So far in this series we have been developing an understanding of the core components of a mental state exam. So far we have discussed how a young persons appearance, behaviour, speech and language can provide indicators as to their mental state. Today we discuss how a young persons mood and affect can provide insight into their current mental health status.
Mood is described using a young person’s own words. Happy, sad, angry, elated, anxious or apathetic. Many young people may be unable to describe their subjective mood state. Throughout my career I have seen a marked decrease in emotional intelligence in our society. It may take some work to flesh out how a young person feels. There are a number of resources to help young people to articulate their emotions, my personal favourites are mood dudes and the stones. In essence Mood is how young people see themselves in their own opinion.
|Emotional intelligence in a squeeze ball|
The key to remember about mood is that it is subjective. The young person is the master of their own emotional state. Only they truly know what is going on inside.
Affect is noted by us when we observe the apparent emotion conveyed by the person’s nonverbal behaviour. Affect may be described as appropriate or inappropriate behaviour to the current situation, and as congruent or incongruent with their thought content. For example, a young person who shows a neutral affect when describing a very distressing experience such as family violence would be described as showing incongruent affect, which might suggest PTSD. The intensity of the young persons affect may be conveyed as normal, blunted, exaggerated, flat, heightened or overly dramatic.
A flat or blunted affect can be associated with schizophrenia, depression or post-traumatic stress disorder. Heightened affect might suggest mania, excitement or anxiety and an overly dramatic or exaggerated affect might suggest certain personality disorders. A young person may show a full range of affect, or a wide range of emotional expression during your assessment. They may move from heightened to blunted or they may only show a single affect.
The key to remember about affect is that it is objective. It is what you observe about a young person. The key here is to be clear about what you are observing and why you believe it means what you believe. For example, “Aaron appeared sad. He spoke slowly, kept eye contact on the ground and cried“.
Stay tuned next week as we discuss part five: Thought process and content.