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.
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