The term “foreign-accent syndrome” was coined in 1982 by the neurolinguist Harry Whitaker, and it is, admittedly, a lot clearer than “dysprosody.” It’s a rare condition, but an interesting one, and there have been more than 100 case studies published. The most recent appeared in Case Reports in Psychiatry this year.

“The patient was a 34-year-old African American U.S.-born single female,” the report begins. She was brought to the psychiatry emergency room after assaulting her mother’s landlady, who she believed had cursed her using voodoo. Her family had a history of schizophrenia, and she was diagnosed with the condition herself upon this visit. She also spoke with a British accent. “She substituted ‘th’ for ‘f’ and ‘w’ for ‘wh’ as well as ‘t’ for ‘d’ and ‘ai’ for ‘ei,’” the researchers write. Unlike Astrid, though, she spoke in a bit of a monotone.

She refused medication, continued to have homicidal ideations toward her mother’s landlady, and eventually was transferred to long-term inpatient care. The researchers plan to follow up with the inpatient facility to see if it ever reverts back to American.

Astrid and this new patient represent the two different types of foreign-accent syndrome that have been reported—neurogenic and psychogenic. Neurogenic foreign-accent syndrome is more common, and comes after someone’s brain has been damaged, either through a stroke or from traumatic brain injury. Exactly how this leads to changed speech is unclear, but the damage is often located in the middle cerebral artery and brain regions associated with speech, especially in the left hemisphere.

In psychogenic foreign-accent syndrome, there isn’t any identifiable brain damage, but the person has some kind of psychiatric disorder, such as schizophrenia, or bipolar disorder, or conversion disorder, as well as the accent. “In the cases of psychosis, the new accent persists throughout the entire episode and may disappear after the psychotic episode subsides,” the researchers write. The patient in their study had a history of losing the accent after a psychotic episode had passed, though they didn’t observe that during her stay in the hospital. They also note that only recently has it been discovered that foreign accent syndrome can be psychogenic.

There’s also a mixed type of foreign-accent syndrome, which may have some neurogenic and some psychogenic characteristics.

There’s a ton of variability in how the syndrome presents—people can have changes in various aspects of prosody. Different listeners may hear different accents when the same person speaks (recall that Monrad-Krohn thought at first that Astrid was speaking with a “German or French” accent), or they may detect hints of the person’s original accent flickering under the new one. Patients may also have trouble putting sentences together, or may stress the wrong words or syllables.