Affect | Mental Status Exam - MedSchool
Sign up to start your free trial of MedSchool Premium!Get Started
 
 
 
Mental Status Exam
 
 
Mental Status Exam
Affect is the immediate expression of emotion, and can be used to objectively assess a patient's mood. Affect can be assessed by covering a wide range of topics through the course of the conversation. Enquire about personal losses as well as loved ones and achievements.
 

Affect

 
 

Overview

  • Affect is the immediate expression of emotion, and can be used to objectively assess a patient's mood. 
  • Affect can be assessed by covering a wide range of topics through the course of the conversation. Enquire about personal losses as well as loved ones and achievements.
  • Flattened affect: limited range of emotion, but not to the point of apathy.Mild to moderate depression
  • Blunted affect: apathy, decreased intensity and small-ranged affect. The patient does not express happiness or sadness and has no depth of conviction.Chronic schizophrenia, severe depression
  • Blunted and flattened affect are often used interchangeably.

Range of Affect

  • Restricted: a spectrum of emotions is not elicitable.Depression, schizophrenia, antisocial personality disorder
  • Expanded: excessive joy, sadness or irritability.Mania

Appropriateness of Affect

  • Appropriate: correlation between the content of speech and the accompanying emotional expression.
  • Inappropriate: lack of correlation between the content of speech and the accompanying emotional expression. The patient may laugh while discussing depression or cry while claiming to be happy.
  • Incongruous: lack of correlation between affect and stated mood. The patient may claim to be depressed but without flattened affect, e.g. laughs at jokes.
  • Fatuous: inappropriate affect that is overly childlike.Associated with hebephrenia, but may indicate an intellectual disability or represent an inappropriate coping mechanism e.g. in an eating disorder.

Intensity of Affect

  • Increased: intense emotional expression with inflexibility in convictions, which may be accompanied by abusive statements.Bipolar affective disorder, cyclothymia, borderline personality disorder
  • Normal: appropriate intensity of emotional response.
  • Decreased: apparent shallowness with little conviction behind responses. A feature of flattened or blunted affect.Depression or schizophrenia

Stability of Affect

  • Stable: changes in mood that are relevant to the flow of conversation.
  • Labile: frequent shifts in emotional expression.
  • Emotional incontinence: extreme lability.
Last updated on November 7th, 2019
 
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------
 
 

Read More...

 Berrios GE. Stupor revisited. Compr Psychiatry. 1981;22:466-478. Chapman LJ. Distractibility in the conceptual performance of schizophrenics.The Journal of Abnormal and Social Psychology. 1956; 53(3): 286-291. Charlton MH. Visual Hallucinations. The Psychiatric Quarterly. 1963 July; 37(3): 490-498. Chorover SL, Schiller PH, Tenen SS. Retrograde Amnesia. Science. 1965 Sept; 149(3691): 1521. Coltheart M, Masterson J, Byng S, Prior M, Riddoch J. Surface Dyslexia. The Quarterly Journal of Experimental Psychology. 1983; 35(3): 469-495. Day RK. Psychomotor Agitation: Poorly Defined and Badly Measured. Journal of Affective Disorders. 1999 Oct; 55(2-3): 89-98. Dubois B, Litvan I. The FAB: A frontal assessment battery at bedside. Neurology. 2000; 55(11): 1621-1626. Ely EW, Truman B, Shintani A, Thomason JWW, Wheeler AP, Gordon S, et al. Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA. 2003 Jun. 11;289(22):2983-2991. Endicott J, Spitzer RL. A Diagnostic Interview: The Schedule for Affective Disorders and Schizophrenia. Arch Gen Psychiatry. 1978; 35(7): 837-844. Faber RA. The Neuropsychiatric Mental Status Examination. Semin Neurol. 2009; 29(3): 185-193.
Fish FJ, Caset PR, Kelly B. Fish's Clinical Psychopathology: Signs and Symptoms in Psychiatry. 2006, RCPsych Publications.
 Ford RA. The Psychopathology of Echophenomena. Psychological Medicine. 1989; 19: 627-635. Kaplan E, Goodglass H, Weintrab S. The Boston Naming Test. 1983. Philadelphia: Lea & Febiger. Lucchelli F, Spinnler H. The Psychogenic versus Organic Conundrum of Pure Retrograde: Amnesia: is it Still Worth Pursuing?. Cortex. 2002; 38: 665-669. Markowitsch HJ. Anterograde Amnesia. 2008; 88: 155-183. Payne RW, Caird WK. Reaction time, distractibility, and overinclusive thinking in psychotics.Jorunal of Abnormal Psychology. 1967; 72(2); 112-121.
Singh P. Hallucinations. 2010 Nov; 44.
 Smaga S. Tremor. American Family Physician. 2003 Oct; 68(8): 1545-1552. Smith JM, Alloy LB. A roadmap to rumination: a review of the definition, assessment, and conceptualization of this multifaceted construct. Clinical Psychology Review. 2009 March; 29(2): 116-128. Veale D. Over-Valued Ideas: A Conceptual Analysis. Behaviour Research and Therapy. 2002; 40: 383-400. Weiner MF, Hynan LS, Rossetti H, Falkowski J. Luria’s three-step test: what is it and what does it tell us? International Psychogeriatrics / Ipa. 2011;23(10):1602-1606. Whitehouse PJ, Patterson MB, Strauss ME, Gelmacher DS, Mack JL, Gilmore GC, Koss E. Hallucinations. International Psychogeriatrics. 1996; 8(S3): 387-392.
Yaryura-Tobias JA. An overview of delusions, obsessions and overvalued ideas. Clinical Neuropsychiatry. 2004; 1(1): 5-12.
Feedback