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Gender differences in immediate memory in bipolar disorder

  • D. Carrus (a1), T. Christodoulou (a1), M. Hadjulis (a1), M. Haldane (a1), A. Galea (a2), A. Koukopoulos (a3), V. Kumari (a2) and S. Frangou (a1)...



Gender is known to modulate the clinical course and severity of bipolar disorder (BD). Although cognitive abnormalities are an established feature of BD, there is limited information regarding whether gender also influences the pattern and severity of cognitive impairment.


We evaluated the performance of 86 remitted patients with BD, type 1, (BD-I) (36 male and 50 female) and 46 healthy participants (21 male and 25 female) on tasks of general intellectual ability, memory encoding, recognition and retrieval, response inhibition and executive function (abstraction and perseveration). The impact of illness severity in patients was assessed using the global assessment of functioning (GAF).


We found a gender effect and an interaction between diagnosis and gender on immediate memory, implicating encoding and retrieval processes, both showing male BD-I patients being disadvantaged compared with female patients and healthy controls. Immediate memory correlated with GAF scores and this association was statistically significant for male BD-I patients.


Our findings suggest that gender differences in BD-I are associated with memory function, particularly processes relating to encoding and retrieval, and may contribute to poor functional outcome particularly in men.


Corresponding author

*Address for correspondence: Dr S. Frangou, Section of Neurobiology of Psychosis (PO66), Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. (Email:


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APA (1994). Diagnostic and Statistical Manual of Mental Disorders (4th edn). American Psychiatric Association: Washington, DC.
Arnold, LM (2003). Gender differences in bipolar disorder. Psychiatric Clinics of North America 26, 595620.
Arts, B, Jabben, N, Krabbendam, L, van Os, J (2008). Meta-analyses of cognitive functioning in euthymic bipolar patients and their first-degree relatives. Psychological Medicine 38, 771785.
Baldassano, CF, Marangell, LB, Gyulai, L, Nassir, , Ghaemi, S, Joffe, H, Kim, DR, Sagduyu, K, Truman, CJ, Wisniewski, SR, Sachs, GS, Cohen, LS (2005). Gender differences in bipolar disorder: retrospective data from the first 500 STEP-BD participants. Bipolar Disorders 7, 465470.
Barrett, SL, Kelly, C, Bell, R, King, DJ (2008). Gender influences the detection of spatial working memory deficits in bipolar disorder. Bipolar Disorders 10, 647654.
Benazzi, F (2006). Gender differences in bipolar-II disorder. European Archives of Psychiatry and Clinical Neuroscience 256, 6771.
Berk, M, Dodd, S (2004). Review: rapid cycling bipolar disorder associated with female gender and bipolar type II subgroup. Evidence Based Mental Health 7, 91.
Bora, E, Yucel, M, Pantelis, C (2009). Cognitive endophenotypes of bipolar disorder: a meta-analysis of neuropsychological deficits in euthymic patients and their first-degree relatives. Journal of Affective Disorders 113, 120.
Burgess, PW, Shallice, T (1997). The Hayling and Brixton Tests. Bury St Edmunds: Thames Valley Test Company.
Curtis, V (2005). Women are not the same as men: specific clinical issues for female patients with bipolar disorder. Bipolar Disorders 7 (Suppl. 1), 1624.
Deckersbach, T, Dougherty, DD, Savage, C, McMurrich, S, Fischman, AJ, Nierenberg, A, Sachs, G, Rauch, SL (2006). Impaired recruitment of the dorsolateral prefrontal cortex and hippocampus during encoding in bipolar disorder. Biological Psychiatry 59, 138146.
Donaldson, S, Goldstein, LH, Landau, S, Raymon, V, Frangou, S (2003). The Maudsley Bipolar Disorder Project: the effect of medication, family history, and duration of illness on IQ and memory in bipolar I disorder. Journal of Clinical Psychiatry 64, 8693.
Eldridge, LL, Engel, SA, Zeineh, MM, Bookheimer, SY, Knowlton, BJ (2005). A dissociation of encoding and retrieval processes in the human hippocampus. Journal of Neuroscience 25, 32803286.
First, M, Spitzer, R, Gibbon, M, Williams, J (1996). Structured Clinical Interview for DSM-IV Axis 1 Disorders. New York, NY: New York State Psychiatric Institute, Biometrics Research Department.
Fletcher, PC, Henson, RN (2001). Frontal lobes and human memory: insights from functional neuroimaging. Brain 124, 849881.
Frangou, S (2005). The Maudsley Bipolar Disorder Project. Epilepsia, 46 (Suppl. 4), 1925.
Frangou, S, Donaldson, S, Hadjulis, M, Landau, S, Goldstein, LH (2005). The Maudsley Bipolar Disorder Project: executive dysfunction in bipolar disorder I and its clinical correlates. Biological Psychiatry 58, 859864.
Friedman, SH, Shelton, MD, Elhaj, O, Youngstrom, EA, Rapport, DJ, Packer, KA, Bilali, SR, Jackson, KS, Sakai, HE, Resnick, PJ, Findling, RL, Calabrese, JR (2005). Gender differences in criminality: bipolar disorder with co-occurring substance abuse. Journal of the American Academy of Psychiatry and the Law 33, 188195.
Frye, MA, Altshuler, LL, McElroy, SL, Suppes, T, Keck, PE, Denicoff, K, Nolen, WA, Kupka, R, Leverich, GS, Pollio, C, Grunze, H, Walden, J, Post, RM (2003). Gender differences in prevalence, risk, and clinical correlates of alcoholism comorbidity in bipolar disorder. American Journal of Psychiatry 160, 883889.
Hamilton, M (1960). A rating scale for depression. Journal of Neurology Neurosurgery and Psychiatry 23, 5662.
Heaton, RK (1981). Wisconsin Card Sorting Test Manual. Psychological Assessment Resources: Odessa, Florida.
Kawa, I, Carter, JD, Joyce, PR, Doughty, CJ, Frampton, CM, Wells, JE, Walsh, AE, Olds, RJ, Kennedy, N, Boydell, J, Kalidindi, S, Fearon, P, Jones, PB, van Os, J, Murray, RM (2005). Gender differences in incidence and age at onset of mania and bipolar disorder over a 35-year period in Camberwell, England. American Journal of Psychiatry 162, 257262.
Kelley, WM, Miezin, FM, McDermott, KB, Buckner, RL, Raichle, ME, Cohen, NJ, Ollinger, JM, Akbudak, E, Conturo, TE, Snyder, AZ, Petersen, SE (1998). Hemispheric specialization in human dorsal frontal cortex and medial temporal lobe for verbal and non-verbal memory encoding. Neuron 20, 927936.
Kennedy, N, Boydell, J, Kalidindi, S, Fearon, P, Jones, PB, van Os, J, Murray, RM (2005). Gender differences in incidence and age at onset of mania and bipolar disorder over a 35-year period in Camberwell, England. American Journal of Psychiatry 162, 257262.
Kessing, LV (2004). Gender differences in the phenomenology of bipolar disorder. Bipolar Disorders 6, 421425.
Martinez-Aran, A, Vieta, E, Colom, F, Torrent, C, Sanchez-Moreno, J, Reinares, M, Benabarre, A, Goikolea, JM, Brugue, E, Daban, C, Salamero, M (2004). Cognitive impairment in euthymic bipolar patients: implications for clinical and functional outcome. Bipolar Disorders 6, 224232.
Mur, M, Portella, MJ, Martinez-Aran, A, Pifarre, J, Vieta, E (2009). Influence of clinical and neuropsychological variables on the psychosocial and occupational outcome of remitted bipolar patients. Psychopathology 42, 148156.
Overall, JE, Gorham, DR (1962). The Brief Psychiatric Rating Scale. Psychological Reports 10, 790812.
Quraishi, S, Frangou, S (2002). Neuropsychology of bipolar disorder: a review. Journal of Affective Disorders 72, 209226.
Raymont, V, Bettany, D, Frangou, S (2003). The Maudsley bipolar disorder project. Clinical characteristics of bipolar disorder I in a Catchment area treatment sample. European Psychiatry 18, 1317.
Robb, JC, Young, LT, Cooke, RG, Joffe, RT (1998). Gender differences in patients with bipolar disorder influence outcome in the medical outcomes survey (SF-20) subscale scores. Journal of Affective Disorders 49, 189193.
Robinson, JL, Bearden, CE, Monkul, ES, Tordesillas-Gutiérrez, D, Velligan, DI, Frangou, S, Glahn, DC (2009). Fronto-temporal dysregulation in remitted bipolar patients: an fMRI delayed-non-match-to-sample (DNMS) study. Bipolar Disorders 11, 351360.
Robinson, LJ, Thompson, JM, Gallagher, P, Goswami, U, Young, AH, Ferrier, IN, Moore, PB (2006). A meta-analysis of cognitive deficits in euthymic patients with bipolar disorder. Journal of Affective Disorders 93, 105115.
Stefanopoulou, E, Manoharan, A, Landau, S, Geddes, J, Goodwin, G, Frangou, S (2009). Cognitive functioning in patients with affective disorders and schizophrenia: a meta-analysis. International Reviews of Psychiatry 21, 121.
Suominen, K, Mantere, O, Valtonen, H, Arvilommi, P, Leppämäki, S, Isometsä, E (2009). Gender differences in bipolar disorder type I and II. Acta Psychiatrica Scandinavica. Published online: 20 May 2009. doi:10.1111/j.1600–0447.2009.01407.x.
Torres, IJ, Boudreau, VG, Yatham, LN (2007). Neuropsychological functioning in euthymic bipolar disorder: a meta-analysis. Acta Psychiatrica Scandinavica (Suppl.) 434, 1726.
Young, R, Biggs, J, Zieglar, V, Meyer, D (1978). A rating scale for mania: reliability, validity sensitivity. British Journal of Psychiatry 133, 429435.
Wechsler, D (1981). Wechsler Adult Intelligence Scale – Revised (WAIS-R) Manual. Psychological Corporation, New York.
Wechsler, D (1998). Wechsler Memory Scale, 3rd edn: Administration and Scoring Manual. London: Psychological Corporation.


Gender differences in immediate memory in bipolar disorder

  • D. Carrus (a1), T. Christodoulou (a1), M. Hadjulis (a1), M. Haldane (a1), A. Galea (a2), A. Koukopoulos (a3), V. Kumari (a2) and S. Frangou (a1)...


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