A double-blind clinical trial has been carried out to ascertain whether patients making a good recovery from depressive illness with tricyclic antidepressant medication derive any benefit from continuation of therapy with the same drug at a lower dose level. Of the 92 patients who entered the trial significantly fewer on active treatment relapsed during the six-month trial period: 22% as compared with 50% of patients receiving placebo. Patients with residual symptoms on entry to the trial derived more benefit from continuation therapy than patients who had made a complete recovery. The findings relate to a six-month trial period only, and any possible advantage of continuation therapy over a longer period remains uncertain.

Suicide deaths by age and sex have been examined in 28 London boroughs for the period 1959–63. In contrast with the findings in 82 county boroughs, the relationships between suicide and 18 other variables did not differ greatly for the sexes. In old age, as in the previous investigation, most of the variables having high correlations with suicide rates tended to disappear. Loneliness and ill-health were probably more important determinants of suicide rates in the elderly than other environmental or personal attributes. The finding that the distribution of suicide in London has not changed much in 40 years implies a need for the development of services to combat this problem in boroughs where suicide is particularly high.

This paper reports the social results of a double-blind placebo controlled trial of fluphenazine decanoate. Among patients on placebo there was a deterioration in family relationships, which was due to an increase in aggression, noisiness, talking about delusions, and socially embarrassing behaviour after withdrawal of active drug.

In a partly retrospective, partly follow-up study, 27 patients aged 1 year 10 months to 16 years 2 months with reversible somatotropin deficiency, showed a relationship between the rate of statural growth and sleep, graded as good, poor, or mixed. During periods of good sleep the overall growth rate averaged 1·04 cm per month, and during periods of poor sleep it averaged 0·34 cm per month (t=8·46, df=32, P<0·001). Presumably, good growth, good sleep, and optimal nocturnal somatotropin release intercorrelate in this syndrome of dwarfism, but the data with regard to nocturnal somatotropin release remain to be demonstrated empirically.

The brains of 15 retired boxers have been studied and the lives of the men concerned have been investigated in retrospect. A characteristic pattern of cerebral change has been identified which appears not only to be a result of the boxing but also to underlie many features of the punch-drunk syndrome.

New cases of neurotic illness identified during one month by each in turn of eight general practitioners in a London borough were investigated by means of standardized clinical and social interviews. When compared with a matched control group of consulting patients, the index group was found to have experienced significantly more life events during the three months before the onset of illness. Events particularly associated with neurotic illness were unexpected crises and failure to achieve various life goals. The distribution of events suggested that serious, threatening events have an important aetiological role; minor events appear to play a small contributory part which may become critical when the morbid risk is already high. The problems of method involved in this type of investigation are discussed.

Results are presented of pituitary gonadotrophic and testicular steroid hormone assays carried out on 11 phenotypic males with a 47, XYY karyotype. These results are compared with those from a control group of normal ambulant males and a group of patients with a 46, XY karyotype who were detained in a maximum security hospital.

Methods are first described for testing for and measuring the proportion involved in the causal link between life-events and psychiatric disorders; the paper then deals with the nature of the causal effect itself. A method is described (and developed mathematically in an appendix) which enables a choice to be made between a triggering effect in which events are seen as precipitating an illness that would probably have occurred before long for other reasons, and a formative effect in which life-events either substantially advance onset in time, or bring it about altogether. The method is used to demonstrate the presence of a formative effect in depressive and a triggering effect in schizophrenic disorders.

The review deals mainly with the more chronic psychiatric sequelae of head injury. The constellation of factors—psychological, social, and organic—which may contribute to enduring disability are discussed. Principal areas of disability are then considered in detail—namely, intellectual impairments, change of personality, psychotic illness, and neurotic disorders.

Increases in barbiturate tolerance and in scores on certain cognitive tests were found to have occurred after the treatment of elderly depressives. These changes were related to original severity of illness and to the extent of improvement, as well as to a number of other clinical features including age at first attack. The reported findings lent support to theories linking depressive illness with reduction in cortical arousability.

The concentration of the acid metabolites of dopamine, and 5-hydroxytryptamine (5-HT), homovanillic acid (HVA), and 5-hydroxyindolacetic acid (5-HIAA) respectively, were estimated in the cerebrospinal fluid of patients suffering from either unipolar or bipolar affective illness, both before and after recovery. Significantly low concentrations of HVA and 5-HIAA (P<0·01 and 0·05 respectively) were found in the unipolar depressed group and these did not return to normal on recovery. Depressed bipolar patients had levels within normal limits. In bipolar manic patients the HVA concentration fell on recovery to a level significantly lower (P<0·05) than controls. There was no difference in the levels of tryptophan in the CSF of any of the groups of patients nor was there any alteration on recovery. There was a high correlation between 5-HIAA and HVA in the same CSF. These findings are against the amine hypothesis which postulated in depression a lowered concentration of transmitter amine at synaptic junction.

Research in neurosis is reviewed from the standpoint of genetics, phylogenesis, physiology, epidemiology, and prognosis. Family and sociocultural variables are discussed, and experimental paradigms noted. Directions for further research are suggested in these areas, including perceptual and physiological reflex mechanisms triggered in neurosis and in normal people, cross-cultural longitudinal epidemiological studies of specific neurotic syndromes which are linked to family and social variables, factors governing illness behaviour, and field observations of family and marital pathology.

Data on serious psychiatric illness (900 cases), suicide (150 cases), indictable crime (1,300 cases), and child welfare problems (800 cases) in individuals living in Brighton have been collected. Rates of these behavioural pathologies have been calculated for 19 wards in the city, and correlated with data collected in the 1966 Census. Results show that the behavioural pathologies are strongly intercorrelated and are associated with in-migrant areas containing rooming houses of poor quality. These areas tend to be in the city centre. Rates of psychiatric illness, including diagnostic groups in different age and sex groups, have been calculated for 110 enumeration districts in the city, and these rates correlated with factor scores from the principal components analysis of 53 census variables. Complex patterning of the data has been demonstrated. The identification of small areas in the city with high rates of behavioural pathology in particular social settings is an important precursor of the establishment of special measures for prevention and treatment. An important area for future research is the establishment of causal patterns, and the investigation of the primary or secondary role of social conditions in the emergence of mental illness and other behavioural pathology.