Ever wondered how to distinguish between mood and affect in a clinical setting? Join us on this episode of the Licensure Exams podcast with Dr. Linton Hutchinson and Stacey Frost as we uncover the critical differences that can transform your mental health assessments. We kick off with a lighthearted chat about weather differences in Florida and Michigan, before diving into how to identify and document mood and affect effectively. Learn to master terms like "euthymic" and "dysphoric," and understand their significance in diagnosing disorders such as major depressive disorder and bipolar disorder.
Get ready to enhance your clinical practice with our deep dive into the nuances of mood and affect. From understanding anhedonia to recognizing the signs of elevated or expansive moods that could indicate mania, we cover it all. Discover how to use descriptors like congruent, incongruent, broad, and labile to accurately assess affect and gain insights into conditions such as schizophrenia and personality disorders. Plus, Stacey gives us a preview of an upcoming episode on adjustment disorder. Don’t miss out on this chance to sharpen your mental health assessment skills!
If you need to study for your national licensing exam, try the free samplers at: LicensureExams
This podcast is not associated with the NBCC, AMFTRB, ASW, ANCC, NASP, NAADAC, CCMC, NCPG, CRCC, or any state or governmental agency responsible for licensure.
Ever wondered how to distinguish between mood and affect in a clinical setting? Join us on this episode of the Licensure Exams podcast with Dr. Linton Hutchinson and Stacey Frost as we uncover the critical differences that can transform your mental health assessments. We kick off with a lighthearted chat about weather differences in Florida and Michigan, before diving into how to identify and document mood and affect effectively. Learn to master terms like "euthymic" and "dysphoric," and understand their significance in diagnosing disorders such as major depressive disorder and bipolar disorder.
Get ready to enhance your clinical practice with our deep dive into the nuances of mood and affect. From understanding anhedonia to recognizing the signs of elevated or expansive moods that could indicate mania, we cover it all. Discover how to use descriptors like congruent, incongruent, broad, and labile to accurately assess affect and gain insights into conditions such as schizophrenia and personality disorders. Plus, Stacey gives us a preview of an upcoming episode on adjustment disorder. Don’t miss out on this chance to sharpen your mental health assessment skills!
If you need to study for your national licensing exam, try the free samplers at: LicensureExams
This podcast is not associated with the NBCC, AMFTRB, ASW, ANCC, NASP, NAADAC, CCMC, NCPG, CRCC, or any state or governmental agency responsible for licensure.
Linton:
Well, welcome to our Licensure Exams podcast. I'm Dr Linton Hutchinson from hot and sunny Florida, and I'm here with my co-host, Stacey Frost, who is still digging herself out from the snow up there in Michigan.
Stacy:
Oh, linton. Well, sometimes I'm not sure if winter will ever end, it's true, but come July and August I'll be enjoying a nice cool breeze on the porch and a cascarelli cashew ice cream cone, instead of sweltering in that muggy, swamp bowl of central Florida.
Linton:
But you forgot to mention munching on pickled bologna and pig's feet, those delicious appetizer you guys like so much up there in Michigan. And for the weather here, well, are you kidding Stacey? The hotter the better.
Stacy:
It's like a free sauna experience, right outside your front door and a lot of times inside as well. I don't buy it. You sound happy and excited, Linton, but I don't know. If only I could see your face right now to determine if your mood is congruent with your affect.
Linton:
Well, speak of the devil Stacey. That's our topic for today. We'll be talking about the mental status exam, which, as you all know, is our go-to assessment tool, used to evaluate a client's current state of mind, cognitive abilities and overall psychological functioning. The MSE assesses several areas, but today we're going to focus this episode on two specific domains that are often confused mood and effect.
Stacy:
All right, so let's start with mood, and mood refers to the client's self-reported, internal, pervasive and sustained emotional state Anxious, sad, overwhelmed, frustrated. It's the client's subjective experience that influences their perception of the world and their interactions with others. On the other hand, affect and that's spelled by the way A-F-F-E-C-T is the outward expression of those emotions. Affect is objective and it's observed by you, the therapist.
Linton:
So I hear you have some visitors up there. I'm wondering how your mood is these days, Stacey.
Stacy:
Well, is that a yes or no question?
Linton:
Of course. Well, can you observe a client's mood? No, dear no. When you assess the client's mood, you rely on the client's own words to describe their internal emotional states. You might ask questions like how have you been feeling lately? Can you describe your mood over the past few weeks? And your client may respond by reporting their feelings of being sad, anxious, irritable or even numb. Obviously not a yes or no question there, stacey.
Stacy:
That's true.
Linton:
They may describe mood swings or a persistently low mood. What are some of the other terms used to describe the mood on the MS East?
Stacy:
Well, when you ask the client to describe their mood, they'll probably use words like depressed, anxious, irritable, scared, angry, maybe feeling guilty. On your exam, however, you might see those words, but you also need to understand how to document and interpret the client's reported experience in clinical language and what they mean when you see them on the exam. And I'm talking about words like euthymic, which is a neutral mood characterized by a sense of well-being and emotional stability. Now, euthymic, which is a neutral mood characterized by a sense of well-being and emotional stability. Now euthymia refers to a balanced mood where the individual is neither experiencing significant depression nor elevated mood states like mania or hypomania that maybe you'd see with bipolar. It's a good sign when clients report feeling euthymic, since it often indicates that their mood is in a healthy, stable range. So euthymia is the term that you look for in therapy and psychiatric evaluations as an indicator of emotional well-being.
Linton:
Here's another one dysphoric, which is a general state of unease, dissatisfaction or unhappiness. If you see the term dysphoric, you want to be thinking about the following Major depressive disorder and bipolar disorder, because depressive episodes can cause dysphoria. No-transcript.
Stacy:
Funny, you mentioned that one too. Lynch and I'm working on a podcast about adjustment disorder, so tune in for that next time.
Linton:
Okay.
Stacy:
All right. Another term is euphoric, and this is not to be confused with that first one. We mentioned euthymic. By the way, those two words are spelled with an E-U at the beginning, and that word E-U is Greek for good or well, so maybe you might be able to remember it that way. Euthymic means a stable and balanced mood, whereas euphoria means extra good. So if euthymic is like cruising steadily down a scenic highway on a clear day, feeling calm and content, then euphoric is like flooring the gas pedal in a sports car, speeding through the same highway, feeling an intense rush of excitement and exhilaration. Think bipolar disorders that involve mania and hypomania, where the client is really jazzed up like they're on cloud nine, and intoxication from certain drugs can also cause euphoria.
Linton:
Next is anhedonia, which is mood characterized by an inability to experience pleasure or joy from which are usually enjoyable activities. We see this term a lot in the context of depression, schizophrenia, ptsd and withdrawal from certain substances. It's essential to distinguish anhedonia from a general lack of interest or apathy, as the later may be more related to motivation than the ability to experience pleasure.
Stacy:
Are there any other terms that are used to describe mood Linton?
Linton:
Right, there are, and you'll need to know them. Elevated or expansive. This is similar to euphoria the client feels intensely happy and excited. Bipolar disorders, particularly bipolar 1 disorder Elevated expansive mood might be an indicator of a manic or hypermanic episode. Another is substance intoxication, withdrawal or medical use. There can also be a medical condition like hyperthyroidism or certain neurological disorders.
Stacy:
And then there's ADHD, where symptoms of impulsivity and hyperactivity can sometimes be mistaken for an elevated mood, and it's really important to differentiate between the two, as ADHD is more about a persistent pattern of inattention and hyperactive impulsive behavior rather than episodic mood elevation. And when we talk about elevated expansive mood, we also want to be thinking about schizoaffective disorder, which involves a combination of mood disorder symptoms and psychotic symptoms like delusions or hallucinations.
Linton:
And lastly, certain personality disorders, such as narcissistic personality disorder Stacey. We've done a podcast on that, yet that's a good question.
Stacy:
Have we done a podcast on narcissistic?
Linton:
I don't think so We've done so many? Yeah, we probably should, though you know.
Stacy:
That's a good idea.
Linton:
Okay. They may include symptoms of grandiosity or elevated sense of self-importance that could be perceived as an expansive mood and borderline personality disorder, Although borderline personality disorder primarily characterized by instability in internal relationships, self-image and, in effect, clients may exhibit periods of elevated or expansive mood.
Stacy:
Yeah, all this talk about elevated or expansive mood, Linton, I'm thinking you know, is this how you feel on Tuesday night when you remember tomorrow's BOGO sushi day at Publix? You know, is this how?
Linton:
you feel on Tuesday night when you remember tomorrow's Bogo Sushi Day at Publix, or maybe how you feel when you find that golden egg without a shell in the chicken coop, Not even close there, Linton.
Stacy:
A shell-less golden egg could indicate a calcium deficiency, stress, hormonal imbalance or health issues, in which case my mood would be more dysphoric. But before we go down.
Linton:
How do you know all this stuff, Stacey?
Stacy:
They call it a gift. But before we go down a rabbit hole about the kinds of things that I do find in the coop because there are some stories there let me point out that you wouldn't use the term elevated expansive mood to describe a client who's, you know, just feeling happy and enthusiastic. Elevated or expansive mood is used to describe an exaggerated sense of wellbeing, self-confidence and optimism, and those people who are experiencing an expansive mood often feel on top of the world, brimming with energy and enthusiasm. They might believe they possess extraordinary abilities or they're destined for greatness, leading to an inflated sense of self-importance.
Linton:
That's a good point. Now let's transition into affect, where you're looking at the client's facial expressions, tone of voice and overall emotional presentation. The client may be reporting feeling fine, but if they appear tearful, have a flat affect and are slumped over in their chair, you would say that the affect is inconsistent with the reported mood. What are some other terms used to describe affect?
Stacy:
Stacey, Well, the example you gave is a great place to start with terminology. You might use the terms congruent and incongruent to describe the relationship between the client's mood and affect, and if something is congruent it means that it matches. Conversely, if it's incongruent, it means that it doesn't match. A few other terms that are commonly used to describe the client's affect on the mental status exam are broad, and this just means that the client can express a variety of expected affects in response to stimuli. For instance, imagine you've got a client who comes in and talks about different aspects of their week. When they describe something sad, like maybe the loss of a pet, they show appropriate sadness and might even tear up a bit. Then when they talk about a fun outing they had with friends, their face lights up, they smile appropriate sadness and might even tear up a bit. Then, when they talk about a fun outing they had with friends, their face lights up, they smile and maybe they even laugh Labile.
Stacy:
This describes rapidly changing emotions where the client swings from one intense emotion to another, like they're smiling one minute and crying the next, or they're laughing one minute and yelling in anger the next. Congruent affect this means that the client's affect is consistent with the content of what they're saying or experiencing. Their emotional expression matches what they're saying. Remember congruent matches Incongruent affect and this is interchangeable with an inappropriate affect. The client's affect does not match the content of their speech or the context of the situation. Their emotional expression is out of sync with their verbal communication. Clients with schizophrenia often exhibit incongruent or inappropriate affect. For example, they might laugh when they're talking about something sad or appear emotionally flat when discussing something that would typically evoke a stronger emotional response.
Linton:
There's also flat affect, and that's when a client shows absolutely no emotion at all. Their face appears unresponsive and emotionless and there's a lack of reactivity to any kind of emotional stimuli. Restricted, conflicted affect, where the client shows a limited range of emotional expression. Emotions are present, but less varied than what is typically expected. And blunt affect, which is similar to constricted affect, but even more severe. There is very little emotional reactivity and the client may appear almost robotic.
Stacy:
Okay. So how does assessing the client's mood and affect help you as the therapist? What clues does this provide you with? We'll go through a few examples.
Linton:
Okay, imagine you had a client who reports feeling I'm all right and I'm not too stressed, a relatively euthymic mood. But as you interact with them you notice their affect is blunted. They're not showing much facial expression, their voices lack any inflection and they're not very animated. The discrepancy between the reported mood and the observed affect could suggest that there's more going on emotionally than they're letting on.
Stacy:
Yes, and that incongruence remember the word incongruence between mood and affect is a significant clinical clue. It might indicate the client is not fully aware of their emotional state, or perhaps they're defending against underlying feelings of depression or anxiety.
Linton:
Here's another scenario A client who describes their mood as fantastic and euphoric, speaking in a rapid, pressured manner, and their affect is expansive and animated. They're smiling broadly, gesturing enthusiastically and seem almost giddy. In this case, the elevated mood and the heightened affect are congruent, but they are both abnormally intense, which could be indicative of a manic or hypermanic episode.
Stacy:
Good one, Okay. So how about this case? A client reports their mood as empty and detached following a recent loss. During the session, their affect is constricted, they're not showing much emotional variation, even when discussing the loss. Their facial expressions are minimal and they're speaking in a monotone that flat, restricted affect, coupled with the anhedonic mood, could point towards a depressive disorder or prolonged grief disorder.
Linton:
Of course, when considering diagnoses and treatment planning, the MSC is just the starting point to determine a clinical's mental state baseline. It's a snapshot of that particular moment in time when you're with them. You need to take into account the full clinical picture.
Stacy:
Exactly, and so, for the instance with the client that you described, linton, you'd want to explore the nature and duration of their grief response. Are there other symptoms present, like changes in appetite or sleep, difficulty concentrating or suicidal ideation? Are they using any substances that might be complicating their clinical presentation? The flat affect and anhedonic mood are important pieces of the puzzle, but you have to gather all of the pieces to see the whole picture. How about a summary before we sign off, linton?
Linton:
Okay, you got it Stacey. The mental status exam is a critical tool for assessing a client's current mental state. Mood and affect are two key components. Mood refers to the client's self-reporting emotional experience, while affect is the therapist's observation of the client's emotional expression. When assessing mood, you listen to the client's words describing their emotional states. Terms like euthymic, dysphoric, euphoric, expansive, elevated and anhedonic.
Stacy:
Why are all the clinical words so hard to pronounce?
Linton:
by the way, I don't know, they just are just something else.
Stacy:
It's like they come from. They're all Greek. This is all Greek to me. It's like we're teaching a different language. I know.
Linton:
When assessing affect, you observe the client's facial expressions, tone of voice and overall emotional presentation. You look for congruence or, as Stacey says, incongruence with the reported mood, and you use terms like broad libel, constricted, restricted and blunted to describe the range and intensity of the observed affect. Discrepancies between mood and affect can provide all those critical clinical clues that you need, especially on the exam. That suggests anything from a lack of emotional awareness to a mental disorder. Congruence between mood and effect is also noteworthy, especially when both are abnormally intense, as a manic episode, or abnormally low, as in a depressive episode.
Stacy:
So oh, we've reached the end. All right, all of you listeners out there, keep honing your mental status exam skills, as this will serve you very well on your exam and in your real life practice. And, as we always say, remember it's in there, it's in there. I got to brush up on my Greek and Latin, Linton.
