Language, executive functioning and symptomatology—Is fluency a transversal tool in schizophrenia?


Despite a large number of studies on fluency disorders in schizophrenia, it is still not clear whether executive functioning and fluency tasks are empirically linked and how symptomatology could specifically get involved on these influences. We carried out analyses of performances in several verbal fluency tasks, a non-verbal fluency task and an executive test (FAB) in 25 schizophrenics and 25 healthy subjects matched in terms demographic data. Patients also completed the Positive and Negative Symptoms Scale in order to control for their clinical profile. Our results suggest that schizophrenic patients show both category and letter fluency deficits with a greater impairment for letter fluency. They also display poorer performances for the non-verbal fluency task. In patients, all the verbal and non-verbal fluencies are significantly correlated with the FAB total score. By contrast, in controls, only letter fluency correlates with the FAB total score, which is congruent with previous literature on the healthy mechanisms of verbal fluency. Besides, factorial analyses show that symptomatology is specifically related to particular indexes of fluency tasks. Taken together, these data lead to support the hypothesis of retrieval rather than semantic difficulties and alargest involvement of executive functioning in schizophrenics during tasks that require a certain degree of efficiency, with performance being influenced by the clinical profile. Yet, the relation between fluency scores and executive functioning has to be more intensively explored and further studies should include semantic memory measures that fit with pathology’s constraints and characteristics.

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Rinaldi, R. , Lefebvre, L. and Trappeniers, J. (2013) Language, executive functioning and symptomatology—Is fluency a transversal tool in schizophrenia?. Open Journal of Psychiatry, 3, 358-369. doi: 10.4236/ojpsych.2013.34038.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Troyer, A.K., Moscovitch, M. and Winocur, G. (2002) Clustering and switching as two components of verbal fluency: Evidence from younger and older healthy adults. Neuropsychology, 11, 138-146.
[2] Bozikas, V.P., Kosmidis, M.H. and Karavatos, A. (2005) Disproportionate impairment in semantic verbal fluency in schizophrenia: Differential deficit in clustering. Schizophrenia research, 74, 51-59.
[3] Troyer, A.K., Moscovitch, M., Winocur, G., Alexander, M.P. and Stuss, D. (1998) Clustering and switching on verbal fluency: The effects of focal frontaland temporal-lobe lesions. Neuropsychologia, 36, 499-504.
[4] Cattelani, R., Dal Sasso, F., Corsini, D. and Posteraro, L. (2011) The Modified Five-Point Test: Normative data for a sample of Italian healthy adults aged 16-60. Neurological Sciences?: Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 32, 595-601.
[5] Goebel, S., Fisher, R., Ferstl, R. and Medhorn, H.M. (2009) Normative data and psychometric properties for qualitative and quantitative scoring criteria of the Fivepoint Test. The Clinical Neuropsychologist, 29, 675-690.
[6] Ruff, R.M., Light, R.H. and Evans, R.W. (1987) The ruff figural fluency test: A normative study with adults. Developmental Neuropsychology, 3, 37-51.
[7] Tucha, L., Aschenbrenner, S., Koerts, J. and Lange, K.W. (2012) The five-point test: Reliability, validity and normative data for children and adults. PloS one, 7, Article ID: e46080.
[8] Goebel, S., Atanassov, L., K?hnken, G., Mehdorn, H.M. and Leplow, B. (2012) Understanding quantitative and qualitative figural fluency in patients with Parkinson’s disease. Neurological Sciences, 34, 1383-1390.
[9] Phillips, T.J., James, A.C.D., Crow, T.J. and Collinson, S.L. (2004) Semantic fluency is impaired but phonemic and design fluency are preserved in early-onset schizophrenia. Schizophrenia research, 70, 215-222.
[10] Bokat, C.E. and Goldberg, T.E. (2003) Letter and category fluency in schizophrenic patients: A meta-analysis. Schizophrenia Research, 64, 73-78.
[11] Ojeda, N., Sánchez, P., Pe?a, J., Elizagárate, E., Yoller, A.B., Larumbe, J., Gutiérrez, M., et al. (2010) Verbal fluency in schizophrenia: Does cognitive performance reflect the same underlying mechanisms in patients and healthy controls? Journal of Nervous and Mental Disease, 198, 286-291.
[12] Juhasz, B.J., Chambers, D., Shesler, L.W., Haber, A. and Kurtz, M.M. (2012) Evaluating lexical characteristics of verbal fluency output in schizophrenia. Psychiatry Research, 200, 177-183.
[13] Birn, R.M., Kenworthy, L., Case, L., Caravella, R., Jones, T.B., Bandettini, P.A and Martin, A. (2010) Neural systems supporting lexical search guided by letter and semantic category cues: A self-paced overt response fMRI study of verbal fluency. NeuroImage, 49, 1099-1107. 1016/j.neuroimage.2009.07.036
[14] Hirshorn, E.A. and Thompson-Schill, S.L. (2006) Role of the left inferior frontal gyrus in covert word retrieval: Neural correlates of switching during verbal fluency. Neuropsychologia, 44, 2547-2557.
[15] Henry, J.D. and Crawford, J.R. (2005) A meta-analyticreview of verbal fluencydeficits in schizophrenia relative to other neurocognitive deficits. Cognitive Neuropsychiatry, 10, 1-33. 1080/13546800344000309
[16] Berenbaum, H., Kerns, J.G., Vernon, L.L. and Gomez, J.J. (2008) Cognitive correlates of schizophrenia signs and symptoms: I. Verbal communication disturbances. Psychiatry Research, 159, 47-56.
[17] Joyce, E.M., Collinson, S.L. and Crichton, P. (1996) Verbal fluency in schizophrenia: relationship with executive function, semantic memory and clinical alogia. Psychological Medicine, 26, 39-49.
[18] Van Beilen, M., Pijnenbord, M., Van Zomeren, E.H., Van den Bosch, R.J., Withaar, F. and Bouma, A. (2004) What is measured by verbal fluency tasks in schizophrenia. Schizophrenia Research, 69(, 267-276.
[19] Sumiyoshi, C., Matsui, M., Sumiyoshi, T., Yamashita, I., Sumiyoshi, S. and Kurachi, M. (2001) Semantic structure in schizophrenia as assessed by the category fluency test: Effect of verbal intelligence and age of onset. Psychiatry Research, 105, 187-199.
[20] Kosmidis, M.H., Bozikas, V.P., Vlahou, C.H., Kiosseoglou, G., Giaglis, G. and Karavatos, A. (2005) Verbal fluency in institutionalized patients with schizophrenia: Age-related performance decline. Psychiatry Research, 134, 233-240.
[21] Sumiyoshi, C., Sumiyoshi, T., Matsui, M., Nohara, S., Yamashita, I., Kurachi, M. and Niwa, S. (2004) Effect of orthography on the verbal fluency performance in schizophrenia: Examination using Japanese patients. Schizophrenia Research, 69, 15-22.
[22] Woodward, T.S., Ruff, C.C., Thornton, A.E., Moritz, S. and Liddle, P.F. (2003) Methodological considerations regarding the association of Stroop and verbal fluency performance with the symptoms of schizophrenia. Schizophrenia Research, 61, 207-214.
[23] Bejaoui, M. and Pedinielli, J.-L. (2010) Flexibilité cognitive, attention sélective et fluidité verbale sémantique dans trois dimensions de schizophrénie: Psychotique, négative et de désorganisation. Pratiques Psychologiques, 16, 259-272.
[24] Frith, C.D. (1992) The Cognitive Neuropsychology of Schizophrenia (Psychology). Psychology Press, London.
[25] Docherty, A.R., Berenbaum, H. and Kerns, J.G. (2011) Alogia and formal thought disorder?: Differential patterns of verbal fluency task performance q. Journal of Psychiatric Research, 45, 1352-1357.
[26] Rossell, S.L., Rabe-Hesketh, S.S., Shapleske, J.S. and David, A.S. (1999) Is semantic fluency differentially impaired in schizophrenic patients with delusions? Journal of Clinical and Experimental Neuropsychology, 21, 629-642. 1076/jcen.21.5.629.865
[27] Brébion, G., Villalta-Gil, V., Autonell, J., Cervilla, J., Dolz, M., Foix, A., Haro, J.M., et al. (2013) Cognitive correlates of verbal memory and verbal fluency in schizophrenia, and differential effects of various clinical symptoms between male and female patients. Schizophreniaresearch, 147, 81-85.
[28] Robert, P.H., Thauby, S., Migneco, V., Chaix, I., Caci, H., Benoit, M., Pringuey, D., et al. (1996) Neurocognitive subtypes of schizophrenia according to performance at verbal fluency tasks. L’Encéphale, 22, 435-442.
[29] Ziauddeen, H., Dibben, C., Kipps, C., Hodges, J.R. and McKenna, P.J. (2011) Negative schizophrenic symptoms and the frontal lobe syndrome: one and the same? European Archives of Psychiatry and Clinical Neuroscience, 261, 59-67.
[30] Pegoraro, L.F.L., Dantas, C.R., Banzato, C.E.M. and Fuentes, D. (2013) Correlation between insight dimensions and cognitive functions in patients with deficit and nondeficit schizophrenia. Schizophrenia Research, 147, 91-94.
[31] Chen, R.Y., Chen, E.Y., Chan, C.K., Lam, L.C. and LiehMak, F. (2000) Verbal fluency in schizophrenia: Reduction in semantic store. The Australian and New Zealand Journal of Psychiatry, 34, 43-48.
[32] Hu, M., Chen, J., Li, L., Zheng, Y., Wang, J., Guo, X., Wu, R., et al. (2011) Semantic fluency and executive functions as candidate endophenotypes for the early diagnosis of schizophrenia in Han Chinese. Neuroscience Letters, 502, 173-177.
[33] American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders. 4th Edition, APA, Washington DC.
[34] Cardebat, D., Doyon, B., Puel, M., Goulet, P. and Joanette, Y. (1990) Evocation lexicale formelle et sémantique chez des sujets normaux?: Performances et dynamiques de production en fonction du sexe, de l’age et du niveau d’étude. Acta Neurologica Belgica, 90, 207-217.
[35] Dubois, B., Slachevsky, A., Litvan, I. and Pillon, B. (2000) The FAB: A frontal assessment battery at bedside. Neurology, 55, 1621-1626.
[36] Cunha, P.J., Nicastri, S., De Andrade, A.G. and Bolla, K.I. (2010) The frontal assessment battery (FAB) reveals neurocognitive dysfunction in substance-dependent individuals in distinct executive domains: Abstract reasoning, motor programming, and cognitive flexibility. Addictive behaviors, 35, 875-881.
[37] Nimatoudis, I., Spyridi, S., Kantartzis, S., Sokolaki, S., Panagiotidis, P., Nassika, Z. and Kaprinis, G. (2007) The frontal assessment battery at bedside (FAB) in patients with schizophrenia. European Psychiatry, 22, S128.
[38] Kay, S.R., Fiszbein, A. and Opler, L.A. (1987) The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 261-276.
[39] Lépine, J.-P. and Perretti, C.S. (2008) Positive and negative syndrome scale. Editions médicales Pierre Fabre, Paris.
[40] Bell, M.D., Lysaker, P.H., Beam-Goulet, J.L., Milstein, R. M. and Lindenmayer, J.P. (1994) Five-component model of schizophrenia: Assessing the factorial invariance of the positive and negative syndrome scale. Psychiatry Research, 52, 295-303.
[41] Liemburg, E., Castelein, S., Stewart, R., Van der Gaag, M., Aleman, A. and Knegtering, H. (2013) Two subdomains of negative symptoms in psychotic disorders: Established and confirmed in two large cohorts. Journal of Psychiatric Research, 47, 1-8.
[42] Allen, H.A., Liddle, P.F. and Frith, C.D. (1993) Negative features, retrieval processes and verbal fluency in schizophrenia. British Journal of Psychiatry, 73, 769-775. 1192/bjp.163.6.769
[43] Heinrichs, D.W. and Zakzanis, K. (1998) Neurocognitive deficits in schizophrenia: A quantitative review of the evidence. Neuropsychology, 12, 426-445.
[44] O’Carroll, R. (2000) Cognitive impairment in schizophrenia. Advances in Psychiatric Treatment, 6, 161-168.
[45] Kiang, M., Christensen, B.K., Kutas, M. and Zipursky, R. B. (2012) Electrophysiological evidence for primary semantic memory functional organization deficits in schizophrenia. Psychiatry Research, 196, 171-180.
[46] Laws, K.R., Al-Uzri, M. and Mortimer, A.M. (2000) Lexical knowledge degradation in schizophrenia. Schizophrenia Research, 45, 123-131.
[47] Moelter, S.T., Hill, S.K., Hughett, P., Gur, R.C., Gur, R.E. and Ragland, J.D. (2005) Organization of semantic category exemplars in schizophrenia. Schizophrenia Research, 78, 209-217.
[48] Niznikiewicz, M., Mittal, M.S., Nestor, P.G. and McCarley, R.W. (2010) Abnormal inhibitory processes in semantic networks in schizophrenia. International Journal of Psychophysiology, 75, 133-140.
[49] Al-Uzri, M., Laws, K.R. and Mortimer, A.M. (2004) An early marker for semantic memory impairment in patients with schizophrenia. Cognitive Neuropsychiatry, 9, 267-279. 1080/13546800344000255
[50] Doughty, O.J. and Done, D.J. (2009) Is semantic memory impaired in schizophrenia? A systematic review and meta-analysis of 91 studies. Cognitive Neuropsychiatry, 14, 473-509. http://dx.doi. org/10.1080/13546800903073291
[51] Joshua, N., Gogos, A. and Rossell, S. (2009) Executive functioning in schizophrenia: A thorough examination of performance on the Hayling Sentence Completion Test compared to psychiatric and non-psychiatric controls. Schizophrenia research, 114, 84-90. http://dx. 1016/j.schres. 2009.05.029
[52] [52] Weisbrod, M., Kiefer, M., Marzinzik, F. and Spitzer, M. (2000) Executive control is disturbed in schizophrenia: Evidence from event-related potentials in a Go/NoGo task. Biological Psychiatry, 47, 51-60.

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