Language may be altered in people with PTSD. Tasks designed to assess language ability include letter fluency tasks that assess the ability to generate words starting with a particular letter. Category fluency tasks assess the ability to name words within a specified category. Working memory is needed for both letter and category fluency as participants must organise and retrieve relevant information.

Other tests designed to assess language include: Boston Naming task; Wechsler Adult Intelligence Scale (WAIS) comprehension (including the subtest information, similarities and vocabulary), WAIS verbal memory, verbal fluency, National Adult Reading Test (NART)/ Wide Range Achievement Test (WRAT), Controlled Oral Word Association Test (COWA), Category Instance Generation Test (CIGT), Multiple Choice Vocabulary Test (MWT-B), Hopkins Verbal Learning Test (HVLT), California Verbal Learning Test (CVLT), Rey Auditory Verbal Learning Test (AVLT), semantic priming tasks and Lexical Decision Task and the Peabody Individual Achievement reading comprehension (PIAT). Latent Semantic Analysis (LSA) is used to determine the degree of incoherence in language.

What is the evidence for language alterations in people with PTSD?

Moderate to low quality evidence finds medium-sized effects showing children and adults with PTSD had poorer language ability than people without PTSD. There were no differences between adults aged over 65 years.

August 2021

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Antecedents, including language problems, are usually subtle deviations in development that may become evident during childhood or adolescence. The presence of these deviations may foreshadow the later development of bipolar disorder, however most children who exhibit deviations do not develop the disorder. Studies exploring antecedents are ideally based on representative, population-based samples that follow the group from birth through childhood and adolescence to adulthood.

What is the evidence from long-term studies on language problems as antecedents of bipolar disorder?

Moderate to low quality evidence suggests a medium-sized effect of poor expressive language, but not receptive language, in childhood of people who developed mania in adulthood. There was no association with childhood speech problems in general and later bipolar disorder.

October 2021

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Language may be altered in people with bipolar disorder and may present in the form of disorganised speech. Tasks designed to assess language ability include; letter fluency tasks that assess the ability to generate words starting with a particular letter; and category fluency tasks that assess the ability to name words within a specified category. Working memory is needed for both letter and category fluency as participants must organise and retrieve relevant information.

Other tests designed to assess language include: Boston Naming task; Wechsler Adult Intelligence Scale (WAIS) comprehension (including the subtest information, similarities and vocabulary), WAIS verbal memory, verbal fluency, National Adult Reading Test (NART)/ Wide Range Achievement Test (WRAT), Controlled Oral Word Association Test (COWA), Category Instance Generation Test (CIGT), Multiple Choice Vocabulary Test (MWT-B), Hopkins Verbal Learning test (HVLT), California Verbal Learning Test (CVLT), Rey Auditory Verbal Learning Test (AVLT), semantic priming tasks and Lexical Decision Task and the Peabody Individual Achievement reading comprehension (PIAT).

What is the evidence on language fluency in people with bipolar disorder?

Moderate to high quality evidence shows a medium-sized effect of poorer language fluency in people with bipolar I disorder than controls. There was also a medium-sized effect of poorer language fluency in people with bipolar II disorder compared to controls. In direct comparison between bipolar I disorder and bipolar II disorder, those with bipolar I disorder showed a small effect of poorer language fluency.

High quality evidence shows a small effect of poorer language fluency in people with first-episode bipolar disorder compared to controls. Moderate to high quality evidence suggests a medium-sized effect of better fluency in people with first-episode bipolar disorder compared to people with first-episode schizophrenia.

High quality evidence suggests a medium to large effect of poorer language fluency in elderly people with bipolar disorder compared to controls matched for age and education.

High quality evidence suggests a small to medium-sized effect of poorer language fluency in first-degree relatives of people with bipolar disorder compared to controls. There was better fluency in first-degree relatives of people with bipolar disorder than first-degree relatives of people with schizophrenia.

High quality evidence suggests a small association between poor verbal ability/fluency and poor general functioning.

Moderate quality evidence suggests no changes in performance on fluency tasks over time (~3-4 years) in people with bipolar disorder.

October 2021

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Language may be altered in people with schizophrenia and may present in the form of disorganised speech. Tasks designed to assess language ability include; letter fluency tasks that assess the ability to generate words starting with a particular letter; and category fluency tasks that assess the ability to name words within a specified category. Working memory is needed for both letter and category fluency as participants must organise and retrieve relevant information.

Other tests designed to assess language include: Boston Naming task; Wechsler Adult Intelligence Scale comprehension (WAIS), including the subtest information, similarities and vocabulary, WAIS verbal memory, verbal fluency, National Adult Reading Test / Wide Range Achievement Test, Controlled Oral Word Association Test, Category Instance Generation Test, Multiple Choice Vocabulary Test, Hopkins Verbal Learning test, California Verbal Learning Test, Rey Auditory Verbal Learning Test, semantic priming tasks and Lexical Decision Task and the Peabody Individual Achievement reading comprehension. Latent Semantic Analysis is a fairly new technique that estimates the degree of incoherence in language use.

What is the evidence for language ability in people with schizophrenia?

Compared to people without schizophrenia, moderate to high quality evidence shows large effects of more incoherent speech, impaired letter and category fluency, verbal learning, verbal working memory, phonological processing and decoding, comprehension, single word reading, and semantic priming in people with schizophrenia. People with schizophrenia with severe negative or disorganised symptoms were most impaired on verbal fluency. Moderate quality evidence also found impaired vocabulary and word fluency in people with first-episode, youth-onset, or late-onset schizophrenia. Moderate to low quality evidence found large effects of poorer reading rate and fluency in people with schizophrenia, with no differences in accuracy or reading speed.

Overall, moderate to high quality evidence found greater improvements in verbal fluency in people with schizophrenia taking second generation antipsychotics than in people with schizophrenia taking first generation antipsychotics. For specific second generation antipsychotics, quetiapine, olanzapine and clozapine improved overall language ability, but there were no improvements with risperidone. For first-generation haloperidol, there were improvements in verbal learning and delayed verbal recall, but not in verbal fluency. Moderate to high quality evidence found improved performance on verbal learning tasks was associated with better community functioning, social behaviour, social skills, and problem solving.

Compared to people with bipolar disorder, moderate to high quality evidence shows a small effect of poorer performance on word association and verbal learning tests in people with schizophrenia. High quality evidence found a small to medium-sized effect of poorer performance on verbal fluency tasks in people with schizophrenia compared to people with schizoaffective disorder, who showed poorer performance on verbal fluency tasks than people with bipolar disorder.

March 2022

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Antecedents such as speech and hearing problems are subtle deviations in development that may become evident during childhood or adolescence. The presence of these deviations may foreshadow the later development of schizophrenia, however most children who exhibit these antecedents do not develop the disorder. Studies exploring antecedents are ideally based on representative, population-based samples that follow the group from birth through childhood and adolescence to adulthood. These studies can provide unique insights into the changes in developmental trajectories that may be associated with schizophrenia.

What is the evidence for speech and hearing deficits as antecedents of schizophrenia?

Moderate to high quality evidence finds medium to large effects of early language dysfunction in children who later develop schizophrenia. These include abnormal speech, delays in talking, poor quality of expressive and receptive language, and poor oral and reading ability in school. A small effect was found for poor word association ability.

Moderate to low quality evidence finds a medium to large increased risk of childhood speech and hearing impairment in people with schizophrenia.

March 2022

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