Psychological Medicine

Original Articles

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

J. McKirdya1, J. E. D. Sussmanna1, J. Halla1, S. M. Lawriea1, E. C. Johnstonea1 and A. M. McIntosha1 c1

a1 Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK


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.

(Received November 15 2007)

(Revised November 04 2008)

(Accepted November 14 2008)

(Online publication December 24 2008)


c1 Address for correspondence: Dr A. M. McIntosh, Division of Psychiatry, University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh EH10 5HF, UK. (Email: