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

Published online by Cambridge University Press:  24 December 2008

J. McKirdy ,
J. E. D. Sussmann ,
J. Hall ,
S. M. Lawrie ,
E. C. Johnstone  and
A. M. McIntosh
J. McKirdy
Affiliation:
Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
J. E. D. Sussmann
Affiliation:
Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
J. Hall
Affiliation:
Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
S. M. Lawrie
Affiliation:
Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
E. C. Johnstone
Affiliation:
Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
A. M. McIntosh*
Affiliation:
Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
*
*Address for correspondence: Dr A. M. McIntosh, Division of Psychiatry, University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, EdinburghEH10 5HF, UK. (Email: andrew.mcintosh@ed.ac.uk)
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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.

Keywords

Bipolar disordercohort studyneuropsychologyschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 8 , August 2009 , pp. 1289 - 1293
Copyright
Copyright © 2008 Cambridge University Press

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References

Clark, L, Goodwin, GM (2004). State- and trait-related deficits in sustained attention in bipolar disorder. European Archives of Psychiatry and Clinical Neuroscience 254, 61–68.CrossRefGoogle ScholarPubMed
Clark, L, Iversen, SD, Goodwin, GM (2001). A neuropsychological investigation of prefrontal cortex involvement in acute mania. American Journal of Psychiatry 158, 1605–1611.CrossRefGoogle ScholarPubMed
Clark, L, Iversen, SD, Goodwin, GM (2002). Sustained attention deficit in bipolar disorder. British Journal of Psychiatry 180, 313–319.CrossRefGoogle ScholarPubMed
Dias, R, Robbins, TW, Roberts, AC (1996). Dissociation in prefrontal cortex of affective and attentional shifts. Nature 380, 69–72.CrossRefGoogle ScholarPubMed
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, 341–355.CrossRefGoogle ScholarPubMed
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, 1975–1977.CrossRefGoogle ScholarPubMed
Hampshire, A, Owen, AM (2006). Fractionating attentional control using event-related fMRI. Cerebral Cortex 16, 1679–1689.CrossRefGoogle ScholarPubMed
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, 578–587.Google Scholar
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), 58–69.CrossRefGoogle ScholarPubMed
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, 262–270.CrossRefGoogle ScholarPubMed
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, 764–770.CrossRefGoogle ScholarPubMed
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, 378–385.Google Scholar
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, 119–125.CrossRefGoogle ScholarPubMed
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, 1004–1015.CrossRefGoogle ScholarPubMed
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, 198–210.CrossRefGoogle ScholarPubMed
Sweeney, JA, Kmiec, JA, Kupfer, D (2000). Neuropsychologic impairments in bipolar and unipolar mood disorders on the CANTAB neurocognitive battery. Biological Psychiatry 48, 674–685.CrossRefGoogle ScholarPubMed
Waltz, JA, Gold, JM (2007). Probabilistic reversal learning impairments in schizophrenia: further evidence of orbitofrontal dysfunction. Schizophrenia Research 93, 296–303.CrossRefGoogle ScholarPubMed