Affect
March 4th, 2023
Overview
Affect is the immediate expression of emotion and serves as an objective measure of a patient's mood. Evaluating affect is a crucial component of the mental status examination, as it can provide insights into the patient's emotional well-being and potential psychiatric conditions.
- To assess affect, engage the patient in a wide-ranging conversation, touching on various topics such as personal losses, relationships, achievements, and experiences. Observe their emotional responses throughout the conversation and consider the following aspects of affect:
- Intensity: the strength and conviction of the patient's displayed emotions.
- Range: the variety, or highs and lows, of emotions displayed by the patient.
- Stability: how consistently the patient's emotions change with the flow of the conversation.
- Appropriateness: whether the patient's emotional expression matches the content of their speech.
Intensity of Affect
The intensity of affect refers to the strength and depth of a patient's emotional expressions. Assess whether the patient is intense in their responses, or have a distinct lack of emotional expression.
Interpretation
- Increased intensity of affect: 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.
- Blunted affect: reduction in the intensity or range of emotional expression - the patient may seem unresponsive, emotionless, or indifferent to their surroundings. Schizophrenia, severe depression, bipolar disorder, post traumatic stress disorder, brain injury, Parkinson's, Alzheimer's, substances
- Flattened affect: complete lack of emotional expression, with no emotional response to events, people, or situations around them.As with blunted affect, however more severe
Range of Affect
Assessing the range of affect involves examining the variety of emotions a patient exhibits during the conversation. A patient may display a restricted or expanded range of emotions.
Interpretation
- Restricted: a spectrum of emotions is not elicitable.Depression, schizophrenia, antisocial personality disorder, post-traumatic stress disorder, substances
- Expanded: excessive joy, sadness or irritability.Mania, anxiety disorders, histrionic personality disorder, substances
Stability of Affect
Stability of affect focuses on the consistency and adaptability of a patient's mood in response to the conversation's flow and topics. Evaluating stability can reveal whether a patient's emotional expression is stable or labile.
Interpretation
- Stable: changes in mood that are relevant to the flow of conversation.
- Labile: frequent shifts in emotional expression.Borderline personality disorder, bipolar disorder, traumatic brain injury, substances
- Emotional incontinence: extreme lability.
Appropriateness of Affect
The appropriateness of affect refers to the congruence between a patient's emotional expression and the content of their speech.
Interpretation
- 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.Schizophrenia, traumatic brain injury, certain personality disorders, substances
- 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.Conversion disorder, dissociative disorders, factitious disorder, malingering
- Fatuous: inappropriate affect that is overly childlike.Hebephrenia, intellectual disability, inappropriate coping mechanism e.g. in an eating disorder.
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