Skip to main content

Neuropsychology of bipolar disorder

  • F. C. Murphy (a1) and B. J. Sahakian (a2)

Although the presence of wide-ranging neuropsychological deficits in individuals with major depression is well established, few studies have investigated the nature of cognitive impairment in patients with bipolar disorder.


To review research of the neuropsychology of bipolar disorder, with special attention to the relationship between mood and cognitive functioning.


Literature review.


Findings generally demonstrate mania-related impairments on conventional neuropsychological tests, with direct comparisons of patients with mania and patients with depression failing to find group differences. More recent work has sought to differentiate these disorders by employing tasks with affective components. This research has demonstrated biases for processing positive and negative stimuli in patients with mania and depression, respectively.


Future studies, employing tasks that require cognitive and emotional processing, should improve our understanding of the deficits observed in depression and mania. Neuroimaging studies of the neural regions that underlie cognitive processing of affective meaning suggest that the medial and orbitofrontal prefrontal cortex may be particularly involved.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Neuropsychology of bipolar disorder
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Neuropsychology of bipolar disorder
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Neuropsychology of bipolar disorder
      Available formats
Corresponding author
Dr B. J. Sahakian, Department of Psychiatry, University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK. Tel: +44 (0) 1223 331209; fax: +44 (0) 1223 336968; e-mail:
Hide All

Declaration of interest


Hide All
Alexander, G. E., DeLong, M. R. & Strick, P. L. (1986) Parallel organization of functionally segregated circuits linking basal ganglia and cortex. Annual Review of Neuroscience, 9, 357381.
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM–IV). Washington, DC: APA.
Andreasen, N. J. C. & Powers, P. S. (1974) Overinclusive thinking in mania and schizophrenia. British Journal of Psychiatry, 125, 452456.
Asarnow, R. F. & MacCrimmon, D. J. (1981) Span of apprehension deficits during the postpsychotic stages of schizophrenia. Archives of General Psychiatry, 38, 10061011.
Austin, M. P., Ross, M., Murray, C., et al (1992) Cognitive function in major depression. Journal of Affective Disorders, 25, 2130.
Baker, S. C., Rogers, R. D., Owen, A. M., et al (1996) Neural systems engaged by planning: a PET study of the lower of London task. Neuropsychologia, 34, 515526.
Barnard, P. J. & Teasdale, J. D. (1991) Interacting cognitive subsystems: a systemic approach to cognitive-affective interaction and change. Cognition and Emotion, 5, 139.
Beats, B. C., Sahakian, B. J. & Levy, R. (1996) Cognitive performance in tests sensitive to frontal lobe dysfunction in the elderly depressed. Psychological Medicine, 26, 591603.
Beauregard, M., Chertkow, H., Bub, H., et al (1997) The neural substrate for concrete, abstract, and emotional word lexica: a positron emission tomography study. Journal of Cognitive Neuroscience, 9, 441461.
Bechara, A., Damasio, A. R., Damasio, H., et al (1994) Insensitivity to future consequences following damage to human prefrontal cortex. Cognition, 50, 715.
Berman, K. F., Randolph, C., Gold, J., et al (1986) Physiological activation of a cortical network of the Wisconsin Card Sorting Test: a positron emission tomography study. Neuropsychologia, 33, 10271046.
Blaney, P. H. (1986) Affect and memory: a review. Psychological Bulletin, 99, 229246.
Bradley, B. P., Mogg, K. & Millar, N. (1996) Implicit memory bias in clinical and non-clinical depression. Behaviour Research and Therapy, 34, 865879.
Brown, R. G., Scott, L. C., Bench, C. J., et al (1994) Cognitive function in depression: its relationship to the presence and severity of intellectual decline. Psychological Medicine, 24, 829847.
Bulbena, A. & Berrios, G. E. (1993) Cognitive function in the affective disorders: a prospective study. Psychopathology, 26, 612.
Bunney, W. E. J. & Hartmann, E. L. (1965) A study of a patient with 48-hour manic–depressive cycles, I. An analysis of behavioural factors. Archives of General Psychiatry, 12, 611618.
Burt, D. B., Zembar, M. J. & Niederehe, G. (1995) Depression and memory impairment: a meta-analysis of the association, its pattern, and specificity. Psychological Bulletin, 117, 285305.
Carroll, B. J. (1994) Brain mechanisms in manic depression. Clinical Chemistry, 40, 303308.
Clark, D. M. & Teasdale, J. D. (1982) Diurnal variation in clinical depression and accessibility of memories of positive and negative experiences. Journal of Abnormal Psychology, 91, 8795.
Clark, L., Iversen, S. D. & Goodwin, G. M. (2000) A neuropsychological investigation of prefrontal cortex function in acute mania. Journal of Psychopharmacology, 14 (suppl.), A22.
Corwin, J., Peselow, E., Feenan, K., et al (1990) Disorders of decision in affective disease: an effect of B-adrenergic dysfunction? Biological Psychiatry, 27, 813833.
Damasio, A. R. (1994) Descartes' Error. New York: Putnam.
Drevets, W. C., Price, J. L., Simpson, J. R. et al (1997) Subgenual prefrontal cortex abnormalities in mood disorders. Nature, 386, 824827.
Drewe, E. A. (1975) Go–no go learning after frontal lobe lesions in humans. Cortex, 11, 816.
Elliott, R. (1998) The neuropsychological profile in unipolar depression. Trends in Cognitive Sciences, 2, 447454.
Elliott, R., Sahakian, B. J., McKay, A. P., et al (1996) Neuropsychological impairments in unipolar depression: the influence of perceived failure on subsequent performance. Psychological Medicine, 26, 975989.
Elliott, R., Sahakian, B. J., Herrod, J. J., et al (1997a) Abnormal response to negative feedback in unipolar depression: evidence for a diagnosis specific impairment. Journal of Neurology, Neurosurgery and Psychiatry, 63, 7482.
Elliott, R., Frith, C. D. & Dolan, R. J. (1997b) Differential neural response to positive and negative feedback in planning and guessing tasks. Neuropsychologia, 35, 13951404.
Elliott, R., Sahakian, B. J., Michael, A., et al (1998) Abnormal neural response to feedback on planning and guessing tasks in patients with unipolar depression. Psychological Medicine, 28, 559571.
Ellis, H. C. & Ashbrook, P. W. (1988) Resource allocation model of the effects of depressed mood states on memory. In Affect, Cognition, and Social Behavior (eds Fiedler, K. & Forgas, J.). Gottingen: Hogrefe.
Ferrier, I. N., Stanton, B. R., Kelly, T. P., et al (1999) Neuropsychological function in euthymic patients with bipolar disorder. British Journal of Psychiatry, 175, 246251.
Franke, P., Maier, W., Hardt, J., et al (1993) Assessment of frontal lobe functioning in schizophrenia and unipolar major depression. Psychopathology, 26, 7684.
Goldberg, T. E., Gold, J. M., Greenberg, R., et al (1993) Contrasts between patients with affective disorders and patients with schizophrenia on a neuropsychological test battery. American Journal of Psychiatry, 150, 13551362.
Gotlib, I. H. & Cane, D. B. (1987) Construct accessibility and clinical depression: a longitudinal investigation. Journal of Abnormal Psychology, 96, 199204.
Grant, D. A. & Berg, E. A. (1948) A behavioural analysis of degree of reinforcement and ease of shifting to new responses in a Weigl-type card sorting problem. Journal of Experimental Psychology, 38, 404411.
Hasher, L. & Zacks, R. T. (1979) Automatic and effortful processes in memory. Journal of Experimental Psychology: General, 108, 356388.
Henry, G., Weingartner, H. & Murphy, D. (1971) Idiosyncratic patterns of learning and word association during mania. American Journal of Psychiatry, 128, 564573.
Ilsley, J. E., Moffoot, A. P. R. & O'Canoll, R. E. (1995) An analysis of memory dysfunction in major depression. Journal of Affective Disorders, 35, 19.
Johnson, M. H. & Magaro, P. A. (1987) Effects of mood and severity on memory processes in depression and mania. Psychological Bulletin, 101, 2840.
Jones, B. P., Duncan, C. C., Mirsky, A. F., et al (1994) Neuropsychological profiles in bipolar affective disorder and complex partial seizure disorder. Neuropsychology, 8, 5564.
Kerry, R. J., McDermott, C. M. & Orme, J. E. (1983) Affective disorders and cognitive performance. Journal of Affective Disorders, 5, 349352.
Kessing, L. V. (1998) Cognitive impairment in the euthymic phase of affective disorder. Psychological Medicine, 28, 10271038.
Kraepelin, E. (1921) Manic–depressive Insanity and Paranoia. Edinburgh: Livingstone.
LeDoux, J. E. (1995) In search of an emotional system in the brain: leaping from fear to emotion and consciousness. In The Cognitive Neurosciences (ed. Gazzaniga, M. S.), pp. 11531164. Cambridge: MIT Press.
Lloyd, G. G. & Lishman, W. A. (1975) Effect of depression on the speed of recall of pleasant and unpleasant experiences. Psychological Medicine, 5, 173180.
Lyon, H. M., Startup, M. & Bentall, R. P. (1999) Social cognition and the manic defense: attributions, selective attention, and self-schema in bipolar affective disorder. Journal of Abnormal Psychology, 108, 273282.
Malloy, P., Bihrle, A., Duffy, J., et al (1993) The orbitomedial frontal syndrome. Archives of Clinical Neuropsychology, 8, 185201.
Martin, D. J., Oren, Z. & Boone, K. (1991) Major depressives' and dysthymics' performance on the Wisconsin card sorting test. Journal of Clinical Psychology, 47, 684690.
McKay, A. P. Tarbuck, A. F., Shapleske, J., et al (1995) Neuropsychological function in manic-depressive psychosis. Evidence for persistent deficits in patients with chronic, severe illness. British Journal of Psychiatry, 167, 5157.
Miller, W. R. (1975) Psychological deficit in depression. Psychological Bulletin, 82, 238260.
Mogg, K., Bradley, B. P. & Williams, R. (1995) Attentional bias in anxiety and depression: the role of awareness. British Journal of Clinical Psychology, 34, 1736.
Morice, R. (1990) Cognitive inflexibility and pre-frontal dysfunction in schizophrenia and mania. British Journal of Psychiatry, 157, 5054.
Murphy, F. C., Sahakian, B. J., Rubinsztein, J. S., et al (1999) Emotional bias and inhibitory control processes in mania and depression. Psychological Medicine, 29, 13071321.
Murphy, F. C., Rubinsztein, J. S., Michael, A. (2001) Decision making cognition in mania and depression. Psychological Medicine, 31, 679694.
Oltmanns, T. F. (1978) Selective attention in schizophrenic and manic psychosis: the effect of distraction on information processing. Journal of Abnormal Psychology, 87, 212225.
Otteson, J. P. & Holzman, P. S. (1976) Cognitive controls and psychopathology. Journal of Abnormal Psychology, 85, 125139.
Owen, A. M., Sahakian, B. J., Semple, J., et al (1995a) Visuo-spatial short-term recognition memory and learning after temporal lobe excisions, frontal lobe excisions or amygdalo-hippocampectomy in man. Neuropsychologia, 33, 124.
Owen, A. M., Sahakian, B. J., Hodges, J. R., et al (1995b) Dopamine-dependent frontostriatal planning deficits in early Parkinson's disease. Neuropsychology, 9, 115.
Pandya, D. N. & Yeterian, E. H. (1996) Morphological correlations of human and monkey frontal lobe. In Neurobiology of Decision-Making (eds Damasio, A. R., Damasio, H. & Christen, Y.), pp. 1345. Berlin: Springer.
Rahman, S., Sahakian, B. J., Hodges, J. R., et al (1999) Specific cognitive deficits in mild frontal variant frontotemporal dementia. Brain, 122, 14691493.
Richards, P. M. & Ruff, R. M. (1989) Motivational effects on neuropsychological functioning: comparison of depressed versus nondepressed individuals. Journal of Consulting and Clinical Psychiatry, 57, 396402.
Robbins, T. W., Joyce, E. M. & Sahakian, B. J. (1992) Neuropsychology and imaging. In The Handbook of Affective Disorders (ed Paykel, E. S.), pp. 289309. London: Churchill Livingstone.
Robbins, T. W., James, M., Owen, A. M., et al (1994) Cambridge Neuropsychological lest Automated Battery (CANTAB): a factor analytic study of a large sample of normal elderly volunteers. Dementia, 5, 266281.
Robbins, T. W., James, M., Owen, A. M., et al (1998) A study of performance on tests from the CANTAB battery sensitive to frontal lobe dysfunction in a large sample of normal volunteers: implications for theories of executive functioning. Journal of the International Neuropsychological Society, 4, 474490.
Rogers, R. D., Everitt, B. J., Baldacchino, A., et al (1999) Dissociable deficits in the decision-making cognition of chronic amphetamine abusers, opiate abusers, patients with focal damage to prefrontal cortex, and tryptophan-depleted normal volunteers: evidence for monoaminergic mechanisms. Neuropsychopharmacology, 20, 322339.
Rubinsztein, J. S., Michael, A., Paykel, E. S., et al (2000) Cognitive impairment in remission in bipolar affective disorder. Psychological Medicine, 30, 10251036.
Sahakian, B. J., Morris, R. G., Evenden, J. L., et al (1988) A comparative study of visuospatial memory and learning in Alzheimer-type dementia and Parkinson's disease. Brain, 111, 695718.
Savard, R. J., Rey, A. C. & Post, R. M. (1980) Halstead–Reitan Category Test in bipolar and unipolar affective disorders. Journal of Nervous and Mental Disease, 168, 297304.
Seligman, M. E. P. (1975) Helplessness: On Depression, Development, and Death. San Francisco, CA: Freeman.
Shallice, T. (1982) Specific impairments of planning. Philosophical Transactions of the Royal Society of London (Biol.), 298, 199209.
Strauss, M. E., Bohannon, W. E., Stephens, J. H., et al (1984) Perceptual span in schizophrenia and affective disorders. Journal of Nervous and Mental Disease, 172, 431435.
Taylor, M. A. & Abrams, R. (1986) Cognitive dysfunction in mania. Comprehensive Psychiatry, 27, 186191.
Teasdale, J. D. & Barnard, P. J. (1993) Affect, Cognition, and Change. Hove: Lawrence Erlbaum.
Teasdale, J. D., Howard, R. J., Cox, S. G., et al (1999) Functional MRI study of the cognitive generation of affect. American Journal of Psychiatry, 156, 209215.
Tham, A., Engelbrektson, K., Mathe, A. A., et al (1997) Impaired neuropsychological performance in euthymic patients with recurring mood disorders. Journal of Clinical Psychiatry, 58, 2629.
Weingartner, H., Cohen, R. M., Murphy, D. L., et al (1981) Cognitive processes in depression. Archives of General Psychiatry, 38, 4247.
Williams, J. M. G. (1996) Depression and the specificity of autobiographical memory. In Remembering our Past: Studies in Autobiographical Memory (ed. Rubin, D. C.), pp. 244267. New York: Cambridge University Press.
Williams, J. M. G., Watts, F. N., MacLeod, C., et al (1997) Cognitive Psychology and Emotional Disorders. Chichester: Wiley.
Wolfe, J., Granholm, E., Butters, N., et al (1987) Verbal memory deficits associated with major affective disorders: a comparison of unipolar and bipolar patients. Journal of Affective Disorders, 13, 8392.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Full text views

Total number of HTML views: 0
Total number of PDF views: 53 *
Loading metrics...

Abstract views

Total abstract views: 237 *
Loading metrics...

* Views captured on Cambridge Core between 2nd January 2018 - 26th May 2018. This data will be updated every 24 hours.

Neuropsychology of bipolar disorder

  • F. C. Murphy (a1) and B. J. Sahakian (a2)
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *