Adult-onset stuttering as a feature of schizophrenia: restoration of fluency with trifluoperazine

Abstract

Disturbances of motor behaviour are predominant in the catatonic subtype of schizophrenia. These disturbances, which may include abnormalities in the motor production of speech, are comparatively uncommon in Western societies. The following is a case report: A 26 year old white New Zealand man was referred for assessment of stuttering and progressive social impairment of 18 months' duration. The onset of problems coincided with a period of severe psychosocial stress, including a marital dissolution. Organic workup, including computerised tomography and electroencephalogram was normal. Mental state examination showed him to be tense and suspicious, with some unusual movements of his head and arms. His guarded manner made it impossible to confirm the presence of delusions or hallucinations. Treatment with 10mg trifluoperazine per day over three months produced a gradual resolution of speech disorder, abnormal movements, and social difficulties. After six months of remission, trifluoperazine was withdrawn and he remained well for a further four months, when a gradual relapse was noted. Placebo treatment over one month had no effect, and re-introduction of trifluoperazine 5mg/d was again effective in restoring normal speech. The results are discussed in terms of (a) motor disturbances in schizophrenia, and (b) the dopaminergic control of the muscles of speech production.