Mood vs. Affect

The difficulty distinguishing mood from affect discussed by Drs. Michael Serby and Tomer Levin in the August 15 and October 3 issues, respectively, will come as no surprise to psychiatric educators, and it may now be time to set aside the outdated use of “affect” in mental-status descriptions.

There are two problems: one conceptual and the other operational. Traditionally mood and affect have been described in two parameters—constancy and subjectivity. Mood was said to be stable and internal, whereas affect was supposed to be shifting and external. This linkage is not supported by clinical reality, as evidenced by patients with a labile mood or a blunted affect. Moreover, mental-status findings are only cross-sectional, describing what the clinician finds at the time of the examination. It is incorrect in the mental status to describe a prevailing emotional tone for anything other than the 30 to 90 minutes of the evaluation. The patient’s description of her mood yesterday or last week or last year is history, not mental status.

Dr. Levin’s imaginative response introduces a degree of interpretation that would tend to make psychiatric evaluations less, rather than more, reliable. It is much simpler and more in keeping with a phenomenologic descriptive system simply to describe emotional expression with two components—subjective and objective. The former is what the patient describes, and the latter is what the examiner observes.