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Mood vs. Affect

Brooklyn, N.Y.

I was quite pleased to see "Distinction Between Mood, Affect Eludes Many Residents" in the August 15 issue. Dr. Michael Serby’s review of the literature on the mood/affect conundrum was overdue and most welcome.

When teaching medical students and residents, I would often do such a review informally by taking a few textbooks off the shelf to compare and contrast their descriptions of the terms and questions. Such an exercise would predictably lead to worsening confusion on all of our parts, but I did it to prove a point—that there is no consensus whatsoever about these terms in our literature and that the students’ bewilderment was a healthy sign.

Beyond this, I’ve always felt that way too much time was spent on these concepts to the detriment of other more important aspects of the mental status exam. The time spent coming up with impressive descriptors of mood and affect when "patient is miserable" would suffice would be better spent in transcribing and documenting examples of "loose associations" or going beyond stating "hearing voices."

Colleagues often appear to try to fit the mood and affect descriptors to the diagnosis. Hence, patients with major depression will tend to have "constricted affects." Patients who are doing well will be described as having a "broad" affect even if their baseline presentation is one of monotony and blandness. I don’t think I’ve ever seen someone described as being "constricted to euphoria."

I agree with Dr. Serby that it is important to document the unstated to get a more complete description of a patient’s presentation. But this is perhaps better communicated through detailed descriptions of appearance, attitude, cognition, and so on.

I find that extensive debate and discussion of affect cause my mood to be other than euthymic, in the direction of dysphoric, and my affect to be sad and somewhat tearful, appropriately so, in a tight range. Or is it the mood that is sad?

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