Maybe you can find that the game has a lot of stuttering. Vsync, unfortunately it's no use in this game.

First of all, open the game, in the Launcher go to "Setup". In the new window, in "Video", select "rOpenGL", then click on "Configure".

In "Video Mode" tab, Select "Full Screen", "Colour Depth: 32 bpp" and your resolution. Then, apply changes.

Now, in "Audio", select "DirectSound 7+ Software - Pan and Volume". This is important too. Using another audio plugin will cause stuttering.

Now the game will run smooth, BUT, with a lot of tearing. To fix this, you'll have to force Vsync with your Nvidia Control Panel / AMD Catalyst Control Center.

With this, now your game will run al 60 FPS without problems.

Thanks! That fixed jumpy camera movement nicely.

[See EDIT II below for a solution that works quite ok for me]
Hello, unfortunately nothing seems to work for me. I tried this solution and others I found in this forum (compatibility mode, run as admin, force Vsync), moreover I experimented with multiple other combinations of "Video Mode" and "Audio", but to no avail. The camera (mouse view) keeps jumping / stuttering and stopping to an extend that it is not playable with the mouse.
The Speed problem remains too sometimes (despite Vsync). I Also experienced that, with some configurations, it initially was too fast, then got slower until it even was far too slow.
So far it remains unplayable for me :(

The System: Win 7 (32 bit), CPU: Intel Core 2, 2,16 GHz, GPU: GeForce Go 7950 GTX

I still hope that there is some solution, but I already lost a lot of time trying to get this game running in a playable state.
I have to say that I'm quite dissapointed because I bought this from GOG under the impression that it will work with, perhaps, minor tweaks at most.

Best regards

EDIT: Another example: If i use "r3Dfx Voodoo 1-2" and Audio: "Miles Fast 2D Positional Audio" the mouse is working good, but the speed in game just constantly changes from too fast to far to slow. When I use "Direct Sound 7+ Software - Pan and Volume" it is always far to fast.
Every single configuration with rOpenGL leads to problems with the mouse look and sometimes speed issues.

EDIT II: I finally found a combination of settings that results in a playable state. So in case somebody has the same problem, here is what I did:
Setup -> Video: rOpenGL
Configure ->Video: I had to choose a higher resolution (1600x1200) otherwise the game was still too fast.
Moreover go to the "Misc" tab and set the "Swap Interval" to 1 (I had to do this in addition to forcing Vsync).
(In my case this, together with the higher resolution was the key for solving the mouse stuttering).
Confirm with OK and set "Audio" to "DirectSound3D 7+ Software - Pan and Volume" as stated by others.

That works for me. Vsync and the combination of rOpenGL and "DirectSound3D 7+ Software - Pan and Volume" alone was not sufficient in my case. So for those still fighting with mouse and speed issues, try the "Swap Interval" and a higher resolution.

And EDIT III: Now I noticed that, quite randomly, the game still runs too fast after starting. Only thing that helps then is restarting the game, it's like rolling a dice, after some restarts the speed is back to normal. It is really annoying, something is terribly wrong. So the status is: sometimes it works, sometimes the character acts as if he/she is on speed. But at least the mouse is still working.