Introduction:
Coprolalia is the most commonly occurring form of the coprophenomena, which is associated with copropraxia (the desire to produce obscene gestures without control), mental coprolalia (thinking about obscenities), and coprographia (the desire to pen down those expressions or obscenities). Obscenities are utterances that describe sexual acts, body function, and organs of reproduction and sexual anatomy. There is almost no information available about coprolalia in the absence of Tourette syndrome. Therefore, most of the information about coprolalia is related to Tourette's and sometimes other tic disorders.
What Is Coprolalia?
Coprolalia is derived from the Greek kopros, which means feces, and lalein, which refers to babble. This disorder involves unintentional obscene and inappropriate language. In 10 to 33 percent of the cases, it can be correlated with tic disorders, particularly with Tourette syndrome. Coprolalia also occurs in patients with brain lesions and in those with neurodegenerative and autoimmune disorders. The prevalence of coprolalia is unclear, and it ranges from very low to very high in different series; however, exact percentages are difficult to determine. Most studies have documented a higher male-to-female ratio. The same higher male-to-female ratio is also seen in patients with Tourette, whose pathognomonic sign is coprolalia.
What Is the Cause of Coprolalia?
The neuroanatomical basis of coprolalia is not clear. It is believed that the limbic circuit can have an essential role in the pathophysiology of coprolalic behaviors. Some other hypotheses have been documented to explain the pathophysiology of Tourette's and describe the development of tics and coprolalia.
One theory explains that the brain regions involved in Tourette's, the limbic system and basal ganglia, resemble those involved in reproductive behavior control in primitive animals. Therefore, tics and coprolalia could result from dysfunction in these regions and appear as primitive vocal and motor fragments. Some studies suggest that coprolalia is a form of the obsessive-compulsive disorder spectrum, which occurs due to the failure to inhibit a part of the cortico-striato-thalamo-cortical pathway.
How Is Coprolalia Diagnosed?
The patient evaluation can be performed through an interview with a detailed clinical history and assessment of the types of tic disorders. Non-controllable uttering might be seen during the interview.
For the confirmation of Tourette syndrome, the following DSM-5 criteria must be met:
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Having multiple motor tics and vocal tics that cannot happen at the same time.
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Tics should be present for at least one year minimum, multiple times daily, and almost every day.
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Tics began before the age of 18 years old.
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Symptoms are not due to drugs or other medical conditions.
How Is Coprolalia Treated?
Generally, the decision to manage tics or coprolalia is based on the level of impairment and how many problems it might cause to the child and requires the family's cooperation. After education about the condition is peer-reviewed, the decision has to be made to monitor it clinically without the need for active intervention, which can be non-pharmacological or pharmacological.
Non-pharmacologic Management:
Behavioral therapy has been demonstrated to help patients manage their compulsive behaviors and is thought to help patients with coprolalia. The best support includes habit reversal therapy (HRT), in which the patient learns to recognize the signs that the desire to exhibit this behavior is anticipated and becomes aware of it, as well as creating a response to these signs or the tic. Other behavioral treatments found effective in clinical trials include comprehensive behavioral intervention for tics (CBIT) and exposure-response prevention (ERP).
Pharmacologic Management:
The pharmacologic management of coprolalia is not generally addressed directly. It is often found with the treatment of tics (motor or phonatory), obsessive-compulsive disorder, impulsivity, and other problems like Tourette syndrome.
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Pimozide has been shown to decrease symptoms by 90 percent after one year of treatment.
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Haloperidol provided a 79 percent improvement in symptoms when talking about tic frequency but non-specific to coprolalia.
However, the side effects of the above drugs have resulted in their limited use as first-line medications.
Clonidine and Clomipramine have been documented to affect behavioral symptoms; however, again, without explicitly mentioning coprolalia.
Risperidone and Aripiprazole are generally chosen before other agents because they have a safer profile and relatively fewer side effects. They are approved for the management of tics by the Food and Drug Administration (FDA). In the cases of comorbid anxiety, OCD, or depressive disorders, it has been shown that children with tic disorders can benefit from selective serotonin reuptake inhibitors (SSRIs).
An interprofessional team is needed to diagnose and manage coprolalia. When a clinician suspects a condition associated with coprolalia, a psychiatric specialist should immediately address it. If pharmaceutical treatment is part of the treatment plan, a certified psychiatric pharmacist can provide additional direction on pharmaceutical care.
What Are the Complications Associated with Coprolalia?
The complications associated with coprolalia include:
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Impact on school performance due to several factors such as difficulty studying and paying attention.
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Inability to go to school.
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Social isolation is seen as a result of bullying and non-acceptance by the community.
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Interpersonal conflict.
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Family conflict.
What Is the Prognosis of Coprolalia?
Symptoms of coprolalia decrease over time for no particular reason. Worsening coprolalia and tics are associated with stress, fatigue, caffeine, excitement, some medications, and hormonal changes. Relaxation is considered to reduce the symptoms. A tiny percentage with this disorder might show symptoms that grow into adulthood with increased severity.
Conclusion:
Coprolalia is the most common copro phenomenon (involuntary use of words that society might find unacceptable). It is often associated with tic disorders, especially Tourette syndrome. The distress it causes can result in a decrease in academic performance and social isolation. Medications, such as Risperidone and Aripiprazole, have proved to improve tics, as well as habit reversal therapy and other specific behavioral management. Individuals with coprolalia might require special education services or be given classroom accommodations (leaving the classroom as necessary or ignoring their tics). More studies and research are required to find out the cause and management of coprolalia. It is important to spread awareness among parents, teachers, coaches, health professionals, and educators who deal with individuals with coprolalia to provide them proper support on how to be supportive rather than punishing them so as not to cause more stress and worsen the condition.
