Mood Off Status Video Download Full Screen
Rochell Estrello
Evidence for diet quality representing a modifiable risk factor for age-related cognitive decline and mood disturbances has typically come from retrospective, cross-sectional analyses. Here a diet screening tool (DST) was used to categorize healthy middle-aged volunteers (n = 141, 40-65 years) into "optimal" or "sub-optimal" diet groups to investigate cross-sectional associations between diet quality, cognitive function, and mood. The DST distinguished levels of nutrient intake as assessed by Automated Self-Administered 24-h dietary recall and nutrient status, as assessed by blood biomarker measures. Compared with the "sub-optimal" group, the "optimal" diet group showed significantly higher intake of vitamin E (p = 0.007), magnesium (p = 0.001), zinc (p = 0.043) and fiber (p = 0.015), higher circulating levels of vitamin B6 (p = 0.030) and red blood cell folate (p = 0.026) and lower saturated fatty acids (p = 0.012). Regarding psychological outcomes, the "optimal" diet group had significantly better Stroop processing than those with a "sub-optimal" diet (p = 0.013). Regression analysis revealed that higher DST scores were associated with fewer mood disturbances (p = 0.002) and lower perceived stress (p = 0.031), although these differences were not significant when comparing "optimal" versus "sub-optimal" as discrete groups. This study demonstrates the potential of a 20-item diet screen to identify both nutritional and psychological status in an Australian setting.
Mood is the patient's internal, subjective emotional state.1 Of note, this is one of the few elements of the MSE that rely on patient self-report in addition to physician observation. It is helpful to ask the patient to report his or her mood over the past few weeks, as opposed to merely asking about the moment. It may also be helpful to determine if mood remains constant over time or varies from visit to visit. Physicians may perform a more objective assessment by asking the patient at each visit to rate mood from 1 to 10 (with 1 being sad, and 10 being happy).
Affect is the physician's objective observation of the patient's expressed emotional state. Often, the patient's affect changes with his or her emotional state and can be determined by facial expressions, as well as interactions. Descriptors of affect may address emotional range (broad or restricted), intensity (blunted, flat, or normal), and stability.1 Affect may or may not be congruent with mood, such as when a patient laughs when talking about the recent death of a family member. Additionally, affect may not be appropriate for a given situation. For example, a patient with delusions of persecution may not seem frightened, as expected. Inappropriateness of affect occurs in some patients with schizophrenia.
A systematic approach to evaluating for cognitive impairment is helpful. The most commonly used method is the Mini-Mental State Examination (MMSE), which takes five to 10 minutes to administer. The MMSE has been validated and used extensively in practice and in research. In clinical practice, it is usually used to detect cognitive impairment in older patients. The MMSE includes 11 questions that test five areas of cognitive function: orientation, registration, attention and calculation, recall, and language.7 Using the MMSE as a screening instrument has not been supported because the specificity of screening tools is poor despite good sensitivity.8 Table 4 summarizes U.S. Preventive Services Task Force screening recommendations for cognitive impairment and other mental disorders.8,9 However, the MMSE is a useful measure of change in cognitive status over time, as well as potential response to treatment. The test is limited in patients who have visual impairment, are intubated, or have a low literacy level.10
The psychiatric interview and mental status examination. In: Hales R, Yudofsky SC, Gabbardd GO, eds. The American Psychiatric Publishing Textbook of Psychiatry. 5th ed. Arlington, Va.: American Psychiatric Publishing, Inc.; 2008.
Please note: Online screening tools are meant to be a quick snapshot of your mental health. If your results indicate you may be experiencing symptoms of a mental illness, consider sharing your results with someone. A mental health provider (such as a doctor or a therapist) can give you a full assessment and talk to you about options for how to feel better.
The purpose of the current study was to explore the physical activity and screen time status among Chinese adolescents during the coronavirus disease (COVID-19) lockdown and their association with mood disturbance and conflicts with parents. A total of 1,680 7th to 12th grade students enrolled at a large middle-high school located in Southwest China completed an online survey measuring mood states, physical activity, screen time, conflicts with parents, and body height and weight. Physical activity, particularly of at least 150 minutes' duration each week, significantly decreased the likelihood of negative mood among adolescents during lock-down. Screen time, specifically other than that spent on online study, had a negative association with mood, after controlling for the relevant variables (i.e., physical activity and body mass index). Less screen time and accumulating 150 minutes of physical activity were associated with fewer conflicts with parents. With the continuing COVID-19 pandemic, local school districts, school leaders, and health professionals should develop greater awareness of potential problems with, and engage parents in developing specific guidance on controlling, screen time and promoting physical activity in a time-sensitive manner. [Journal of Psychosocial Nursing and Mental Health Services, 59(4), 14-20.].
The mental status examination is a structured assessment of the patient's behavioral and cognitive functioning. It includes descriptions of the patient's appearance and general behavior, level of consciousness and attentiveness, motor and speech activity, mood and affect, thought and perception, attitude and insight, the reaction evoked in the examiner, and, finally, higher cognitive abilities. The specific cognitive functions of alertness, language, memory, constructional ability, and abstract reasoning are the most clinically relevant.
One could scarcely improve on this advice in the present-day approach to mental status evaluation. The knowledge that the modern physician can bring to bear on this task is certainly much more extensive than in 1801. Nevertheless, the observational skills and subtle discriminations that constitute "great discernment," and the traits of professional and scientific integrity that are likewise required, must be cultivated afresh in each generation of physicians.
The mental status examination, in many respects, lends itself less well to a systematic and structured approach than other portions of the examination of the patient. On the one hand, because mental status testing can be threatening to the patient and requires much cooperation on the part of the patient, it is desirable to leave the mental status testing to the end of the overall evaluation when the patient can be placed most at ease and when some degree of rapport has been established between the examiner and the patient. On the other hand, the mental state of the patient colors the accuracy and sensitivity of the entire medical history, and from this standpoint, the physician wishes he or she could perform a mental status examination as a prelude to the rest of the medical history in order to have the assessment as a template against which to measure the accuracy of the rest of the history. The successful clinician must develop a style in which much of the mental status examination is performed through relatively unstructured observations made during the routine history and physical. The way in which the patient relates the history of the present illness will reveal much about general appearance and behavior, alertness, speech, activity, affect, and attitude. A primary technique, then, in mental status testing is the imposition of some structure on these observations and raising them from the level of subliminal impressions to clinically useful descriptions of behavior.
Affect is the patient's immediate expression of emotion; mood refers to the more sustained emotional makeup of the patient's personality. Patients display a range of affect that may be described as broad, restricted, labile, or flat. Affect is inappropriate when there is no consonance between what the patient is experiencing or describing and the emotion he is showing at the same time (e.g., laughing when relating the recent death of a loved one). Both affect and mood can be described as dysphoric (depression, anxiety, guilt), euthymic (normal), or euphoric (implying a pathologically elevated sense of well-being).
Of all portions of the mental status examination, the evaluation of a potential thought disorder is one of the most difficult and requires considerable experience. The primary-care physician will frequently desire formal psychiatric consultation in patients exhibiting such disorders.
The preceding sections of the mental status examination provide a Gestalt view of the patient and his illness. A structured examination of specific cognitive abilities is a more reductionistic approach to the patient and pays careful attention to neuroanatomic correlates. Such testing logically follows a hierarchic ordering of cortical function with attention and memory being the most basic functions on which higher-ordered abilities of language, constructional ability, and abstract thinking are layered.
The past several decades have seen the development of a large body of literature dealing with neuropsychologic testing. It is beyond the scope of this chapter to consider this broad topic; however, some recent efforts to simplify and systematize the cognitive portion of mental status testing will be of interest and use to the primary-care physician.
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