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Mental Status Exam
 
 

Affect

 
 
 
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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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