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34 Cards in this Set

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Asking about mood
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
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
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
Dysphoric mood - clinical associations
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
Pseudobulbar palsy/emotional incontinence
may look like dysphoria; accompanied by significant emotional lability with frequent, brief episodes (often incongruent and inappropriate) of tearfulness
MSE 43
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
Abnormally elevated mood - DDx
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
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
Anger - DDx
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
Mood vs Affect
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
Six clusters of terms to describe types of mood and affect
Euthymic, Apathetic, Angry, Dysphoric, Euphoric, Apprehensive
MSE 42
Terms to describe mood/affect in the Euthymic range
Calm, Comfortable, Euthymic, Friendly, Normal, Pleasant, Unremarkable
MSE 42
Terms to describe mood/affect in the Apathetic range
Apathetic, bland, dull, flat
MSE 42
Terms to describe mood/affect in the Angry range
Angry, bellicose, belligerent, confrontational, frustrated, hostile, impatient, irascible, irate, irritable, oppositional, outraged, sullen
MSE 42
Terms to describe mood/affect in the Dysphroic range
Despondent, distraught, dysphoric, grieving, hopeless, lugubrious, overwhelmed, remorseful, sad
MSE 42
Terms to describe mood/affect in the Euphoric range
Cheerful, ecstatic, elated, euphoric, giddy, happy, jovial
MSE 42
Terms to describe mood/affect in the Apprehensive range
Anxious, apprehensive, fearful, frightened, high-strung, nervous, overwhelmed, panicked, tense, terrified, worried
MSE 42
Parameters of affect
appropriateness, intensity, mobility, range, reactivity
MSE 46
Appropriateness of affect - normal and abnormal
Normal - appropriate, congruent
Abnormal - inappropriate, incongruent
Commonly inappropriate in psychotic patients, who are responding to internal stimuli
MSE 46, 48
Intensity of affect - normal and abnormal
Normal - normal
Abnormal - Flat, blunted, heightened, exaggerated, overly dramatic
MSE 46
Mobility of affect - normal and abnormal
Normal - Mobile, supple
Abnormal - Fixed, immobile, constricted, decreased, labile
MSE 46
Range of affect - normal and abnormal
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
Reactivity of affect - normal and abnormal
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
Heightened affective intensity; clinical associations
commonly seen in mania, histrionic and borderline personality disorders. Histrionic patients are also melodramatic, seductive, and strikingly sentimental
MSE 47
Blunted affect; clinical associations
reduced intensity; usually accompanied by reduced reactivity. May be seen in schizophrenia, depression, or prefrontal cortex injury
MSE 47
Flat affect
complete lack of affective expression or reactivity. "The patient has flat affect" = no range, little intensity, no mobility, and inappropriateness of affect.
MSE 47
Lability of affect
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
Alexithymia; clinical associations
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
Anxious mood
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
Apathy; clinical associations; damage to what part of brain
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
Blunted affect; vs. flat affect; clinical associations; damage to what part of brain
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
La belle indifference; clinical associations
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
Anosognosia; vs. la belle indifference; associated brain damage
Extreme lack fo awareness of a motor or sensory deficit, often concomitant of right cerebral hemisphere damage
MSE 51
mildest form of la belle indifference - patient admits disability but is not appropriately concerned
MSE 51