Section 1: Disorders of Mood and Affect
Introduction: Climate vs. Weather
In psychopathology, the terms 'mood' and 'affect' describe our emotional state, but they are not identical. Understanding the distinction is fundamental to an accurate mental state examination. The most effective way to remember the difference is through a simple analogy: Mood is to Affect as Climate is to Weather.
Mood refers to a sustained and pervasive emotional state that colors the individual's entire perception of the world. It is the underlying emotional "climate" of a person over a period of time (days or weeks). Mood is typically assessed by asking the patient subjective questions like, "How have your spirits been recently?" or "How is your mood in yourself?"
Affect is the moment-to-moment, observable expression of emotion. It is the fluctuating, external display of feeling—the emotional "weather" you can see on a person's face, in their voice, and through their body language. Affect is assessed through objective observation during the clinical interview.
The Examiner's Focus
The examiner expects you to understand this core distinction.
- Mood = Subjective & Sustained. (What the patient reports over time).
- Affect = Objective & Moment-to-moment. (What you observe right now).
A Important sign of pathology is a discrepancy between the two (e.g., a patient reports a low mood but has a bright, reactive affect).
The Dimensions of Affect: A Clinical Framework
When describing a patient's affect, clinicians use several dimensions to provide a precise and professional picture.
Valence
This is the quality of the affect—the specific emotion being expressed (e.g., depressed, anxious, angry, euphoric, perplexed).
Reactivity
This refers to the affect's responsiveness to environmental and conversational cues. A normal affect is reactive (e.g., smiling at a joke, showing concern when discussing sad topics). A conspicuous lack of reactivity is described as blunted affect.
Range and Intensity
This describes the breadth and intensity of emotional expression.
- Restricted/Constricted: The range of expression is reduced, but not entirely absent. This is common in depression and anxiety.
- Blunted: A significant reduction in the intensity of emotional expression.
- Flat: The virtual absence of any sign of affective expression. Both blunted and flat affect are considered hallmark negative symptoms of schizophrenia.
Congruence
This dimension assesses whether the expressed affect matches the content of the patient's thought.
- Congruent Affect: The emotional expression is appropriate for the topic being discussed (e.g., appearing sad when talking about a loss).
- Incongruent Affect (or Parathymia): There is a clear mismatch between the expressed emotion and the content of thought. This is highly suggestive of a psychotic disorder, particularly schizophrenia.
Clinical Example: A patient smiles and giggles while describing a terrifying delusion that people are trying to poison him.
The Examiner's Focus
Incongruity of affect is a powerful clinical sign. The examiner will test your ability to identify this mismatch in a clinical vignette as it points strongly towards a thought disorder rather than a primary mood disorder.
A middle-aged gentleman was noticed to be giggling inappropriately on hearing the news of his father's death. What is the term used to denote this type of pathological change in affect?
Explanation: The Important here is the mismatch between the situation (tragic news) and the emotional reaction (giggling). This is the textbook definition of incongruous affect. Options A, C, and D describe a reduction or absence of emotion, which is the opposite of what is being displayed. Apathy (B) is a lack of feeling or concern, which does not fit the active emotional expression of giggling.
Stability
This dimension refers to the persistence of an affective state.
- Stable Affect: A normal state where an emotion is maintained appropriately until a new stimulus warrants a change.
- Labile Affect: Characterized by rapid, exaggerated, and often unprovoked shifts in affect. The patient may switch from laughter to tears and back again with minimal provocation. This is seen in histrionic and borderline personality disorders, as well as some organic states.
- Emotional Incontinence: This is an extreme form of lability where there is a complete loss of control over emotional expression. It is a sign of organic brain disease, such as pseudobulbar palsy or frontal lobe damage. The emotional display is explosive and disconnected from the patient's underlying mood. The analogy is an "incontinence of the emotion-filled bladder."
The Examiner's Focus
The crucial distinction to make is between the "functional" lability seen in personality disorders and the "organic" disinhibition of emotional incontinence. If a vignette mentions a neurological context (e.g., stroke, head injury), the answer is likely emotional incontinence.
Emotional lability is least likely to be due to
Explanation: This question tests your knowledge of the common causes of emotional lability. Frontal lobe damage (A), pseudobulbar palsy (B), and delirium (E) are all classic organic causes of emotional lability/incontinence. Rapid mood swings are a core feature of some forms of bipolar disorder (C). Temporal lobe atrophy (D) is primarily associated with memory impairment (amnesia), personality change, or seizures, and is the least likely cause of emotional lability among the options.
A 64-year-old patient admitted in a stroke ward bursts out to laughter or tears within minutes with no control over these emotions. What is the psychopathology seen in this case?
Explanation: This is the definition of emotional incontinence. The patient shows rapid, uncontrolled emotional outbursts that are not congruent with their underlying mood. The context of a stroke ward is a major clue pointing directly to an organic cause, making emotional incontinence the most precise and correct term. The other options describe sustained mood states, not this specific pattern of disinhibited emotional expression.
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