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Birth and developmental history were unremarkable. The patient had a family history of sickle cell disease (brother had sickle cell disease) and schizophrenia (brother, mother, and uncle had schizophrenia). She was then treated with risperidone tablets with improvement including change in accent on discharge, when she was less psychotic. The patient had her first inpatient psychiatry admission for acute exacerbation of paranoid schizophrenia and FAS ten months earlier. The patient denied use of nicotine, alcohol, and other psychoactive substances currently or in the past. There was no symptom suggestive of mania, seizure disorder, head trauma, loss of consciousness, cerebrovascular accident, Parkinson’s disease, anxiety, or other organic brain disorder. The patient broke up with her fiancée ten months previously after cutting her fiancée’s stepfather’s face following verbal altercation. She lost her job as a nurse aide five months earlier and had not been able to secure another job since then.
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She reported an unchanged pattern of sleep and appetite, which she described to be “good.” Prior to this episode, the patient had been under economic and emotional stress. She denied visual and tactile hallucinations, thought insertion, and thought broadcasting. The patient denied auditory hallucinations but appeared to be internally preoccupied. She refused to follow up with outpatient care after the last inpatient admission ten months previously.
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Collateral information from the patient’s mother revealed that the patient had not been compliant with her medications. The patient did not show any remorse for her actions: “I hate her,” “I did the right things,” and “She is evil” are examples of statements made by the patient. She described an overwhelming rage prior to the physical assault. The patient started the altercation because she felt that the landlady practiced voodoo and had cursed her, causing her hair to fall off. Upon presentation, the patient described an altercation with her mother’s landlady, hitting her numerous times in the face with a closed fist. The patient was brought to the psychiatry emergency room by ambulance for evaluation of aggression. At the time of the investigation she was unemployed and lived temporarily with her mother, who had a history of paranoid schizophrenia. The patient was a 34-year-old African American US-born single female. The patient presented here had a known schizophrenia and psychogenic FAS, a combination for which only few cases have been reported to date in the medical literature. There has been an increase in the number of reported FAS cases especially of the neurogenic variety. Each of these variants has unique characteristics. There is evidence from the medical literature to suggest that there are three main types of FAS: neurogenic, psychogenic, and mixed. It is important to note that the affected patient may never have lived in the country of origin of the new accent. This new accent is foreign to both the speaker and the listener. Introductionįoreign Accent Syndrome (FAS) is a rare condition where speech is characterized by a new accent to the patient’s native language. The case is discussed in the context of a brief review of the syndrome. FAS recurred during psychotic exacerbation and did not reverse before transfer to a long-term psychiatric facility. This paper presents a patient with schizophrenia and FAS, without any evidence of organic brain injury. Some other cases have been described without identifiable organic brain injury, especially in patients with psychiatric illness. More than 100 cases with the syndrome have been published, the majority of which were associated with observed insults of the speech center. Foreign Accent Syndrome (FAS) is a rare phenomenon where speech is characterized by a new accent to the patient’s native language.