Neuroimaging research is now a major research domain in the investigation of affective disorders (Haldane & Frangou Acta Neuropsychiatrica 2006, 18 88–99). However, while distinct changes have been identified in schizophrenia and neurodegenerative disorders, markers in mood disorders, in particular in bipolar disorder, are in comparison sparse. Neuro-imaging technology affords examination of structure, function and ‘process’, and has in recent years begun to provide new insights into the pathophysiology of bipolar disorder (Lagopoulos et al. Acta Neuropsychi-atrica 2006, 18 100–104). Imaging studies have shown subtle structural changes and interesting functional changes that may have implications for understanding the neuropsychological profile of bipolar disorder and the affective instability experienced by patients. Clinically, patients with bipolar disorder often describe difficulties in negotiating real-world problems and have been shown to have neuropsychological deficits both across mood states and when well. This presentation examines the evidence thus far and discusses how emerging findings inform neurobiological models of the disease.