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.

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.

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.

L-tryptophan 50 mg/kg was administered orally to patients suffering from either unipolar or bipolar affective illness, and the concentration of 5-hydroxyindol-acetic acid estimated in their cerebrospinal fluid eight hours later. There was no significant difference between the patient groups or between these and patients with neurological disease. These findings suggest a reduced neuronal activity in the 5-hydroxytryptaminergic system in some depressed patients rather than an absolute deficiency of tryptophan-5-hydroxylase. The synthesis of 5-HIAA in response to tryptophan varied with age.

The concentration of 3-methoxy-4-hydroxyphenylglycol (MHPG) in the cerebrospinal fluid of patients suffering from unipolar depressive illness did not differ significantly from the concentration in a neurological control group. After recovery there was a small but significant decrease in the concentration of MHPG and there was positive correlation between the concentration of MHPG and severity of depression as measured by the Beck Inventory. There was no correlation between urinary excretion of MHPG and the concentration of MHPG in cerebrospinal fluid. In contrast with the findings in cerebrospinal fluid there was a significant increase in the urinary excretion of MHPG after recovery.

Two different types of hypothyroidism can occur during lithium administration, one with evidence of underlying thyroiditis, the other without. Two cases are reported, one of type 1, the other of type 2, and 17 other cases of lithium-induced hypothyroidism in the literature are reviewed. The literature on the occurrence of goitre during lithium treatment, and that on the alteration of thyroid function tests are also reviewed. Possible mechanisms for the disturbance of thyroid function are discussed and recommendations for managing this complication of lithium therapy are made.

In an experiment to investigate the relationship of exercise response to the personality dimensions of introversion-extraversion and neuroticism, 30 subjects filled in an Eysenck Personality Inventory and were later given a standard amount of exercise on a bicycle ergometer, with blood samples being taken before and afterwards to be analysed for lactate and glucose. A highly significant positive correlation was found between neuroticism and the change in blood glucose and a highly significant curvilinear relationship between neuroticism and the increase in blood lactate, with the largest increases in lactate occurring at the extremes of the neuroticism scale. No significant relationship was found between introversion-extraversion and either of the biochemical variables. Hypotheses are put forward to account for the relationship between neuroticism and the change in blood glucose in terms of the action of adrenaline in releasing glucose from the liver, and to account for the relationship between neuroticism and the increase in blood lactate in terms of differing rates of pulmonary ventilation during and after exercise.

A five-year sample of suicide deaths in 82 county boroughs in England and Wales has been examined according to the age and sex of the victims. A number of demographic and other factors were chosen to test out the hypothesis that male suicides were more likely to be associated with other forms of violent death in the community and that female suicides would correlate with a number of variables measuring aspects of sociosexual life. In old age it was postulated that mental and physical illness would outweigh any environmental factors—apart from social isolation—as contributory causes to suicide by both sexes. The fmdings give limited support to the original hypothesis which needs to be checked by a sociomedical investigation of as many suicides as possible in a large number of towns.

An epidemic of falling, confined to one single class of a large comprehensive school in a London suburb, is described. There were 24 adolescent girls in the class, all in the 16 to 17 age group, and the class was involved in examinations. The school authorities decided to close down the class one week before the end of term, when eight girls and a young locum teacher lay unconscious on the floor. Most of the girls affected belonged to the ‘in group’: the very bright, the Greek, the Jewish, and the one coloured girl were unaffected. Although the school refused permission for a sociometric investigation, information was obtained from the school medical officer, from two teachers, and from the two girls who were clearly the most powerful members of the class and the protagonists of the epidemic. They were both referred for medical treatment and, after all physical investigations had proved negative, they were both admitted to a psychiatric hospital for observation and treatment. Their case histories are given in some detail, together with a ‘confession’ written by the girl who started the epidemic. This same girl, during the course of her hospital admission, started a ‘pseudo-pregnancy epidemic’ in her ward. It was discovered that one member of the class had left the school during the course of the previous trimester because she had become pregnant. The epidemic, which appears to follow her childbirth and subsequent death from cerebral haemorrhage, lasted from December to the following July. Possible dynamic factors are discussed.

Forty-nine patients with radiological evidence of cortical atrophy were followed up five to 10 years after their radiographic examination. The survivors were examined personally. The original radiographs were then reassessed to establish features indicating a good and poor prognosis. Dimensions of the body of the lateral ventricle distinguished good and poor prognosis, whereas the appearance of the cortical surface did not.

The Medical Research Council Unit for Metabolic Studies in Psychiatry was set up at Middle-wood Hospital, Sheffield, in 1967. It was to a considerable extent a continuation of the Medical Research Council Unit for the Chemical Pathology of Mental Disorders which had been associated with the Department of Physiology in the University of Birmingham under the direction of Professor I. E. Bush. The latter unit had in its turn largely corne from a group headed by Sir George Pickering at Oxford.

Eugen Bleuler's Dementia Praecox oder die Gruppe der Schizophrenien was published in 1912. Thirty years later an erudite historian of psychiatry referred to it as an epoch-making monograph, a product of many years of careful research—‘the most important contribution to psychiatry made in the 20th century’. It was a bold prediction, and he could hardly have foreseen that in another 30 years there would be another product of many years of careful research into schizophrenia, again providing a classic of psychiatry, the work of yet another Bleuler. There have been many instances of son following father in the psychiatric career but in none of them have father and son tilled the same wide field with the same assiduity and unremitting mastery as these.