Coprolalia is the unintentional, inappropriate, pathologically obsessive 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. May be a side effect of taking neuroleptics. Coprolalia is diagnosed by clinical methods (talk, observation), identification of its causes requires instrumental (MRI, EEG) and laboratory diagnostics. Treatment depends on the etiology of the disorder, including pharmacological agents, psychotherapy, and rehabilitation techniques.
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. Swear words are shouted out by patients deliberately loudly, abruptly, impulsively, sometimes aggressively.
Along with involuntary vocalizations, motor tics are noted - hyperkinesis: squinting eyes, frequent blinking, twitching. Sometimes patients can demonstrate obscene gestures - this phenomenon is called copropraxia. Patients are aware of the inappropriateness and inadmissibility of their behavior, but they cannot voluntarily control offensive statements and actions.
Coprolalia in patients with schizophrenia is woven into delusional ideas and disorders of thought processes. Characteristic speech symptoms are incoherence, illogicality of speech, an abundance of neologisms, paraphasia, inability to keep up a conversation. The patient can modify obscene words, but the meaning of the curse remains obvious and understandable to everyone. The utterance of swear words and obscene phrases is, as it were, “savored” by the patient, and the shock reaction of others is satisfying.
It is observed in bipolar affective disorder, psychoses of organic, infectious genesis, etc. Manic syndrome is characterized by a triad of symptoms: euphoric mood, acceleration of thought processes (“jump of ideas”), increased craving for activity. Patients are verbose, are in a state of speech excitement: they speak quickly, inconsistently, with pathetic intonation.
Sometimes elevated mood is replaced by angry mania, manifested by irritability, anger, outbursts of anger. At the height of the state, aggression and auto-aggression, coprolalia can occur. Obscene language is shouted out loudly, emotionally, directed at individual people.
Coprolalia
Bayle's disease refers to the 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 comply with the norms of social interaction. At the same time, criticism of their behavior is completely absent.
In the heyday of the disease, changes in personality and behavior progress. Dysarthria grows, speech becomes slurred, handwriting is disturbed. In the final stage, the absurdity of judgments, dementia, develops. There are neurological complications (epileptiform seizures, strokes).
Much less frequently than in mental disorders, coprolalia occurs in the clinic of a number of neurological diseases. Among them are organic brain damage, neuroinfections, hereditary syndromes:
The "psychotic swearing symptom" may occur during long-term treatment with neuroleptic drugs. Coprolalia is complemented by other side effects: articulation disorders, grimacing, hyperkinesis. The severity of the disorders correlates with the type, dosage, and duration of the antipsychotic medication. 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 the phenomena of coprolalia apply:
Psychotherapeutic treatment
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, the following can be used:
As part of neurorehabilitation, patients after stroke undergo physiotherapy exercises, mechanotherapy, speech therapy classes to overcome aphasic disorders. For Tourette's syndrome, psychotherapy is the preferred treatment. Art therapy, massage, and reflexology help 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 psychoverbal syndrome is closely related to the course of the causative pathology. With recovery or achievement of remission of the underlying disease, coprolalia disappears.