I can ran the game fine on the highest settings. Very smooth. I enter a building or dungeon, very smooth too. I exit it, and its turns into a lag hell, I can't even move my mouse dude to the extreme lag, and my character takes ages to move even a step, and the main menu takes a while to come up.
I am running it on windows vista , and nvidia graphics card GTX285.
I thought it was the patch, but not without the patch, it seems to be affecting me too.