Affect and Mood

Affect and Mood
Describing affect: Type / quality, Range / variability, Degree / intensity, Stability / reactivity, Congruence, Appearance
Affect has three functions
Describing mood: Type / quality, Stability, Pattern of mood disturbance

1. Affect & Mood Made by Psychologist Stella

2. Affect: Visible external, objective manifestation of emotional state. Dynamic changes in the expression of emotional responses. Both internal stimuli ( eg . Memories, ideas, preoccupation) and external events ( eg . Changes in the environment) can after affect. ‘Emotional foreground’

3. Mood Subjective (described by patient) internal feeling state or emotional tone over an extended period of time. Less connected to internal stimuli or external events. ‘Emotional background’

4. Describing Affect Affect can be evaluated along the following parameters: Type/Quality Range/Variability Degree/Intensity Stability/Mobility Appropriateness Congruence

5. 1. Type/ Quality Type or quality is the predominant emotion expressed. There are nine principal types of affect: Happiness Sadness Fear/anxiety Surprise Shame Anger Interest Disgust Contentment

6. 2. Range/Variability The degree to which visible emotions vary. The patient would be expected to display various types of affect ( eg . Smile, frown, appear interested, sad, or anxious. No standard degree of affect Terms used is ‘the patient showed an adequate range of affect.? ‘Narrow/Restricted Range: Expression of only one or two emotional states ( eg . Mania, schiz paranoid disorders, OCD ). Wide Range or Expanded range: Several emotions are displayed, eg . Cluster B PDs , dementia, delerium and intoxication or withdrawal.

7. 3. Degree/Intensity (also called amplitude)

8. 3. Degree/Intensity (also called amplitude) contd ……. . The ‘force of the expression’ eg . the good actor... Measure of the energy expended in Conveying the feeling. Emotional expression is on continuum. Intense affect may go with narrow range eg . mania or depn . Low intensity may go with wide range. eg . histrionic personalities, delirium.

9. Degree/Intensity (also called amplitude) contd ……. . Blunting : lack of emotional sensitivity to other. Flattening : Limitation of useful intensity of emotion (as in Schiz , conversion– la belle indifferénce , and OC and schiz personalities. Heightened: seen in mania, narcisstic and borderline personalities. Depressives conveny Either intense distress. Or are muted and apathetic

10. 4. Stability/Reactivity Duration of an affective response . eg . As brief as a facial expression, or a tear shed; other may be more pervasive. During an interview, for eg . There may be shifts anxiety at the beginning, sadness when discussing a loss, anger at the husband’s infidelity, happiness at the son’s academic achievement. These periods (shifts) may be for some moments and are appropriate to the context.

11. 4. Stability/Reactivity contd... If shifts in affect are small or non-existent, are considered fixed or immobile and are more referable to mood. Labile : rapid and frequent changes in affect. Changes could be either in intensity or range . eg . Happy  tearful, low irritations  high irritation (mania)

12. Inappropriate affect is seen in: Malingering - the emotional component of a patient’s presentation doesn’t “add up” to the verbalized problems. Substance use – introxication or withdrawal can cause patients to be inappropriately jovial or unconcerned with medical problems, criminal charges, etc. Conversion disorder – la belle indiference describes a distinct lack of concern for reported neurologic deficits

13. Inappropriate affect is seen in contd … Depression - when patients have decided to attempt suicide, they can become unconcerned or untroubled by their pre-existing problems Delirious or demented patients can seem to be unusually concerned about trivial matters (or the converse) Antipsychotic use – affective flattening can occur through the parkinsonian side-effects of these medications.

14. 6. Congruence Mood : Affect may not be congruent to mood state described by the Incongruity may mean Malingering Two or more condition (mood & personality disorder) Substance use Schizoaffective disorder Schizophrenia Psychotic mood disorder.

15. Appearance: Patient have little time or interest Grooming & Attire – Depressed patients neglect self care  disheveled. Manic patients dress flamboyantly (often in red) and use poor judgement in picking new looks or styles. Schizophrenic patients may make bizarre alterations and become unkempt. Facial expression – Unvarying movements are seen in depression and schizophrenia In mania and personality disorders: dramatic and exaggerated. Behaviour Posture Body movement/gesticulation Speech Inflection provides Modulation and emphasis in speech Makes speech interesting Reduced in depression, schizopohrenia or OC personalities. Enhanced in mania and cluster B personality disorders.

16. Affect has 3 functions Self perception – providing an emotional value judgement . Communication – expression of feelings is made known to others. Motivation –affect is one of the key elements leading to the initiation of action.

17. Describing Mood Reactivity Intensity same as in affect Stability/Duration Pattern Type/Quality

18. Type/Quality Quality of mood is the patient’s self report on emotional state. DSM includes Depressed Mood Euphoric Mood Angry / Irritable Mood Anxious Mood

19. Depressed Mood: Less energetic, less hopeful, less worthy or less capable than what is usual for them. Dysphoria : a state of unhappiness, or feeling ill at ease.

20. Double Depression: Depressive episode on dysthymia

21. Euphoric Mood Patient feel energized, elated or ecstatic. Of a greater degree than what is experienced when patients are ‘up’ or in a ‘good mood.”

22. Euphoric mood often occurs with changes in: Appearance (unusual or bizarre changes). Behavior (move rapidly and continuously). Speech (speak loudly and have a lot to say). Affect (expanded range; labile, intense). Thought content (grandiose themes). Thought form (flight of ideas; pressure of speech). Cognitive functioning (creativity and word association) may be enhanced or diminished because of distractibility.

23. Angry/Irritable Mood Irritability: is being easily provoked to anger. Is one of the three mood states in mania or hypomania. Irritability is usually seen as the mood disorder increases in severity. Anger or irritability: seen in any condition and, in isolation, is not of significance.

24. Anxious Mood Can be normal Anxiety: is pathological when it is pervasive or to a degree, interferes with social or occupational functioning. To distinguish anxiety from that seen in anxiety disorders, this mood state is frequently referred to as apprehension.

25. Stability Describes the length of time a mood disturbance exists without significant variation. Rapid Cycling Subtype: Four or more cycles Mixed State: Mania and depression coexist.

26. Mood- incogruent psychotic features ( MIPF ) Four possibilities: Do not denote a specific subtype of illness. MIPF indicate a distinct subtype of mood disorder. MIPF denote a form of schizoaffective disorder. MIPF are a type of schizophrenia. The strongest evidence was for the second possibility, with some support for the third.

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