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

Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK.
Psychological Medicine (Impact Factor: 5.94). 08/2009; 39(8):1289-93. DOI: 10.1017/S0033291708004935
Source: PubMed


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.
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.
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.
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.

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    • "BPD has been proposed to be part of a spectrum of bipolar affective disorders (Smith, Muir, & Blackwood, 2004). Our findings suggest that this is less likely as subjects with bipolar affective disorder demonstrate deficits in both EDS and later reversal learning stages of the IDED task (McKirdy et al., 2009) and subjects with depression tend to fail at the EDS stage of the task (Purcell et al., 1997; Taylor Tavares et al., 2007), whereas the subjects in our study with BPD do not demonstrate these shortfalls in performing the task. The one stage that BPD subjects did show impaired performance on was the simple reversal stage as indicated by a small to medium effect size. "
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