Investigate Coprolalia Disorder

Name: Linda Ellison.

Course Name and Number: PSY 303, PSK1327A

Instructor: Renina Deeminter

Date:

COPROLALIA DISORDER, SYMPTOMS AND RELATED COMORBID CONDITIONS. Coprolalia disorder is a condition that is characterized by loud vociferous swearing, or the utterance of words that are obscene, derogatory or socially inappropriate, which is done involuntarily by an afflicted patient. It is primarily a compulsive psychological disorder, although it may manifest itself physically in involuntary motor movements e.g. jerking gestures, arm flailing, groaning and grunting, shouting obscenities etc (Mink, 2008, p. 211). This is a publication that extensively covers the recent advances in neurology; it covers Tourette’s syndrome and Coprolalia in extension. It expounds on the Coprolalia disorder, its symptoms, causes, manifestations and its relation with its comorbid disorders. Coprolalia disorder is a symptom of other malaises like Tourette’s syndrome or schizophrenia and has links with other medical disorders or conditions. The word Coprolalia stems from two Greek words, ‘kopros’, which means feces, and ‘lalien’, which means to talk. Therefore, Coprolalia is characterized by the profuse and uncontrolled usage of foul or obscene language punctuated by words related to feces. Coprolalia occurs solely or as a manifestation of several other associated comorbid conditions such as ADHD (Attention deficit and hyperactivity disorder), OCD (Obsessive compulsive disorder) Tourette’s syndrome, tics and schizophrenia. The presence of these comorbid disorders raises the probability of a patient suffering from Coprolalia quite significantly. Coprolalia includes phrases remarks and words that are tabooed in a culture and are thus unacceptable for social use especially when they are used in out of context situations. Indeed, contextual swearing is not included in the disorder. The patient swears out of context, emotionally and socially, and in a voice much louder than the normal conversational tone. He or she may repeat a word or a complex phrase repeatedly mentally, instead of voicing it out loud. This particular manifestation of Coprolalia causes causing great emotional distress to the patient. The uncontrollable and undesirable outbursts can be very disconcerting to the patient especially when they occur in public where most people would be offended, for instance in the case of ethnic, racial or religious slurs. Much of the general public has little or no information about the condition and this leads to the stigmatization, ostracisation and even violent attacks on the patients who are hapless victims who cannot exercise any control over their offensive outbursts. (Benbir, 2012, p. 159). This is a collection of case reports, letters, video and audio media material collected over a period of 10 years, on the Tourette’s syndrome and its Coprolalia manifestation, in people, their reactions feelings and opinions on the disorder, together with those of the general public, which was mostly ignorant of the condition. It is therefore important to note, that those compulsive outbursts do not necessarily correspond to the patient’s opinions, beliefs and thoughts. Coprolalia is often a manifestation of Tourett’s syndrome, which is a neuropsychiatric disorder which commences in early childhood. (Della, 2001, p. 123). This publication consisted of an evaluation of 44 patients who were suffering from tics and Tourette’s syndrome, with its emphasis on the, age of onset of symptoms, the influence of sex in its occurrence, the localization and classification of tics and the related or associated signs symptoms and comorbidities. It causes several motor or physical tics such as arm jerking and flailing and aggressive body movements, and at least one vocal or phonic tic which include Coprolalia, echolalia (compulsively repeating other people’s words, phrases and sentences) and copropraxia which is the imitation by the afflicted patient the actions of other people. Tic disorders cause repetitive and involuntary movement of the body and vocalizations, which are rapid and non rhythmic. Coprolalia though a component, is not exclusive to tic disorders, but is also an occasional symptom of other neurological disorders such as schizophrenia (Cheung, 2009, p. 409). This publication was written by its authors, with an aim to raise awareness and also to draw attention to the grave and potentially function impairing and life threatening symptoms, signs and manifestations associated with Tourette’s syndrome and Coprolalia in extension and also to explore the condition’s relationship to its comorbid conditions such as schizophrenia, ADHD, and OCD. Here the patient exhibits classic manifestations of reality loss, social withdrawal and public bizarre conduct displays such as tics, jerking and flailing arm movements, grunting, groaning and speaking in a loud voice loaded with profanities, regarding feces and related matters. Doctors and medical research scientists believe that this disorder is a symptom of other diseases and disorders such as Tourette’s syndrome and schizophrenia which results in compulsive physical movements in the afflicted patients. This disorder mainly manifests itself in early childhood where their brain is not fully developed; and therefore it is most clearly displayed during the early onset of childhood especially since the child has not learnt to exercise any control over his mental abilities and habits and also has not formed his own distinct character and personality. The disorder is a primarily a spectrum disorder, ranging from mild to severe. The mild cases are the majority and they normally require no treatment. The general prognosis is positive but some rare cases have some pretty severe symptoms that could persist unto adulthood and beyond.
While Coprolalia disorder is not common in many of the third world countries, there seems to be no established bias towards the poorer societies. Ethnicity bias to the affliction with the disorder is nonexistent. However, boys are more vulnerable genetically to contract it than are girls. Coprolalia is 3 to 4 times more frequent in boys than in girls (Bloch, 2008, p. 53). This is a text which covers Tourette’s syndrome and Coprolalia extensively, and here it explains whether there is bias in the condition based on various factors such as ethnicity, sex, age, social status, the environment and biological factors such as genetics and heredity. There is no discrimination between the social classes, as it crops up in any and every class, regardless whether they are rich or poor. Another determining factor is age, where the condition afflicts people in their early childhood years probably due to their underdeveloped mental faculties. Between 0.4%- 3.8% of children ages 5 – 18 may have Tourette’s syndrome that exhibits Coprolalia. By 19 years and over, the symptoms have just a subtle effect on the overall functioning of the patient. It also seldom occurs in adults (18 years old and over), but these are better at suppressing it, thus you may not even realize they have the condition (Cheung, 2009, p. 88). The other determining factor is the genetic makeup of the patient as the disorder is inherited. Environmental factors (psychosocial factors) are also thought to influence the etiology the condition, although it is not known exactly how it does that. It is more like they influence the severity of the condition. Autoimmune processes also influence the commencement of the condition and in some cases they exacerbate it. Risk factors in the contracting of Coprolalia are mainly genetical, as the disease is inherited, although it displays partial penetration, which means that there is but 50% chance of parents passing on the condition to their offspring, and that many people with no effects of Coprolalia disorder are latent carriers of the disorder in their genetic constitution. Social and psychological factors mainly act to increase or decrease the intensity of the condition, as in if the patient is in a relaxed serene environment, or something is agitating him or her. Actually relaxation techniques e.g. yoga and meditation are very useful in the relief of the stress that accumulates and aggravates the onset of tics, Coprolalia included. Due to the fact that the Coprolalia disorder occurs in early childhood, chances of complete treatment are high. (Caplan, 2009, p. 317) Its prognosis is easy to start treatment off at the earliest chance. However if it occurs as a manifestation of a deeper more serious condition, further measures should be taken to diagnose and treat the condition along with its comorbid conditions. 10% at most of Tourette’s disorder patients display Coprolalia. 14% of Tourette’s disorder patients with comorbid conditions, (related disorders in addition to the original disorder), have Coprolalia, as compared to the only 6% of those with pure Tourette’s condition who had Coprolalia (Benbir, 2009, p. 160). The chances of contracting Coprolalia rise proportionally to the number of comorbid disorders. Comorbid conditions that are related etiologically to Coprolalia, include attention deficit hyperactivity disorder (ADHD), and obsessive compulsive disorder (OCD). They may occur in alongside Coprolalia and they cause more impairment of a patient’s normal functions. Tourette’s syndrome patients with the Coprolalia disorder show much higher rates of copropraxia (imitating other people’s actions) and echolalia which is the repeating other peoples words compulsively. The risk factors that have been implicated by many researchers in the area often rule out psychological and/or social factors as causative agents of the Coprolalia disorder. However, this two factors influence the presence, intensity and subsequent control and treatment of the disorder, where the social environment may calm the patient and reduce the frequency and intensity of his attacks. On the other hand, an irritating or agitating psychosocial environment causes the exacerbation of the signs and symptoms in the afflicted patient.
There is no really effective treatment for Coprolalia, but some isolated medicines and treatment therapies help ease the disease, if their use is allowed by the governing regulatory bodies. There are three avenues of treatment for Tourette’s syndrome and the Coprolalia aspect of its manifestation. The pharmacological, psychological and behavioral therapies (Caplan, 2009, pg 212). This publication is a clinical neurosciences journal article, and research findings on the surgical aspect of treatment of conditions and disorders in neuropsychiatry. It covers a case of a 10 year old girl with intractable complex partial seizures, aphasia, Coprolalia and repetitive motor behavior involving touching, sexual touching and aggressive acts. Her seizures were controlled and her symptoms effectively subsided after she underwent a surgical operation consisting of the resection of her left anterior temporal lobe.
The other treatment methods, psychotherapy and cognitive behavioral treatment help to avoid isolation which in turn avoids depression in the patient. Cognitive behavioral therapy is particularly useful when you have obsessive compulsive disorder as a comorbid disorder. Education and awareness programs about Coprolalia in the patient, friends and family and the community as a whole are vital in the treatment and control process, and actually may be all that is required to cure mild cases. Psycho behavioral therapies help when the condition doesn’t require pharmacological treatment (Black, 2008, p. 90). This is a publication which deals comprehensively on the background, the pathopsychology, etiology, epidemiology, prognosis and patient and general public education and awareness.
The pharmacological aspect is reserved for very severe symptoms. Medication assists to control symptoms when they threaten to affect a patient’s functionality. Neuroleptics are anti psychotics that are most effective in controlling the condition and they have both long and short term effects. They include clonidine patches, and Haloperidol used to treat Tourette’s syndrome and Coprolalia. Anti depressants such as Prozac and Zoloft have variable efficacy in Coprolalia treatment. Some patients may exhibit extreme hypersensitivity to neuroleptics thus resulting in their bodies rejecting the medication. In such cases Aripiprazole is used as a last resort. It causes up to 75% improvement in the patients symptoms and the patients show great tolerance to the drug. Control for Coprolalia is also done through introducing limited amounts of Botox, (botulinum toxin), intravenously into the vocal chords. This results in their partial paralysis. The botulinum toxin interferes with the sensory reflex arc that perpetuates tics and the Coprolalia disorder in Tourette’s syndrome patients most probably by relieving the local buildup of tension and spasmodic muscle contractions in the affected area. While this method is ineffective in treating the psychological aspect of the condition, it manages to effectively lower the volume of the outbursts. This method unexpectedly resulted in the more generalized relief to tics than the vocal relief it was originally intended to give. Another method of treatment is through disabling surgically, the nuclei in the particular potions of the brain that regulate emotion, involuntary movement and speech. (Caplan, 2009, pg 144). The thalamus, the basal ganglia and the frontal cortex portions are thought to be dysfunctional causing Coprolalia. This method reduces the seriousness of the outbursts and cuts down on the frequency of their occurrence.
There are also some practical age old and tried and tested herbal and homeopathic remedies to the condition that have had substantial success in the treatment and control of Tourette’s syndrome, the Coprolalia disorder and tics in general. An excellent example is the use of hysoscyamus, a marvelous herb that is used to relieve tics and muscle twitching primarily due to its potent antispasmodic properties. Through this it soothes the nervous irritations and reduces the intensity and the frequency of tics.
Similarly, homeopathic ingredients such as Zinc met is a proficient aid in the absorption of minerals e.g. magnesium in the body. This helps to soothe the nervous system and simultaneously relieving an afflicted patient’s muscle spasms, twitching, jerking and fidgety movements especially those associated with the effects of exhaustion, stress and fatigue. In conclusion, Coprolalia disorder is an inherited psychological condition. It often occurs as a manifestation of other conditions, or accompanied by comorbid disorders. This comorbid disorders increase the chances of an afflicted patient contracting Coprolalia. They are related and their treatment is to be done simultaneously for the effective treatment of the patient. Although no effective cure has been found for the condition, education and awareness are more often than not effective in managing the disease and the patient can live a pretty normal life especially towards their adulthood where they are able to effectively manage their symptoms and also the symptoms have somewhat cooled off in their intensity. Also the adult is able to exercise more of his or her willpower towards the control of his or her outbursts. Also, more research and advances are being made in the field of neuropsychology and better medication is being made to combat many of these disorders and they have cut down significantly on their grim side effects which were the main deterrent in the use of pharmacology in the past. Surgical correction of the malfunctioning parts of the brain has advanced in leaps and bounds due to the invention of modern equipment which helps us to understand our brains and their functioning better. However as we continue in our modernization conquest, more and more doctors and researchers are realizing the great healing treasure we have in nature and discovering the uncanny wisdom in ancient herbal remedies to such conditions, therefore research has been massively galvanized in that direction, and for now it shows the most promise, particularly due to its lack of adverse side effects to the patients other bodily functions. This has been the main disadvantage in pharmacology and surgical remedies, which always seemed to cause more harm than good in a patient.

References
Benbir. G. (2012). A Movement of Disorders. London: Lees publishing.
Caplan. R. (2009). Coprolalia, a Pediatric Case Study. Boston: Lipincott Williams publishing.
Della .C. M. (2001). Tics and Tourette’s syndrome, a clinical evaluation. Sao Paulo: Associacao Neuro Psiquitria.
Cheung. M.Y. (2009). Malignant Tourette’s syndrome. Perth: Blackwell Science press.
Mink. J. W. (2008). Advances in Neurology, Tourette’s syndrome. Philadelphia: Lipincott, Williams and Wilkins publishers. Black. K.J. (2008). Tourette’s syndrome and other tic disorders. eMedicine.