With the speech option, the game might crash to the desktop but you should be able to click on the shortcut and get back into the options screen.
For options like screen rez, you'll probably need to edit dangerouswaters.ini to make any changes. Just open the .ini file in notepad (and only in notepad) and make the changes you want, then save. The options are listed under [graphics] and should be self-explanatory but if you're unsure just ask.
