Abstract
Bipolar disorder (BD) is characterized by speech abnormalities, reflected by symptoms such as pressure of speech in mania and poverty of speech in depression. Here we aimed at investigating speech abnormalities in different episodes of BD, including mixed episodes, via process-oriented measures of verbal fluency performance – i.e., word and error count, semantic and phonological clustering measures, and number of switches–, and their relation to neurocognitive mechanisms and clinical symptoms. 93 patients with BD – i.e., 25 manic, 12 mixed manic, 19 mixed depression, 17 depressed, and 20 euthymic–and 31 healthy controls were administered three verbal fluency tasks – free, letter, semantic–and a clinical and neuropsychological assessment. Compared to depression and euthymia, switching and clustering abnormalities were found in manic and mixed states, mimicking symptoms like flight of ideas. Moreover, the neuropsychological results, as well as the fact that error count did not increase whereas phonological associations did, showed that impaired inhibition abilities and distractibility could not account for the results in patients with manic symptoms. Rather, semantic overactivation in patients with manic symptoms, including mixed depression, may compensate for trait-like deficient semantic retrieval/access found in euthymia.“For those who are manic, or those who have a history of mania, words move about in all directions possible, in a three-dimensional ‘soup’, making retrieval more fluid, less predictable.” Kay Redfield Jamison (2017, p. 279).
Highlights
“For those who are manic, or those who have a history of mania, words move about in all directions possible, in a three-dimensional ‘soup’, making retrieval more fluid, less predictable.”
While early studies focused on associational fluency as a measure of creativity and thinking style in mania[3,4,5,6,7], more recent studies have favored the use of verbal fluency tasks (VFT) with more restrained instructions to tackle executive and language impairments mostly in euthymia, i.e., during periods of mood stabilization[8]
Only the depression group tended to produce fewer words compared to healthy controls and manic patients in the semantic VFT
Summary
“For those who are manic, or those who have a history of mania, words move about in all directions possible, in a three-dimensional ‘soup’, making retrieval more fluid, less predictable.”. Bipolar disorder (BD) is characterized by acute episodes of mania and depression, mixed episodes wherein depressive and manic symptoms co-occur, and periods of partial or full remission, called ‘euthymic states’ Language disturbances such as speech pressure or poverty are among the main symptoms of acute episodes in BD1, and may prevail during periods of remission[2]. We investigated language disturbances, by means of both free and restrained VFT across different mood episodes of BD, to determine the contribution of clinical symptoms and executive functioning to word production in BD. VFT are widely used neuropsychological methods for studying language disorders[16] In these tasks, subjects are instructed to generate words according to specified rules based on phonemic or semantic criteria (‘letter’ and ‘semantic’ fluency, respectively), or in the absence of a specified criterion (free word generation). These processes underlie two aspects of word output that are responsible for optimal performance: the ability to produce words within semantic or phonological clusters, and the ability to shift to a new category, i.e., clustering and switching respectively[17]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
