The scrupulosity syndrome.
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The diagnosis "brief reactive psychosis" leaves little implied in the way of etiology or treatment approach. Three case histories are presented to illustrate the term, followed by brief summaries of the major dynamics involved. The older diagnostic term "hysterical psychosis" is discussed, and a parallel is drawn between this form of brief reactive psychosis and others so that they may be psychodynamically understood and that treatment may be rationally based upon this model.
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A total of 52 patients (28 males and 24 females from 16.5 to 21.5 years of age) observed in childhood because of obsessional neuroses were studied. All the studied cases were divided into 3 groups: patients with obsessional movements and actions, patients with obsessional fears and patients with obsessions of the mixed type. Follow-up studies of the patients demonstrated that the prognosis of obsessional states with an onset in childhood and adolescency should not be based only on the duration of the disease. It depends on the combination of a number of factors: the clinical form of neuroses, type of development, traits of the "basis", stage of psychophysical development, determing evolution of the disease and degree of social adaptation.
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Psychosocial and standard risk factors were assessed in 21 young males aged 32--45 admitted for acute myocardial infarction. All patients underwent extensive clinical, dietary and psychosocial investigation by a team of cardiologists, psychiatrists, dieticians, social workers and physiotherapists both during hospitalization and later at home. Most standard risk factors were found infrequently and the estimated risk of coronary disease would have been low. Heavy smokers (1--4 packs of cigarettes per day) totalled 20/21 patients. In every case the patients, before myocardial infarction, had sustained severe long-term stress in their professional, social and/or familial environments. With rigid and obsessive personality patterns, they appeared to be the prisoners of their problem situations and totally unable to relax. Severe psychosocial stress and heavy smoking appear to be almost constant findings in young males admitted with acute myocardial infarction.
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