Coprolalia is an unintentional, inappropriate, pathologically intrusive utterance of swear words and obscene language. It occurs in a number of mental and neurological diseases: Tourette’s syndrome, schizophrenia, manic syndrome, neuroinfections, Kleine-Levin syndrome, in the post-stroke period. It may be a side effect of taking neuroleptics. Coprolalia is diagnosed by clinical methods (conversation, observation), identification of its causes requires instrumental (MRI, EEG) and laboratory diagnostics. Treatment depends on the etiology of the disorder, includes pharmacopreparations, psychotherapy, rehabilitation techniques.
Causes of coprolalia
Tourette ‘s syndrome
Coprolalia occurs in more than a third of adult patients with Gilles de la Tourette’s disease. More often this phenomenon is observed in male patients. In Tourette’s syndrome, coprolalia is a manifestation of vocal tics, which also include various sound phenomena, echolalia, palilalia, changes in the rhythm and volume of speech. Abusive words are shouted out by patients deliberately loudly, jerkily, impulsively, sometimes aggressively.
Along with involuntary vocalizations, motor tics – hyperkinesis are noted: closing the eyes, frequent blinking, twitching. Sometimes patients can demonstrate obscene gestures – this phenomenon is called copropraxia. Patients are aware of the inappropriateness and unacceptability of their behavior, but they cannot arbitrarily control offensive statements and actions.
Coprolalia in patients with schizophrenia is intertwined with delusional ideas and disorders of thought processes. Characteristic speech symptoms are incoherence, illogical speech, an abundance of neologisms, paraphasias, inability to maintain a conversation. The patient can modify obscene words, but the meaning of swearing at the same time remains obvious and understandable for everyone. The utterance of swear words and obscene phrases is “savored” by the patient, and the shock reaction of others gives satisfaction.
It is observed in bipolar affective disorder, psychoses of organic, infectious genesis, etc. Manic syndrome is characterized by a triad of signs: euphoric mood, acceleration of thought processes (“leap of ideas”), increased craving for activity. Patients are voluble, are in a state of speech excitement: they speak quickly, confusingly, with a pathetic intonation.
Sometimes an elevated mood is replaced by an angry mania, manifested by irritability, bitterness, outbursts of anger. At the height of the condition, aggression and autoaggression, coprolalia may occur. Obscene language is shouted loudly, emotionally, directed at individuals.
Bayle’s disease refers to manifestations of neurosyphilis. Coprolalia occurs already in the initial stage of the disease. Obscene expressions, obscene phrases, cynical statements, ambiguous jokes that are pronounced inappropriately and involuntarily appear in the speech of patients. Patients lose their sense of tact and modesty, do not observe the norms of social interaction. At the same time, criticism of their behavior is completely absent.
During the heyday of the disease, personality and behavior changes progress. Dysarthria increases, speech becomes slurred, handwriting is broken. In the final stage, the absurdity of judgments, dementia develops. There are neurological complications (epileptiform seizures, strokes).
Coprolalia is much less common than in mental disorders in the clinic of a number of neurological diseases. Among them are organic brain damage, neuroinfections, hereditary syndromes:
- Stroke. Patients who have suffered an acute violation of cerebral circulation often develop aphasia. In the case of gross afferent or efferent motor aphasia, a speech embolus appears, which may be abusive vocabulary.
- Neuroinfections. Coprolalia occurs against the background of psychomotor agitation in encephalitis, meningoencephalitis. The patient becomes verbose, shouts out individual sounds and words, including obscene ones. The behavior is characterized by motor anxiety, bitterness or gratuitous fun.
- Kleine-Levine-Critchley syndrome. During episodes of hypersomnia, patients have polyphagia, disinhibited behavior, hypersexuality. In response to a strong stimulus, anger, aggression, including verbal, occurs.
- Lesh-Nihen syndrome. A hereditary disease characterized by a violation of purine metabolism is accompanied by a complex of neurological and behavioral disorders. There are sharp mood swings, aggressive attitude towards others, self-harming behavior. Dysarthria is present in the speech status, coprolalia is possible.
Complications of pharmacotherapy
A “symptom of psychotic abuse” may occur against the background of long-term treatment with neuroleptic drugs. Coprolalia is supplemented by other side effects: articulatory disorders, grimacing, hyperkinesis. The severity of the disorders correlates with the type, dosage, duration of taking an antipsychotic drug. Symptoms disappear with the withdrawal of the drug.
Patients suffering from coprolalia are examined by a psychiatrist and a neurologist. To establish an etiological diagnosis, a clinical examination, instrumental and laboratory diagnostics are carried out. When coprolalia phenomena are applied:
- Clinical and empirical methods are used. The patient is interviewed, the anamnesis of the disease (complaints, prescription of symptoms) is found out. If the patient is non-contact or uncritical of his own condition, relatives can be interviewed. During the conversation and observation, various behavioral and verbal deviations, including coprolalia, are revealed.
- Instrumental diagnostics. To confirm or exclude focal lesions of cerebral structures, MRI of the brain, MR angiography, PET-CT are prescribed. Neuroimaging and EFI (EEG, EMG) methods are used in the diagnosis of Tourette syndrome. In Kleine–Levin syndrome, polysomnographic monitoring is performed. With progressive paralysis, a lumbar puncture is indicated.
- Laboratory tests. They are of primary diagnostic importance in neuroinfections, metabolic diseases. A biochemical analysis of blood and urine, tests for syphilis (RW, RPR test), determination of catecholamines, a study of the cerebrospinal fluid. With the hereditary nature of the pathology, a molecular genetic study is necessary.
The scheme of pharmacotherapy depends on the specific disease, the severity of its course, the stage of development (acute period, remission). In some cases, medical methods are the main ones, in others they are auxiliary. To reduce the manifestations of coprolalia in various nosologies , they can be used:
- Neuroleptics. Antipsychotic drugs are used in the treatment of Tourette’s syndrome, schizophrenia, manic syndrome. However, they should be prescribed carefully, because long-term use of neuroleptic drugs by itself can provoke coprolalia.
- Anticonvulsants. They are prescribed in the presence of epileptiform seizures, tics. They allow to stop muscle cramps, additionally reduce aggressiveness and irritability.
- Nootropics. They have a wide range of applications, are used for neuroinfections, ischemic stroke, hyperkinesis, dementia, etc. They reduce neurological deficits, have a positive effect on blood circulation and metabolic processes in the brain.
- Antidepressants. They are indicated for depression, obsessive states, concentration disorders. Important therapeutic effects of this group of drugs are the elimination of aggression and autoaggression, improving the control of impulsive actions.
- Etiopathogenetic therapy. Antibacterial and antiviral agents are used in neuroinfections, progressive paralysis. In Lesh-Nihen syndrome, drugs that disrupt the production of uric acid, NSAIDs are used. Botulinum therapy for Tourette syndrome eliminates severe motor and vocal tics, including coprolalia.
As part of neurorehabilitation, physical therapy, mechanotherapy, speech therapy classes to overcome aphasic disorders are carried out for patients after CVA. In Tourette’s syndrome, psychotherapy is the preferred method of treatment. Art therapy, massage, reflexology helps to reduce vocal tics and hyperkinesis. As emotional tension decreases, coprolalia also disappears.
Cognitive behavioral and supportive psychotherapy is required for patients with schizophrenia in remission, bipolar affective disorder. This method of treatment helps patients learn to control rage and anger, develop a new model of behavior, and acquire communication skills. Social rehabilitation plays an important role. The prognosis of the psychorechoic syndrome is closely related to the course of causal pathology. Upon recovery or achieving remission of the underlying disease, coprolalia disappears.