’ being preferable to ‘committed suicide’ (which is a hangover from suicide being a criminal offence in the UK until 1961) and ‘person who self-harms’ being preferable to ‘self-harmer’ (which is more labelling and less supportive of change). Suicide is a leading cause of death in young people aged 5 to 19 years, with a peak in suicide and self-harm in late teens and 50% of deaths by suicide being young people who had previously self-harmed. Indeed, approximately 1 in 5 of the population will be affected by suicide in some way, with each death by suicide affecting an average of 115 people.
Research has tended to focus on either a few factors contributing to suicide and self-harm or on high-risk groups. A small study of 56 young offenders provided a snapshot highlighting low self-esteem, anxiety, depression, impulsivity and alcohol all as relevant factors, with low self-esteem being the most important. A longitudinal study found that an insecure attachment style led to repeated self-harm, less improvement in problem solving, and poorer concordance with therapy. There are also many other related issues which vary in personal importance.
Interestingly, our abilities to predict whether someone is at risk of suicide or self-harm have not improved in the past 50 years. Current approaches tend to concentrate on understanding why young people self-harm or attempt suicide by focusing on thoughts, feelings, events and behaviours, using sequence analysis to enable researchers to understand the complex pattern of events in the lead up to an act of self-harm and spot key patterns.
One way to do this is using a Card sort Task for Self-harm (CaTS), where young people are asked about their first and their most recent act of self-harm, using pre-made cards and making their own. In this study young people aged 11 to 21 years used 117 cards to describe what was going on for them in the 6 months to 1 hour before self-harming, during the act of self-harm, and after. Researchers looked at what card pairing occurred together most recently and found that immediately before the first act of self-harm impulsivity was the most important factor, before which it was opportunity. Afterwards feelings were complex, but generally better than before, however for the most recent act of self-harm the better feelings had disappeared and there were more negatives. The young people involved had high levels of mistrust and felt that they had no one to talk to. Despite common concerns, talking about self-harm did not make them feel worse and actually helped them to feel slightly better, and they particularly liked the card-sort approach.
When it comes to helping young people who are at risk of suicide or self-harm they generally rate clinical services as unhelpful, with psychological (talking) therapies helpful for those over the age of 18 years but not adolescents, although there are some promising trials. The best advice for those supporting young people in distress is to listen, be non-judgemental and compassionate, and encourage self-care.
After a frantic few days that included Eurovision, the Quaker Bake Off and Pint of Science, the Nottingham Young Quakers were somehow still alive, and their lives greatly enriched by their experiences. All in all, a huge success, although I think I prefer to stay inside for a few days to recover!