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Coprolalia

Summary

Coprolalia (/ˌkɒprəˈleɪliə/ KOP-rə-LAY-lee-ə) is involuntary swearing or the involuntary utterance of obscene words or socially inappropriate and derogatory remarks. The word comes from the Greek κόπρος (kópros), meaning "dung, feces", and λαλιά (laliā́) "speech", from λαλεῖν (laleîn) "to talk".[1]

Coprolalia is an occasional characteristic of tic disorders, in particular Tourette syndrome, although it is not required for a diagnosis of Tourette's and only about 10% of Tourette's patients exhibit coprolalia.[2] It is not unique to tic disorders; it may also present itself as a neurological disorder.[3][4]

Itard was credited with describing the first case of Tourette syndrome, including coprolalia, in the Marquise de Dampierre, a woman of nobility[5]

Coprolalia is one type of coprophenomenon. Other coprophenomena include the related symptoms of copropraxia, involuntary actions such as performing obscene or forbidden gestures,[6] and coprographia, making obscene writings or drawings.[7]

Characteristics

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Coprolalia encompasses the uncontrollable utterance of words and phrases that are culturally taboo or generally unsuitable for acceptable social use, when used out of context. The term is not used to describe contextual swearing. It is usually expressed out of social or emotional context, and may be spoken in a louder tone or different cadence or pitch than normal conversation. It can be a single word, or complex phrases. A person with coprolalia may repeat the word mentally rather than saying it out loud; these subvocalizations can be very distressing.[8]

Coprolalia is an occasional characteristic of Tourette syndrome, although it is not required for a diagnosis of Tourette's. Typically, symptoms of coprolalia follow the development of phonic or motor tics by four to seven years. The severity of symptoms tends to peak during adolescence and subside during adulthood.[9]  In Tourette syndrome, compulsive swearing can be uncontrollable and undesired by the person uttering the phrases. Involuntary outbursts, such as racial or ethnic slurs in the company of those most offended by such remarks, can be particularly embarrassing. The phrases uttered by a person with coprolalia do not necessarily reflect the thoughts or opinions of the person as they are unconsciously produced.[9]

Cases of deaf Tourette patients swearing in sign language have been described.[10][11]

It may occur after traumatic brain injury such as stroke[4] and encephalitis;[4][12] in other neurological conditions such as choreoacanthocytosis,[13] seizures,[14] and Lesch–Nyhan syndrome;[15] and rarely in persons with dementia or obsessive-compulsive disorder in the absence of tics.[4]

Brain regions implicated

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The neural mechanisms underlying the presence of coprolalia alone are poorly understood. Current research is designed to locate the brain regions that are active during an involuntary tic. Individuals with Tourette Syndrome (TS) exhibit the symptoms of coprolalia, so researchers can study subjects with TS to deduce an etiology for phonic tics. Patterns of neural activity were tracked by using Positron Emission Tomography (PET) scans. The activity of the frontal operculum and Broca’s area (Brodmann’s area 44 and 45), may be responsible for the initiation of these vocal tics. Both of these brain areas are responsible for planning and producing speech, which are active during coprolalic vocal tic episodes.[16]

Limbic system structures such as the posterior cingulate cortex are also activated during coprolalic vocal tics. This region of the brain is responsible for emotional processing, so its increase in activation could reveal insights as to how taboo words may be organized differently than the neurolinguistic aspect of the brain.[17]

Prevalence in Tourette syndrome

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Only about 10% of people with Tourette's exhibit coprolalia,[2] but it tends to attract more attention than any other symptom.[18]

There is a low number of epidemiological studies on Tourette syndrome due to ascertainment bias affecting clinical studies. Studies on people with Tourette's often "came from tertiary referral samples, the sickest of the sick".[19] Further, the criteria for Tourette's syndrome changed in 2000 when the impairment criterion was removed from the DSM-IV-TR for all tic disorders.[20] This resulted in an increase of diagnoses in milder cases. Additionally, many clinical studies suffer from small sample size. These factors combine to render older estimates of coprolalia occurrences outdated.

An international, multi-site database of 3,500 individuals with Tourette syndrome drawn from clinical samples found 14% of patients with Tourette's accompanied by comorbid conditions had coprolalia, while only 6% of those with uncomplicated ("pure") Tourette's had coprolalia. The same study found that the chance of having coprolalia increased linearly with the number of comorbid conditions: patients with four or five other conditions—in addition to tics—were four to six times more likely to have coprolalia than persons with only Tourette's.[21]

One study of a general pediatric practice found an 8% rate of coprolalia in children with Tourette syndrome, while another study found 60% in a tertiary referral center (where typically more severe cases are referred).[22] A more recent study in Brazil had 44 patients with Tourette syndrome, and found a 14% rate of coprolalia;[23] a study in Costa Rica had 85 patients, and found that 20% had coprolalia;[24] a study in Chile had 70 patients, and found an 8.5% rate of coprolalia;[25] older studies in Japan reported a 4% incidence of coprolalia;[26] a 1996 clinical trial, conducted in Brazil, found that only 9 of 32 patients (28%) had coprolalia.[27] Considering the methodological issues affecting all of these reports, the consensus of the Tourette Syndrome Association is that the actual number is below 15 percent. Specific treatment options for reliving motor and phonic tics (coprolalia) in Gilles de la Tourette syndrome include but are not limited to Botulinum toxin injections, antipsychotics or behavioral therapy depending on the individual's severity of symptoms.

Management

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Botox Injections

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Some patients have been treated by injecting botulinum toxin (botox) near the vocal cords. This does not prevent the vocalizations, but the partial paralysis that results helps to control the volume of any outbursts.[28][29][30] Botox injections result in more generalized relief of tics than the vocal relief expected.[31] Botulinum injections block neuromuscular transmission and decrease hyperactive muscle fibres thus reducing involuntary movement production.

Antipsychotic drugs

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Aripiprazole is an FDA-approved antipsychotic drug that "acts as an antagonist at the Dopamine receptor D2 under hyperdopaminergic conditions and displays agonist properties under hypodopaminergic conditions." D2 receptors (striatal dopamine receptors) play an essential role in motor output and the initiation of movements. The overproduction of dopamine exacerbates the production of tics.[32] Aripiprazole works as a selective dopamine regulator controlling the release of dopamine in the brain, reducing the production of tics.[33] Recent studies provide support for aripiprazole for symptom management. Aripiprazole oral dosages were recently approved in 2012 for the management of tics in children and adults.[34]

Comprehensive Behavioral Intervention (CBI)

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Habit reversal training is one of the most common CBI strategies used for patients with Tourettes syndrome. Patients work with a therapist to develop strategies to better anticipate the occurrence of potential tics and establish a designated response preventing the tics from occurring. Additionally, these therapies also support TS patients in implementing coping mechanisms following stress-inducing tics.[33]

Coprolalia in deaf individuals

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Coprolalia has also been documented in deaf individuals. Non-verbal phonic tics are referred to as "signing phonic tics" in deaf individuals. Coprolalia in signing individuals is characterized by uncontrollable fingerspelling of obscene and inappropriate words and phrases, the production of intercourse related signs, flicking middle fingers, or compulsive repetition of signs.[35] TS is extremely understudied in the deaf community, often being misdiagnosed as schizophrenia. Researchers are still studying the relationship between deafness and Tourette's syndrome to combat misdiagnosis.[36] 

Society and culture

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The entertainment industry often depicts those with Tourette syndrome as being social misfits whose only tic is coprolalia, which has furthered stigmatization and the public's misunderstanding of those with Tourette's.[37][38][39] The coprolalic symptoms of Tourette's are also fodder for radio and television talk shows.[40]

See also

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References

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  1. ^ Coprolalia. Dictionary.com, Accessed 30 October 2006.
  2. ^ a b Singer HS (March 2005). "Tourette's syndrome: from behaviour to biology". Lancet Neurol. 4 (3): 149–59. doi:10.1016/S1474-4422(05)01012-4. PMID 15721825. S2CID 20181150.
  3. ^ Singer C (May 1997). "Tourette syndrome. Coprolalia and other coprophenomena". Neurol Clin. 15 (2): 299–308. doi:10.1016/s0733-8619(05)70314-5. PMID 9115463.
  4. ^ a b c d Freeman RD, Zinner SH, Müller-Vahl KR, et al. (March 2009). "Coprophenomena in Tourette syndrome". Dev Med Child Neurol. 51 (3): 218–27. doi:10.1111/j.1469-8749.2008.03135.x. PMID 19183216.
  5. ^ Teive HA, Chien HF, Munhoz RP, Barbosa ER (December 2008). "Charcot's contribution to the study of Tourette's syndrome". Arq Neuropsiquiatr. 66 (4): 918–21. doi:10.1590/S0004-282X2008000600035. PMID 19099145.
  6. ^ Schapiro NA (2002). "'Dude, you don't have Tourette's:' Tourette's syndrome, beyond the tics". Pediatr Nurs. 28 (3): 243–6, 249–53. PMID 12087644.
  7. ^ "Linguistics 210 Semantics" (PDF). Semantic features and Tourette's Syndrome. Retrieved 21 November 2006. While this source defines coprographia, it makes misrepresentations about copro phenomena in relation to Tourette's: they are not common, and not required for diagnosis.
  8. ^ Tourette Association of America. Understanding Coprolalia – A misunderstood symptom. Accessed 12 October 2021.
  9. ^ a b Singer, Carlos (1997-05-01). "Coprolalia and Other Coprophenomena". Neurologic Clinics. 15 (2): 299–308. doi:10.1016/S0733-8619(05)70314-5. ISSN 0733-8619. PMID 9115463.
  10. ^ Morris HR, Thacker AJ, Newman PK, Lees AJ (March 2000). "Sign language tics in a prelingually deaf man". Mov. Disord. 15 (2): 318–20. doi:10.1002/1531-8257(200003)15:2<318::AID-MDS1018>3.0.CO;2-H. PMID 10752584. S2CID 7102229.
  11. ^ Dalsgaard S, Damm D, Thomsen PH (December 2001). "Gilles de la Tourette syndrome in a child with congenital deafness". Eur Child Adolesc Psychiatry. 10 (4): 256–9. doi:10.1007/s007870170015. PMID 11794551. S2CID 26254893.
  12. ^ Dale RC, Webster R, Gill D (November 2007). "Contemporary encephalitis lethargica presenting with agitated catatonia, stereotypy, and dystonia-parkinsonism". Mov. Disord. 22 (15): 2281–4. doi:10.1002/mds.21664. PMID 17914719. S2CID 38995008.
  13. ^ Ruiz-Sandoval JL, García-Navarro V, Chiquete E, et al. (November 2007). "Choreoacanthocytosis in a Mexican family". Arch. Neurol. 64 (11): 1661–4. doi:10.1001/archneur.64.11.1661. PMID 17998451.
  14. ^ Caplan R, Comair Y, Shewmon DA, Jackson L, Chugani HT, Peacock WJ (1992). "Intractable seizures, compulsions, and coprolalia: a pediatric case study". J Neuropsychiatry Clin Neurosci. 4 (3): 315–9. doi:10.1176/jnp.4.3.315. PMID 1498584.
  15. ^ Jinnah HA. Lesch-Nyhan Syndrome. eMedicine.com (August 29, 2006). Accessed 28 October 2006.
  16. ^ Stern, Emily; Silbersweig, David A.; Chee, Kit-Yun; Holmes, Andrew; Robertson, Mary M.; Trimble, Michael; Frith, Christopher D.; Frackowiak, Richard S. J.; Dolan, Raymond J. (2000-08-01). "A Functional Neuroanatomy of Tics in Tourette Syndrome". Archives of General Psychiatry. 57 (8): 741–748. doi:10.1001/archpsyc.57.8.741. hdl:21.11116/0000-0001-A000-9. ISSN 0003-990X. PMID 10920461. S2CID 28185231.
  17. ^ "Basal Ganglia: What It Is, Function & Anatomy". Cleveland Clinic. Retrieved 2023-12-09.
  18. ^ Tourette Syndrome FAQ. Tourette Syndrome Association. Accessed 6 October 2006.
  19. ^ Swerdlow NR (September 2005). "Tourette syndrome: current controversies and the battlefield landscape". Curr Neurol Neurosci Rep. 5 (5): 329–31. doi:10.1007/s11910-005-0054-8. PMID 16131414. S2CID 26342334.
  20. ^ "What is DSM-IV-TR?". Psychnet-UK. Retrieved 21 June 2016. Tourette's Disorder and all of the Tic Disorders no longer require that symptoms cause distress or impair functioning.
  21. ^ Freeman RD, Fast DK, Burd L, Kerbeshian J, Robertson MM, Sandor P (July 2000). "An international perspective on Tourette syndrome: selected findings from 3,500 individuals in 22 countries". Dev Med Child Neurol. 42 (7): 436–47. doi:10.1017/S0012162200000839. PMID 10972415.
  22. ^ Singer C (May 1997). "Tourette syndrome. Coprolalia and other coprophenomena". Neurol Clin. 15 (2): 299–308. doi:10.1016/s0733-8619(05)70314-5. PMID 9115463.
  23. ^ Teive HA, Germiniani FM, Della Coletta MV, Werneck LC (September 2001). "Tics and Tourette syndrome: clinical evaluation of 44 cases". Arq Neuropsiquiatr. 59 (3–B): 725–8. doi:10.1590/S0004-282X2001000500014. PMID 11593273.
  24. ^ Mathews CA, Herrera Amighetti LD, Lowe TL, van de Wetering BJ, Freimer NB, Reus VI (April 2001). "Cultural influences on diagnosis and perception of Tourette syndrome in Costa Rica". J Am Acad Child Adolesc Psychiatry. 40 (4): 456–63. doi:10.1097/00004583-200104000-00015. PMID 11314572.
  25. ^ Miranda C, Marcelo; Menéndez H, Pedro; David G, Perla; Troncoso Sch, Mónica; Hernández Ch, Marta; Chaná C, Pedro (1999). "Enfermedad de los tics (síndrome de Gilles de la Tourette): Características clínicas de 70 pacientes" [Tics disease (Gilles de la Tourette syndrome): clinical characteristics of 70 patients]. Revista Médica de Chile (in Spanish). 127 (12): 1480–6. doi:10.4067/S0034-98871999001200010. PMID 10835756.
  26. ^ Kano Y, Ohta M, Nagai Y (August 1998). "Tourette syndrome in Japan: a nationwide questionnaire survey of psychiatrists and pediatricians". Psychiatry Clin. Neurosci. 52 (4): 407–11. doi:10.1046/j.1440-1819.1998.00412.x. PMID 9766689.
  27. ^ Cardoso F, Veado CC, de Oliveira JT (February 1996). "A Brazilian cohort of patients with Tourette's syndrome". J. Neurol. Neurosurg. Psychiatry. 60 (2): 209–12. doi:10.1136/jnnp.60.2.209. PMC 1073809. PMID 8708658.
  28. ^ Scott BL, Jankovic J, Donovan DT (July 1996). "Botulinum toxin injection into vocal cord in the treatment of malignant coprolalia associated with Tourette's syndrome". Mov. Disord. 11 (4): 431–3. doi:10.1002/mds.870110413. PMID 8813224. S2CID 10339547.
  29. ^ Jankovic J (May 1994). "Botulinum toxin in the treatment of dystonic tics". Mov. Disord. 9 (3): 347–9. doi:10.1002/mds.870090315. PMID 8041378. S2CID 19270507.
  30. ^ Kwak CH, Hanna PA, Jankovic J (August 2000). "Botulinum toxin in the treatment of tics". Arch. Neurol. 57 (8): 1190–3. doi:10.1001/archneur.57.8.1190. PMID 10927800.
  31. ^ Stern JS, Burza S, Robertson MM (January 2005). "Gilles de la Tourette's syndrome and its impact in the UK". Postgrad Med J. 81 (951): 12–9. doi:10.1136/pgmj.2004.023614. PMC 1743178. PMID 15640424.
  32. ^ Augustin, Shana M.; Loewinger, Gabriel C.; O’Neal, Timothy J.; Kravitz, Alexxai V.; Lovinger, David M. (2020-08-18). "Dopamine D2 receptor signaling on iMSNs is required for initiation and vigor of learned actions". Neuropsychopharmacology. 45 (12): 2087–2097. doi:10.1038/s41386-020-00799-1. ISSN 0893-133X. PMC 7547091. PMID 32811899.
  33. ^ a b Padala, Prasad R.; Qadri, S. Faiz; Madaan, Vishal (2005). "Aripiprazole for the treatment of Tourette's disorder". Primary Care Companion to the Journal of Clinical Psychiatry. 7 (6): 296–299. doi:10.4088/pcc.v07n0605. ISSN 1523-5998. PMC 1324961. PMID 16498492.
  34. ^ Sallee, Floyd; Kohegyi, Eva; Zhao, Joan; McQuade, Robert; Cox, Kevin; Sanchez, Raymond; van Beek, Alet; Nyilas, Margaretta; Carson, William; Kurlan, Roger (November 2017). "Randomized, Double-Blind, Placebo-Controlled Trial Demonstrates the Efficacy and Safety of Oral Aripiprazole for the Treatment of Tourette's Disorder in Children and Adolescents". Journal of Child and Adolescent Psychopharmacology. 27 (9): 771–781. doi:10.1089/cap.2016.0026. ISSN 1044-5463. PMC 5689110. PMID 28686474.
  35. ^ Robertson, M. M.; Roberts, S.; Pillai, S.; Eapen, V. (2015-10-01). "Gilles de la Tourette syndrome in a cohort of deaf people". Asian Journal of Psychiatry. 17: 65–70. doi:10.1016/j.ajp.2015.06.017. ISSN 1876-2018. PMID 26216703.
  36. ^ Burd, Larry (2014-08-27). "Language and Speech in Tourette Syndrome: Phenotype and Phenomenology". Current Developmental Disorders Reports. 1 (4): 229–235. doi:10.1007/s40474-014-0027-1. ISSN 2196-2987. S2CID 143272775.
  37. ^ Calder-Sprackman S, Sutherland S, Doja A (March 2014). "Tourette syndrome in film and television". The Canadian Journal of Neurological Sciences. 41 (2): 226–32. doi:10.1017/S0317167100016620. PMID 24534035. S2CID 39288755.
  38. ^ Lim Fat MJ, Sell E, Barrowman N, Doja A (2012). "Public perception of Tourette syndrome on YouTube". Journal of Child Neurology. 27 (8): 1011–16. CiteSeerX 10.1.1.997.9069. doi:10.1177/0883073811432294. PMID 22821136. S2CID 21648806.
  39. ^ Holtgren B (January 11, 2006). "Truth about Tourette's not what you think". The Cincinnati Enquirer. As medical problems go, Tourette's is, except in the most severe cases, about the most minor imaginable thing to have. ... the freak-show image, unfortunately, still prevails overwhelmingly. The blame for the warped perceptions lies overwhelmingly with the video media—the Internet, movies and TV. If you search for 'Tourette' on Google or YouTube, you'll get a gazillion hits that almost invariably show the most outrageously extreme examples of motor and vocal tics. Television, with notable exceptions such as Oprah, has sensationalized Tourette's so badly, for so long, that it seems beyond hope that most people will ever know the more prosaic truth.
  40. ^ Oprah and Dr. Laura – Conflicting Messages on Tourette Syndrome. Oprah Educates; Dr. Laura Fosters Myth of TS as "Cursing Disorder". Tourette Syndrome Association (May 31, 2001). Accessed 6 October 2001.
    * Letter of response to Dr. Phil. Archived August 31, 2008, at the Wayback Machine Tourette Syndrome Association. Accessed 8 May 2006.
    * Letter of response to Garrison Keillor radio show. Tourette Syndrome Association. Accessed 8 May 2006.

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