In healthy individuals, thoughts flow at a steady pace and in a logical order.
racing) or abnormally slow thought processing. Patient’s may demonstrate abnormally fast (i.e.
Thought form refers to the processing and organisation of thoughts. Thought can be described in terms of form, content and possession. Incongruent affect is typically associated with schizophrenia. A patient sharing distressing thoughts whilst demonstrating a flat affect or laughing would be described as showing incongruent affect. Note if the patient’s affect appears in keeping with the content of their thoughts (known as congruency). Blunted or flat: associated with schizophrenia, depression and post-traumatic stress disorder.Heightened: associated with mania and some personality disorders.Patients typically feel like they have no control over their emotions.Ī patient’s intensity of affect may be described as: Labile affect: characterised by exaggerated changes in emotion which may or may not relate to external triggers.Restricted affect: the patient’s affect changes slightly throughout the interview, but doesn’t demonstrate the normal range of emotional expression that would be expected.Fixed affect: the patient’s affect remains the same throughout the interview, regardless of the topic.Range and mobility of affect refer to the variability observed in the patient’s affect during the assessment. Observe the apparent emotion reflected by the patient’s affect, examples may include: To assess affect you need to observe the patient’s facial expressions and overall demeanour. “Have you been feeling low/depressed/anxious lately?”.MoodĪ patient’s mood can be explored by asking questions such as: Mood represents a patient’s predominant subjective internal state at any one time as described by them.Īffect is what you observe and mood is what the patient tells you. the patient’s facial expression or overall demeanour). Mood and affect both relate to emotion, however, they are fundamentally different.Īffect represents an immediately expressed and observed emotion (e.g. Slurred speech: may occur in major depression due to psychomotor retardation.Note the fluency and rhythm of the patient’s speech for abnormalities: Tremulous speech: associated with anxiety.Monotonous speech: associated with conditions such as depression, schizophrenia and autism.Excessive speech: associated with mania and schizophrenia.Minimal or absent speech: associated with depression.Note the quantity of the patient’s speech: Slow speech: may occur due to psychomotor retardation which is typically associated with major depression.Pressure of speech: a tendency to speak rapidly, motivated by an urgency that may not be apparent to the listener (often a manifestation of thought abnormalities such as flight of ideas, which is described later in the article).Pay attention to the patient’s rate of speech: Restlessness: the patient may continuously fidget, pace and refuse to sit still.Īssess the patient’s speech to identify abnormalities which may indicate underlying mental health issues.Psychomotor retardation: associated with a paucity of movement and delayed responses to questions.Observe for any evidence of psychomotor abnormalities: Note any evidence of exaggerated gesticulation or unusual mannerisms. standing up close to you) or withdrawn (e.g. Observe the patient’s body language which may appear threatening (e.g. Observe the patient’s facial expression (e.g. Observe the patient’s level of eye contact and note if this appears reduced or excessive. replying to auditory hallucinations in schizophrenia). Note if they appear distracted or if they appear to be engaging with hallucinations (e.g. Note if the patient appears engaged in the consultation and if you are able to develop a rapport with them. Objects: look around to see if the patient has brought any objects with them and note what they are.Ī patient’s behaviours may provide insights into their current mental state.Clothing: note if this is appropriate for the weather/circumstances and if the clothes have been put on correctly.Personal hygiene: this can provide insight into the patient’s current ability to care for themselves.Stigmata of disease: note any stigmata of disease (e.g.Weight: note if they appear significantly underweight or overweight.self-harm), tattoos and signs of intravenous drug use. Distinguishing features: these may include scars (e.g.Observe the patient’s general appearance: The appearance of the patient may provide some clues as to their lifestyle, current mental state and ability to care for themselves. You might also be interested in our OSCE Flashcard Collection which contains over 2000 flashcards that cover clinical examination, procedures, communication skills and data interpretation.