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Set shifting and reversal learning in patients with bipolar disorder or schizophrenia

  • J. McKirdy (a1), J. E. D. Sussmann (a1), J. Hall (a1), S. M. Lawrie (a1), E. C. Johnstone (a1) and A. M. McIntosh (a1)...
Abstract
Background

Bipolar disorder and schizophrenia have both been associated with deficits in extra-dimensional set shifting (EDS). Deficits in reversal learning (RL) have also been shown in schizophrenia but not in bipolar disorder. This study sought to assess the specificity of these findings in a direct comparison of clinically stable patients with each disorder.

Method

The intra-dimensional/extra-dimensional (IDED) set-shifting task, part of the Cambridge Neuropsychological Test Automated Battery (CANTAB), was administered to 30 patients with schizophrenia, 47 with bipolar disorder and a group of 44 unaffected controls. EDS and RL errors were compared between the groups and related to measures of current and past psychiatric symptoms and medication.

Results

Both groups of patients with schizophrenia or bipolar disorder made more EDS and RL errors than controls. Neither measure separated the two disorders, even when the analysis was restricted to euthymic patients. No relationship was found with prescribed medication.

Conclusions

Patients with bipolar disorder or schizophrenia show common deficits in EDS and RL. These deficits do not seem to be attributable to current symptoms and are consistent with disrupted networks involving the ventral prefrontal cortex.

Copyright
Corresponding author
*Address for correspondence: Dr A. M. McIntosh, Division of Psychiatry, University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh EH10 5HF, UK. (Email: andrew.mcintosh@ed.ac.uk)
References
Hide All
Clark L, Goodwin GM (2004). State- and trait-related deficits in sustained attention in bipolar disorder. European Archives of Psychiatry and Clinical Neuroscience 254, 6168.
Clark L, Iversen SD, Goodwin GM (2001). A neuropsychological investigation of prefrontal cortex involvement in acute mania. American Journal of Psychiatry 158, 16051611.
Clark L, Iversen SD, Goodwin GM (2002). Sustained attention deficit in bipolar disorder. British Journal of Psychiatry 180, 313319.
Dias R, Robbins TW, Roberts AC (1996). Dissociation in prefrontal cortex of affective and attentional shifts. Nature 380, 6972.
Dickstein DP, Nelson EE, McClure EB, Grimley ME, Knopf L, Brotman MA, Rich BA, Pine DS, Leibenluft E (2007). Cognitive flexibility in phenotypes of pediatric bipolar disorder. Journal of the American Academy of Child and Adolescent Psychiatry 46, 341355.
Gorrindo T, Blair RJ, Budhani S, Dickstein DP, Pine DS, Leibenluft E (2005). Deficits on a probabilistic response-reversal task in patients with pediatric bipolar disorder. American Journal of Psychiatry 162, 19751977.
Hampshire A, Owen AM (2006). Fractionating attentional control using event-related fMRI. Cerebral Cortex 16, 16791689.
Lawrence NS, Williams AM, Surguladze S, Giampietro V, Brammer MJ, Andrew C, Frangou S, Ecker C, Phillips ML (2004). Subcortical and ventral prefrontal cortical neural responses to facial expressions distinguish patients with bipolar disorder and major depression. Biological Psychiatry 55, 578587.
Malhi GS, Lagopoulos J, Sachdev PS, Ivanovski B, Shnier R (2005). An emotional Stroop functional MRI study of euthymic bipolar disorder. Bipolar Disorders 7 (Suppl. 5), 5869.
Martinez-Aran A, Vieta E, Reinares M, Colom F, Torrent C, Sanchez-Moreno J, Benabarre A, Goikolea JM, Comes M, Salamero M (2004). Cognitive function across manic or hypomanic, depressed and euthymic states in bipolar disorder. American Journal of Psychiatry 161, 262270.
McGuffin P, Farmer A, Harvey I (1991). A polydiagnostic application of operational criteria in studies of psychotic illness. Development and reliability of the OPCRIT system. Archives of General Psychiatry 48, 764770.
McIntosh AM, Harrison LK, Forrester K, Lawrie SM, Johnstone EC (2005). Neuropsychological impairments in people with schizophrenia or bipolar disorder and their unaffected relatives. British Journal of Psychiatry 186, 378385.
Nieuwenstein MR, Aleman A, de Haan EHF (2001). Relationship between symptom dimensions and neurocognitive functioning in schizophrenia: a meta-analysis of WCST and CPT studies. Journal of Psychiatric Research 35, 119125.
Ragland JD, Gur RC, Valdez J, Turetsky BI, Elliott M, Kohler C, Siegel S, Kanes S, Gur RE (2004). Event-related fMRI of frontotemporal activity during word encoding and recognition in schizophrenia. American Journal of Psychiatry 161, 10041015.
Schneider F, Habel U, Reske M, Kellermann T, Stocker T, Shah NJ, Zilles K, Braus DF, Schmitt A, Schlosser R, Wagner M, Frommann I, Kircher T, Rapp A, Meisenzahl E, Ufer S, Ruhrmann S, Thienel R, Sauer H, Henn FA, Gaebel W (2007). Neural correlates of working memory dysfunction in first-episode schizophrenia patients: an fMRI multi-center study. Schizophrenia Research 89, 198210.
Sweeney JA, Kmiec JA, Kupfer D (2000). Neuropsychologic impairments in bipolar and unipolar mood disorders on the CANTAB neurocognitive battery. Biological Psychiatry 48, 674685.
Waltz JA, Gold JM (2007). Probabilistic reversal learning impairments in schizophrenia: further evidence of orbitofrontal dysfunction. Schizophrenia Research 93, 296303.
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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
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