Mse - Mood And Affect

Front 1

Asking about mood

Back 1

Initially, use open-ended questions, such as "How have you been feeling lately/right now?" Encourage them to elaborate, provide intensity, synonyms, ask if it is typical for them. Reflect affect back for confirmation. Use closed-ended questions if needed
MSE 40-1

Front 2

Euthymic

Back 2

such pts appear calm, consistent in emotional expression, comfortable, appropriately friendly, reasonably cooperative. May be appropriately concerned or anxious about problems, but not overly frightened or agitated. Normal mood should be considered in the context of circumstances.
MSE 41

Front 3

Dysphoric

Back 3

pts may describe feeling down, blue, sad, worthless, upset, hopeless, and frustrated. Anhedonic, reduced concentration, insomnia, decreased appetite, loss of libido, feeling of remorse, crying
MSE 42

Front 4

Dysphoric mood - clinical associations

Back 4

MDD (though they can also appear angry or apathetic), mixed bipolar states, schizophrenia, anxiety disorders, drug/EtOH abuse, medical disorders (particularly neurologic, oncologic, endocrinologic d/o, postop and chronic illness states), and personality d/o. Be mindful of suicidal indicators
MSE 43

Front 5

Pseudobulbar palsy/emotional incontinence

Back 5

may look like dysphoria; accompanied by significant emotional lability with frequent, brief episodes (often incongruent and inappropriate) of tearfulness
MSE 43

Front 6

Euphoria/happiness

Back 6

Manic patients classically have elated moods, often to point of elation or giddiness (may also present as irritable or angry). Rapid speech, impulsiveness, exagerated self-confidence or self-regard, and hyperactivity usually accompany a manic patient's elevated mood. Elicity poor judgment and grandiosity because of association with elevated mood in mania
MSE 43

Front 7

Abnormally elevated mood - DDx

Back 7

drug intoxication (mj, EtOH, amphetamines, NO), disorganized schizophrenia (appear to be in silly mood because of unprovoked/inappropriate smiling/laughter), gelastic epilepsy (rare form of complex partial seizure d/o that can result in sustained, inappropriate laughter)
MSE 43

Front 8

Anger

Back 8

Record anger communicated in direct verbal statements, as well as in indirect ways, such as hostile tone, threatening postures, terseness, tense facial expression, glaring, increased muscle tension, abrupt movements, violent action, etc.
MSE 43

Front 9

Anger - DDx

Back 9

anger and irritability most common alternative mood for manics who aren't elated, and frequent alternate mood in depressives are not simply sad; drug/EtOH intoxication; complex partial epilepsy, head trauma, stroke, dementia; pts with neurologic d/o are often irritable and affectively labile, esp when prefrontal cortex or amygdala is affected; seen in psychosis (esp paranoid), as response to delusion, as part of psychotic derangement without evident explanation (e.g. in excited catatonics), and poorly modulated anger in personality d/o, esp in narcissistic-antisocial-borderline spectrum
MSE 43-4

Front 10

Mood vs Affect

Back 10

mood - more of a sustained feeling state; subjective experience of patient
affect - involves moment-to-moment changes in emotional state and external expression of those feelings as observed by examiner
MSE 39, 45

Front 11

Six clusters of terms to describe types of mood and affect

Back 11

Euthymic, Apathetic, Angry, Dysphoric, Euphoric, Apprehensive
MSE 42

Front 12

Terms to describe mood/affect in the Euthymic range

Back 12

Calm, Comfortable, Euthymic, Friendly, Normal, Pleasant, Unremarkable
MSE 42

Front 13

Terms to describe mood/affect in the Apathetic range

Back 13

Apathetic, bland, dull, flat
MSE 42

Front 14

Terms to describe mood/affect in the Angry range

Back 14

Angry, bellicose, belligerent, confrontational, frustrated, hostile, impatient, irascible, irate, irritable, oppositional, outraged, sullen
MSE 42

Front 15

Terms to describe mood/affect in the Dysphroic range

Back 15

Despondent, distraught, dysphoric, grieving, hopeless, lugubrious, overwhelmed, remorseful, sad
MSE 42

Front 16

Terms to describe mood/affect in the Euphoric range

Back 16

Cheerful, ecstatic, elated, euphoric, giddy, happy, jovial
MSE 42

Front 17

Terms to describe mood/affect in the Apprehensive range

Back 17

Anxious, apprehensive, fearful, frightened, high-strung, nervous, overwhelmed, panicked, tense, terrified, worried
MSE 42

Front 18

Parameters of affect

Back 18

appropriateness, intensity, mobility, range, reactivity
MSE 46

Front 19

Appropriateness of affect - normal and abnormal

Back 19

Normal - appropriate, congruent
Abnormal - inappropriate, incongruent
Commonly inappropriate in psychotic patients, who are responding to internal stimuli
MSE 46, 48

Front 20

Intensity of affect - normal and abnormal

Back 20

Normal - normal
Abnormal - Flat, blunted, heightened, exaggerated, overly dramatic
MSE 46

Front 21

Mobility of affect - normal and abnormal

Back 21

Normal - Mobile, supple
Abnormal - Fixed, immobile, constricted, decreased, labile
MSE 46

Front 22

Range of affect - normal and abnormal

Back 22

Normal - full range
Abnormal - Restricted range
e.g. pts who are depressed are characteristically sad and do not return social smiles or react to humorous statements - i.e. "affect was restricted to the dysphoric range and is nonreactive" Range is often abnormal in schizophrenia, affective d/o, prefrontal cortex d/o and Parkinson's
MSE 46-7

Front 23

Reactivity of affect - normal and abnormal

Back 23

Normal - reactive, responsive
Abnormal - unreactive, unresponsive
May be dulled in schizophrenia, retarded depression, psychic shock, d/o that impair consciousness or self-expression
MSE 46, 47

Front 24

Heightened affective intensity; clinical associations

Back 24

commonly seen in mania, histrionic and borderline personality disorders. Histrionic patients are also melodramatic, seductive, and strikingly sentimental
MSE 47

Front 25

Blunted affect; clinical associations

Back 25

reduced intensity; usually accompanied by reduced reactivity. May be seen in schizophrenia, depression, or prefrontal cortex injury
MSE 47

Front 26

Flat affect

Back 26

complete lack of affective expression or reactivity. "The patient has flat affect" = no range, little intensity, no mobility, and inappropriateness of affect.
MSE 47

Front 27

Lability of affect

Back 27

Can occur at different rates in various conditions. A brain damaged (e.g. pseudobulbar palsy) or delirious patient's affect can be labile from minute to minute. Personality d/o patient's affect can fluctuate over course of minutes to hours

Front 28

Alexithymia; clinical associations

Back 28

Deficient awareness of different mood states and diminished capacity to describe their feelings verbally. Spontaneous facial expression, especially of negative feelings, is inhibited. Thought to be common in substance abuse, PTSD, somatoform d/o. Similar deficits sometimes observed in pts with autism, schizophrenia, right hemispheric stroke
MSE 49

Front 29

Anxious mood

Back 29

uncomfortable, tense, apprehensive, vigilant. Generally occurs in response to psychologically perceived threats or danger. Worried, tense, hypervigilant, sometimes psychomotorically agitated, often experiencing physical symptoms of autonomic overactivity (tremor, palpitations, nausea, sweating, enlarged pupils, rapid breathing), have difficulty relaxing or accepting reassurance
MSE 49

Front 30

Apathy; clinical associations; damage to what part of brain

Back 30

mood typified by lack of interest or desire; decreased reaction to internal/external stimuli. Apathetic indivuals are poorly motivated, uninterested, unemotional. Depression is a common cause. Prefrontal cortex dysfunction produces apathy, as seen in patients with structural damage, schizophrenia, and dementias involving this region. Apathy can be difficult to differentiate from abulia
MSE 49

Front 31

Blunted affect; vs. flat affect; clinical associations; damage to what part of brain

Back 31

decreased, but present, emotional expression; e.g. when patient feels "numb" after traumatic event. Most frequently occurs in psychotic patients. Also seen in delirium, dementia, lesions of frontal lobes or R hemisphere
MSE 50

Front 32

La belle indifference; clinical associations

Back 32

lack of normally expected concern for apparently serious conditions; associated with conversion d/o and various neurologic d/o. Typically lack insight regarding the emotions or conflict that underlie the conversion. In most severe forms, victim will claim that disabled body part does not belong to him
MSE 41

Front 33

Anosognosia; vs. la belle indifference; associated brain damage

Back 33

Extreme lack fo awareness of a motor or sensory deficit, often concomitant of right cerebral hemisphere damage
MSE 51

Front 34

Anosodiaphoria

Back 34

mildest form of la belle indifference - patient admits disability but is not appropriately concerned
MSE 51