Psychological Medicine

  • Psychological Medicine / Volume 39 / Issue 05 / May 2009, pp 773-783
  • Copyright © Cambridge University Press 2008. The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution-NonCommercial-ShareAlike licence <>. The written permission of Cambridge University Press must be obtained for commercial re-use.
  • DOI: (About DOI), Published online: 16 September 2008

Original Articles

Cognitive processing in bipolar disorder conceptualized using the Interactive Cognitive Subsystems (ICS) model

C. L. Lomaxa1 c1, P. J. Barnarda2 and D. Lama3

a1 Department of Psychology, Institute of Psychiatry, London, UK

a2 MRC Cognition and Brain Sciences Unit, Cambridge, UK

a3 Department of Clinical Psychology, University of Hull, UK


Background There are few theoretical proposals that attempt to account for the variation in affective processing across different affective states of bipolar disorder (BD). The Interacting Cognitive Subsystems (ICS) framework has been recently extended to account for manic states. Within the framework, positive mood state is hypothesized to tap into an implicational level of processing, which is proposed to be more extreme in states of mania.

Method Thirty individuals with BD and 30 individuals with no history of affective disorder were tested in euthymic mood state and then in induced positive mood state using the Question–Answer task to examine the mode of processing of schemas. The task was designed to test whether individuals would detect discrepancies within the prevailing schemas of the sentences.

Results Although the present study did not support the hypothesis that the groups differ in their ability to detect discrepancies within schemas, we did find that the BD group was significantly more likely than the control group to answer questions that were consistent with the prevailing schemas, both before and after mood induction.

Conclusions These results may reflect a general cognitive bias, that individuals with BD have a tendency to operate at a more abstract level of representation. This may leave an individual prone to affective disturbance, although further research is required to replicate this finding.

(Received February 27 2008)

(Revised June 27 2008)

(Accepted July 16 2008)

(Online publication September 16 2008)


c1 Address for correspondence: Dr C. L. Lomax, Department of Psychology, Institute of Psychiatry, London SE5 8AF, UK. (Email: