Skip to main content Accessibility help

Negative emotion impairs working memory in pediatric patients with bipolar disorder type I

  • L. S. Schenkel (a1), A. M. Passarotti (a2), J. A. Sweeney (a3) and M. N. Pavuluri (a2)



We investigated affect recognition and the impact of emotional valence on working memory (using happy, angry, and neutral faces) in pediatric patients with bipolar disorder (BD) and healthy control (HC) subjects.


Subjects (N=70) consisted of unmedicated patients with BD type I (BD I, n=23) and type II (BD II, n=16) and matched HC subjects (n=31). All subjects completed tasks of emotion recognition (Chicago Pediatric Emotional Acuity Task; Chicago PEAT) and working memory for happy, angry, and neutral faces (Affective N-Back Memory Task; ANMT).


Compared to HC subjects, BD patients performed significantly more poorly when identifying the intensity of happy and angry expressions on the Chicago PEAT, and demonstrated working-memory impairments regardless of the type of facial emotional stimuli. Pediatric BD patients displayed the most impaired accuracy and reaction time performance with negative facial stimuli relative to neutral stimuli, but did not display this pattern with positive stimuli. Only BD I patients displayed working-memory deficits, while both BD I and BD II patients displayed emotion-identification impairments. Results remained significant after controlling for co-morbid ADHD and mood state.


Both BD I and BD II youth demonstrate emotion-identification deficits. BD youth also demonstrate working-memory impairments for facial stimuli irrespective of emotional valence; however, working-memory deficits were the most pronounced with negative emotional stimuli. These deficits appear to be specific to BD I patients, and suggest therefore that a more severe form of illness is characterized by more severe social-cognitive impairment.


Corresponding author

*Address for correspondence: L. S. Schenkel, Ph.D., Department of Psychology, Rochester Institute of Technology, 18 Lomb Memorial Drive, Rochester, NY, USA. (Email:


Hide All
Adolphs, R (2009). The social brain: neural basis of social knowledge. Annual Review of Psychology 60, 693716.
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, Text Revision (DSM-IV-TR). American Psychiatric Association: Washington, DC.
Bearden, CE, Thompson, PM, Dutton, RA, Frey, BN, Peluso, MA, Nicoletti, M, Dierschke, N, Hayashi, KM, Klunder, AD, Glahn, DC, Brambilla, P, Sassi, RB, Mallinger, AG, Soares, JC (2008). Three-dimensional mapping of hippocampal anatomy in unmedicated and lithium-treated patients with bipolar disorder. Neuropsychopharmacology 33, 12291238.
Blumberg, HP, Kaufman, J, Andrés, M, Whiteman, R, Hongyuan Zhang, J, Gore, JC, Charney, DC, Krystal, JH, Peterson, BS (2003). Amygdala and hippocampal volumes in adolescents and adults with bipolar disorder. Archives of General Psychiatry 60, 12011208.
Bora, E, Yücel, 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.
Botvinick, M (2004). Probing the neural basis of body ownership. Science 305, 782783.
Brotman, MA, Guyer, AE, Lawson, ES, Horsey, SE, Rich, BA, Dickstein, DP, Pine, DS, Leibenluft, E (2008 a). Facial emotion labeling deficits in children and adolescents at risk for bipolar disorder. American Journal of Psychiatry 165, 385389.
Brotman, MA, Skup, M, Rich, BA, Blair, KS, Pine, DS, Blair, JR, Leibenluft, E (2008 b). Risk for bipolar disorder is associated with face-processing deficits across emotions. Journal of the American Academy of Child & Adolescent Psychiatry 47, 14551461.
Carter, TD, Mundo, E, Parikh, SV, Kennedy, JL (2003). Early age at onset as a risk factor for poor outcome of bipolar disorder. Journal Affective Disorders 37, 297303.
Chang, K, Adleman, NE, Dienes, K, Simeonova, DI, Menon, V, Reiss, A (2004). Anomalous prefrontal-subcortical activation in familial pediatric bipolar disorder. Archives of General Psychiatry 61, 781792.
Cools, R, Clark, L, Owen, AM, Robbins, TW (2002). Defining the neural mechanisms of probabilistic reversal learning using event-related functional magnetic resonance imaging. Journal of Neuroscience 22, 45634567.
Craney, JL, Geller, B (2003). A prepubertal and early adolescent bipolar disorder – I phenotype: review of phenomenology and longitudinal course. Bipolar Disorders 5, 243256.
Dickstein, DP, Rich, BA, Roberson-Nay, R, Berghorst, L, Vinton, D, Pine, DS, Leibenluft, E (2007). Neural activation during encoding of emotional faces in pediatric bipolar disorder. Bipolar Disorders 9, 679692.
Dickstein, DP, Treland, JE, Snow, J, McClure, EB, Mehta, MS, Towbin, KE, Pine, DS, Leibenluft, E (2004). Neuropsychological performance in pediatric bipolar disorder. Biological Psychiatry 55, 3239.
Doyle, AE, Wozniak, J, Wilens, TE, Henin, A, Seidmen, LJ, Petty, C, Fried, R, Gross, LM, Faraone, SV, Biederman, J (2009). Neurocognitive impairment in unaffected siblings of youth with bipolar disorder. Psychological Medicine 39, 12531263.
Durand, K, Gallay, M, Seigneuric, A, Robichon, F, Baudouin, JY (2007). The development of facial emotion recognition: the role of configural information. Journal of Experimental Child Psychology 97, 1427.
Erwin, RJ, Gur, RC, Gur, RE, Smailis, J, Skolnick, B (1992). Facial emotion discrimination: I. Task construction and behavioral findings in normal subjects. Psychiatry Research 42, 231240.
Geller, B, Warner, K, Williams, M, Zimerman, B (1998). Prepubertal and young adolescent bipolarity versus ADHD: assessment and validity using the WASH-U-KSADS, CBCL, and TRF. Journal of Affective Disorders 51, 93–100.
Gur, RC, Sara, R, Hagendoorn, M, Marom, O, Hughett, P, Macy, L, Turner, T, Bajcsy, R, Posner, A, Gur, RE (2002). A method for obtaining 3-dimensional facial expressions and its standardization for use in neurocognitive studies. Journal of Neuroscience Methods 115, 137143.
Guyer, AE, McClure, EB, Adler, AD, Brotman, MA, Rich, BA, Kimes, AS, Leibenluft, E (2007). Specificity of facial expression labeling deficits in childhood psychopathology. Journal of Child Psychology and Psychiatry 48, 863871.
Herbener, ES, Hill, SK, Marvin, RW, Sweeney, JA (2005). Effects of antipsychotic treatment on emotion perception deficits in first-episode schizophrenia. American Journal of Psychiatry 162, 17461748.
Hopkins, IM, Gower, MW, Perez, TA, Smith, DS, Amthor, FR, Wimsatt, FC, Biasini, FJ (2011). Avatar assistant: improving social skills in students with an ASD through a computer-based intervention. Journal of Autism and Developmental Disorders 41, 15431555.
Jolles, DD, Kleibeuker, SW, Rombouts, SA, Crone, EA (2011). Developmental differences in prefrontal activation during working memory maintenance and manipulation for different memory loads. Developmental Science 14, 713724.
Kaufman, J, Birmaher, B, Brent, D, Rao, U, Flynn, C, Moreci, P, Ryan, N (1997). Schedule for Affective Disorders and Schizophrenia for School-Age Children – Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry 36, 980988.
Leibenluft, E (2011). Severe mood dysregulation, irritability, and the diagnostic boundaries of bipolar disorder in youths. American Journal of Psychiatry 168, 129142.
Leibenluft, E, Charney, DS, Towbin, KE, Bhangoo, RK, Pine, DS (2003). Defining clinical phenotypes of juvenile mania. American Journal of Psychiatry 160, 430437.
Leibenluft, E, Rich, BA (2008). Pediatric bipolar disorder. Annual Review of Clinical Psychology 4, 163187.
McClure, EB, Treland, JE, Snow, J, Dickstein, DP, Towbin, KE, Charney, DS, Pine, DS, Leibenluft, E (2005). Memory and learning in pediatric bipolar disorder. Journal of the American Academy of Child & Adolescent Psychiatry 44, 461469.
Nowicki, S, Duke, MN (1994). Individual differences in the nonverbal communication of affect: the Diagnostic Analysis of Nonverbal Accuracy Scale. Journal of Nonverbal Behavior 18, 9–35.
Packard, MG, Cahill, LL (2001). Affective modulation of multiple memory systems. Current Opinion in Neurobiology 11, 752756.
Passarotti, AM, Sweeney, JA, Pavuluri, MN (2010). Emotion processing influences working memory circuits in pediatric bipolar disorder and attention deficit hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry 49, 10641080.
Passarotti, AM, Sweeney, JA, Pavuluri, MN (2011). Fronto-limbic dysfunction in mania pre-treatment and persistent amygdala over-activity post-treatment in pediatric bipolar disorder. Psychopharmacology 216, 485499.
Pavuluri, MN, Birmaher, B, Naylor, MW (2005). Pediatric bipolar disorder: a review of the past 10 years. Journal of American Academy of Child and Adolescent Psychiatry 44, 846871.
Pavuluri, MN, Marlow-O'Connor, M, Harral, E, Sweeney, JA (2007). Affective neural circuitry during facial emotion processing in pediatric bipolar disorder. Biological Psychiatry 62, 158167.
Pavuluri, MN, O'Connor, MM, Harral, EM, Sweeey, JA (2008). An fMRI study of the interface between affective and cognitive neural circuitry in pediatric bipolar disorder. Psychiatry Research 162, 244255.
Pavuluri, MN, Passarotti, AM, Fitzgerald, JM, Wegbreit, E, Sweeney, JA (2012). Risperidone and divalproex differentially engage the fronto-striato-temporal circuitry in pediatric mania: a pharmacological functional magnetic resonance imaging study. Journal of the American Academy of Child and Adolescent Psychiatry 5, 157170.
Pavuluri, MN, Passarotti, AM, Mohammed, T, Carbray, JA, Sweeney, JA (2010 a). Enhanced working and verbal memory after lamotrigine treatment in pediatric bipolar disorder. Bipolar Disorders 12, 213220.
Pavuluri, MN, Passarotti, AM, Parnes, Fitzgerald, Sweeney, JA (2010 b). A pharmacological functional magnetic resonance imaging study probing the interface of cognitive and emotional brain systems in pediatric bipolar disorder. Journal of Child and Adolescent Psychopharmacology 20, 395406.
Pavuluri, MN, Schenkel, LS, Aryal, S, Harral, EM, Hill, SK, Herbener, ES, Sweeney, JA (2006). Neurocognitive function in unmedicated manic and medicated euthymic pediatric bipolar patients. American Journal of Psychiatry 163, 286293.
Poznanski, EO, Freeman, LN, Mokros, HB (1985). Children's depressive rating scale-revised. Psychopharmacology Bulletin 21, 979989.
Rich, BA, Fromm, SJ, Berghorst, LH, Dickstein, DP, Brotman, MA, Pine, DS, Leibenluft, E (2008 a). Neural connectivity in children with bipolar disorder: impairment in the face emotion processing circuit. Journal of Child Psychology & Psychiatry 49, 8896.
Rich, BA, Grimley, ME, Schmajuk, M, Blair, KS, Blair, RJ, Leibenluft, E (2008 b). Face emotion labeling deficits in children with bipolar disorder and severe mood dysregulation. Development and Psychopathology 20, 529546.
Rich, BA, Holroyd, T, Carver, FW, Onelio, LM, Mendoza, JK, Cornwell, BR, Fox, NA, Pine, DS, Coppola, R, Leibenluft, E (2010). A preliminary study of the neural mechanisms of frustration in pediatric bipolar disorder using magnetoencephalography. Depression and Anxiety 27, 276286.
Rich, BA, Schmajuk, M, Perez-Edgar, KE, Pine, DS, Fox, NA, Leibenluft, E (2005). The impact of reward, punishment, and frustration on attention in pediatric bipolar disorder. Biological Psychiatry 58, 532539.
Rich, BA, Vinton, DT, Roberson-Nay, R, Hommer, RE, Berghorst, LH, McClure, EB, Fromm, SJ, Pine, DS, Leibenluft, E (2006). Limbic hyperactivation during processing of neutral facial expressions in children with bipolar disorder. Proceeding of the National Academy of Science 103, 89008905.
Schenkel, LS, Pavuluri, MN, Herbener, ES, Harral, EM, Sweeney, JA (2007). Facial emotion processing in acutely ill and euthymic patients with pediatric bipolar disorder. Journal of the American Academy of Child and Adolescent Psychiatry 46, 10701079.
Schenkel, LS, West, AE, Harral, EM, Patel, NB, Pavuluri, MN (2008). Parent–child interactions in pediatric bipolar disorder. Journal of Clinical Psychology 64, 422437.
Schenkel, LS, West, AE, Jacobs, R, Sweeney, JA, Pavuluri, MN (2012). Cognitive dysfunction is worse among pediatric patients with bipolar disorder type I than type II. Journal of Child Psychology and Psychiatry. Published online: 17 February 2012. doi:10.1111/j.1469-7610.2011.02519.x.
Shaffer, D, Gould, MD, Brasic, J, Ambrosini, P, Fisher, P, Bird, H, Aluwahlia, S (1983). A children's global assessment scale. Archives of General Psychiatry 40, 12281231.
Simonsen, C, Vaskinn, A, Birkenaes, AB, Engh, JA, Hansen, CF, Jósdóttir, H, Ringen, PA, Opjordsmoen, S, Friis, S, Andreassen, OA (2008). Neurocognitive profiles in bipolar I and bipolar II disorders: Differences in pattern and magnitude of dysfunction. Bipolar Disorders 10, 245255.
Tanaka, JW, Wolf, JM, Klaiman, C, Koenig, K, Cockburn, J, Herlihy, L, Brown, C, Stahl, S, Kaiser, MD, Schultz, RT (2010). Using computerized games to teach face recognition skills to children with autism spectrum disorder: the Let's Face It! program. Journal of Child Psychology and Psychiatry 51, 944952.
Völlm, B, Taylor, A, Richardson, P, Corcoran, R, Stirling, J, McKie, S, Elliott, R (2006). Neuronal correlates of theory of mind and empathy: a functional magnetic resonance imaging study in a nonverbal task. Neuroimage 29, 9098.
Wechsler, D, Wycherley, RJ, Benjamin, L (1998). Wechsler Memory Scale: WMS-III. Manual. The Psychological Corporation: San Antonio, TX.
Weissman, D, Perkins, A, Woldorff, M (2008). Cognitive control in social situations: a role for the dorsolateral prefrontal cortex. Neuroimage 40, 955962.
West, AE, Jacobs, RH, Westerholm, R, Lee, A, Carbray, J, Heidenreich, J, Pavuluri, MN (2009). Child and family-focused cognitive-behavioral therapy for pediatric bipolar disorder: pilot study of group treatment format. Journal of the Canadian Academy of Child and Adolescent Psychiatry 18, 239246.
Womer, FY, Kalmar, KH, Wang, F, Blumberg, HP (2009). A ventral prefrontal-amygdala neural system in bipolar disorder: a view from neuroimaging research. Acta Neuropsychiatrica 21, 228238.
Young, RC, Biggs, JT, Ziegeler, VE, Mayer, DA (1978). A rating scale for mania: reliability, validity and sensitivity. British Journal of Psychiatry 133, 429435.


Related content

Powered by UNSILO

Negative emotion impairs working memory in pediatric patients with bipolar disorder type I

  • L. S. Schenkel (a1), A. M. Passarotti (a2), J. A. Sweeney (a3) and M. N. Pavuluri (a2)


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.