Running head: MOOD & AFFECT 1

The Concept of Mood and Affect

Nicky Reed

Ferris State University

Abstract

Mood and affect are very different in definition. The state of one’s mood is subjective in nature

while affect is the expression of one’s mood. There continues to be conflict over the actual

definition but literature shows many similarities. Assessment of mood and affect within

healthcare is important to direct a plan of care for patients. The brain is complex and its

communication processes multifaceted. It is important for nurses to understand the

pathophysiology processes of mood and how pharmaceuticals affect those individuals with mood

disorders. Research is ongoing in discovering how mood is affected by external stimuli and the

impact of pharmaceutical agents. A teaching tool used for education of awareness of one’s mood

and how it affects a person’s thoughts or physiological response is beneficial for comprehension

of how individuals handle environmental conditions and situations. Application of the Theory of

Unpleasant Symptoms to mood and affect shows similarities in process.

The Concept of Mood and Affect

Did you wake up on the wrong side of the bed today? This is a common metaphorical

question that is reflective of one’s mood. Mood and affect are concepts within healthcare that

are important to assess and monitor. The purpose of this paper is to define, describe the

assessment, understand abnormal assessment findings, discuss the pathophysiological and

pharmaceutical processes, review literature, analyze research and apply the middle range theory

of Unpleasant Symptoms to mood and affect.

Definition

Mood can be defined as a current state of feeling or affective state (Kivumbi, 2017).

Though mood is primarily subjective it can be observable at times. In general, mood is described

as either good or bad. Mood range can vary from being depressed, normal, or excited. A

person’s baseline mood also known as euthymia, it can be a normal happiness to a normal

sadness (Giddens, 2017). It is expected that an individual mood cycle’s from a baseline normal

state to variable irregularity. The spectrum of mood can fluctuate from the lowest state of

melancholy to the highest state of mania (Giddens, 2017, p. 319). As a person cycles out of their

baseline stage of mood their functional status will decrease along with satisfaction of daily well-

being. To summarize, mood is how the individual feels that is typically temporary and is a result

of external stimulus.

Affect can be defined as a brief state of emotional feelings (Giddens, 2017). A person's

affect is the expression of emotion or feelings displayed to others through body language.

Simple facial expressions, hand movements, voice level, and other emotional signs such as

laughter or tears is an expression of one’s affect (Ekkekakis, 2009). Individual affect fluctuates

according to their emotional state. A normal range of affect or one’s baseline affect varies from
MOOD & AFFECT 4

culture to culture, and even within a culture (Ekkekakis, 2009). A person may make frequent

hand movements while talking or display dramatic facial expressions in reaction to social

situations. Others may show little or no outward response to social environments or interactions,

expressing a narrow range of emotions to those around them (Giddens, 2017, p. 318). The

difference between mood and affect is quite simple. Mood is the state of feeling while affect is

the occurrence of emotion that is reflective of mood.

Assessment

During the head to toe assessment, evaluation of mood and affect takes place during the

cognition exam. Mood and affect is a subjective finding but can be objective at times when

warranted as in infants, children or those with disability. Interpretation of body language and

facial expression is important to visualize while asking, “How are you feeling today?” or “How

have you been feeling?” (Jarvis, 2016, p.70). Comparing the mood with place and condition

allows the examiner an opportunity to evaluate the appropriateness of their mood. According to

Jarvis (2016), Abnormal findings of mood or affect includes flat affect, depression,

depersonalization, elation, euphoria, anxiety, fear, irritability, rage, ambivalence, lability, and

inappropriate affect. A common abnormal finding is depression and screened for throughout

healthcare (Carniaux-Moran, 2008). A screening tool that is used for evaluation of depression is

the Patient Health Questionnaire that initially consists of two simple questions, “Over the past

two weeks have you felt down, depressed or hopeless?” and “Over the past two weeks, have you

felt little interest or pleasure in doing things?” (Spritzer, Williams, & Kroenke, 2010). If the

response to either of the questions is, “several days” or higher, a more thorough nine question

screen is completed. There are many different screening tools that can be used to assess the

severity of moods such as anxiety or depression. There is no right or wrong screening tool.
MOOD & AFFECT 5

Consideration of age and culture should be acknowledged to assess appropriately. It is important

to screen for depression and suicide at all ages. It is undetermined at which age mood is

experienced or expressible. Mood should be observed in infants, adolescents, and teens as

emotional understanding emerges when a child recognizes emotions of others and copies the

behavior (Giddens, 2017, p. 318). Within each culture, a child is influenced by the norms within

that culture that develops a child’s awareness of what is expected behavior within certain

situations. These cultural norms are developed over time and exposure to each given situation.

On the opposite end of the spectrum, as older adults develop cognition decline they are noted to

be highly satisfied in well-being and display less negative affect and more positive affect

(Giddens, 2017, p. 319).

Pathophysiology

The pathophysiological processes of mood are very complex. Neurotransmitters, such as

serotonin and dopamine, are used as chemical messengers to send signals across our complex

network within the brain (McCance & Heuther, 2014, p. 457). Regions within the brain such as

the prefrontal cortex and limbic system receive these signals and filter the message to gain

understanding of the objects and/or situations, assigning them an emotional value to guide our

behavior and make a quick interpretation (Giddens, 2017). The limbic system sits under the

cerebrum and is made up of structures such as the hypothalamus, hippocampus and the

amygdala. The amygdala resembles an almond in which attaches emotional significance to

events and memories (NIMH, 2017). The hippocampus reminds us what courses of action is

congruent with our mood and has been shown to shrink in people with chronic depression

(McCance & Heuther, 2014). Furthermore, The limbic system regulates biological functions in

line with our mood, for example accelerated heart rate and sweating triggered by our feelings of
MOOD & AFFECT 6

stress or frustration (Giddens, 2017). Networks within the brain are controlled by the limbic

system, coordinating our thoughts and actions, which is reflective of how our mood will be

today.

What is happening in the brain when someone has abnormal finding? Current

understanding of the interplay between life stressors and the dysfunction of the serotonin system

potentially increases an individuals risk of depression and suicide (McCance & Huether, 2014, p.

648). Furthermore, researchers believe that irregularity of serotonin transporters prohibit

reuptake at the synapse and prevent an appropriate response to the stress (McCance & Huether,

2014, p. 648). When it comes to bipolar disorder it is thought that the elevated increases of

monoamines effects individuals ability to make rational thoughts. Researchers continue to focus

on the hypothalamic-pituitary-adrenal (HPA) system because of its function to regulate

hormones within the body. It was found that 30-70% of people with major depression see an

increase of glucocorticoid secretion and continual activation of the HPA system (McCance &

Huether, 2014, p. 648). Post-mortem assessments performed by brain imaging found that

individuals that presented as depressed had a reduction of serotonin binding within the frontal,

temporal, and limbic cortex as well as limited serotonin transporter binding in the hippocampus

and cerebral cortex (McCance & Huether, 2014, p. 650).

Pharmacological Components

The central nervous system (CNS) consists of the brain and spinal cord. Limited

knowledge is known for the drugs that are used for depression, mania, and mood stabilization

and how they work as the complexity of the brain and neurochemical makeup has been

challenging to researchers (Burchum-Rosenjack & Rosenthal, 2016). To put a perspective on the

complexity, within the cerebral hemisphere there are nearly 50 billion neurons alone (Burchum-
MOOD & AFFECT 7

Rosenjack & Rosenthal, 2016). Researchers have found 21 neurotransmitters in the central

nervous system detecting that many have yet to be discovered (NIMH, 2017). To further

investigate the pathophysiological processes within the CNS receptor sites, it is noted that

norephinephrine acts as a communicator to suppress neuronal excitability but researchers are not

certain of the precise relationship between neuronal excitability suppression and the impact to

the function of the organism (Burcham-Rosenjack & Rosenthal, 2016). Another fact about the

functional complexity of the brain is the impediment of protein bound or highly ionized drugs

across the blood brain barrier (NIMH, 2017). The passage is exclusively limited to lipid soluble

drugs. It is very important to know this fact as when a fetus is within the uterus and initially

after birth, the blood brain barrier is not fully developed to protect the infant from these chemical

agents. Even though there is a better understanding of the biochemical and electrophysiological

effects of CNS drugs there is uncertainty of these agent’s true benefits and the effects on

individuals. Close evaluation when an individual takes the medication on a long term basis. The

CNS drug effects may differ from when they initially start the drug therapy as the brain adapts to

the medication and can alter the effects (Burchum-Rosenjack & Rosenthal, 2016).

There are many types of CNS medications that are used to treat different mood disorders.

The disorders that will be focused on are depression and bipolar with extreme mania. In around

1960, a research study was conducted and found that monoamine neurotransmitter-deficiency

was a potential cause for depression (Burchum-Rosenjack & Rosenthal, 2016). The findings

were made after a drug called reserpine caused a loss of monoamines from the brain and

inhibitors of tyrosine hydroxylase fuse the monoamine communicators (Burchum-Rosenjack &

Rosenthal, 2016). Given the study was very simplistic it still provided a conceptual framework

to better understanding of antidepressant medications. It has been found that individuals that
MOOD & AFFECT 8

suffer a severe level of depression benefit the greatest from anti-depressant agents and those with

lesser forms of depression find little or no benefit in use of these drugs (Burchum-Rosenjack &

Rosenthal, 2016, p. 341). Distinct types of antidepressant agents include selective serotonin

reuptake inhibitors, serotonin/norepinephrine reuptake inhibitors, tricyclic’s, monoamine oxidase

inhibitors, and atypical antidepressants (Burchum-Rosenjack & Rosenthal, 2016). To achieve a

therapeutic level it has been found that within 1-3 weeks individuals may start to feel a response

but it can take up to 12 weeks before the drug is at its peak (Burchum-Rosenjack & Rosenthal,

2016). It is important to consider the potential side effects and knowing the individual before

selecting an antidepressant. Risk of suicide increases with certain antidepressants and the

individual should be closely monitored.

Mood stabilizers are used when treating bipolar disorder. Currently, 3.7% of adults are

affected by bipolar disorder (Burchum-Rosenjack & Rosenthal, 2016). Mood stabilizers are

drugs that relieve symptoms of mania and depression and prevent occurrence of these episodes.

The three chemical agents that are commonly used are lithium, carbamazepine and divalproex

sodium (Burchum-Rosenjack & Rosenthal, 2016). Other anti-psychotic drugs that are typically

given in combination with mood stabilizers are risperidone or olanzapine (McCoy, 2015). The

use of combination therapy is seen when an individual is having a psychotic episode and is

cycling into extreme mania. One of the first discovered mood stabilizers that were known to

treat mood disorder was, Lithium (NAMI, 2012). Lithium is a simple inorganic ion that carries a

positive charge that reduces euphoria and hyperactivity (Burchum-Rosenjack & Rosenthal,

2016). It is not clear the mechanism of stabilization but hypothesis of an alteration of

distribution of certain positively charged ions such as calcium that are critical to neuronal

transmission altering the synthesis and release of natural chemicals like norepinephrine,
MOOD & AFFECT 9

serotonin, and dopamine then affect the messengers (McInnis, 2014). Current research has

thought that glutamate uptake and release is altered by the lithium, blocking serotonin at the

receptor site and inhibiting glycogen synthase kinase-3 beta (Burchum-Rosenjack & Rosenthal,

2016, p. 367). Research continues to be ongoing.

Research

After reviewing research on mood and affect, one hypothesis stood out the most.

Connelly (2012), investigated the individual’s responsiveness to mood and well-being during

varying climate and transitory weather conditions by analyzing subjective mood. Data was

collected in the Princeton Affect and Time Survey during the summer months (Connelly, 2012).

The study consisted of satisfaction questions about life in general, home life, one’s health and

job, as well as questions concerning the strength of feelings during specific episodes. The results

concluded that women are much more responsive than men to the weather, and that life

satisfaction decreases with the amount of rain on the day of the interview (Connelly, 2012). Low

temperatures were found to increase happiness and reduced tiredness and stress, raising the mood

affect while high temperatures lessened happiness (Connelly, 2012). The study was conducted

following review of literature and during the summer months. Potential bias of the time of year

was considered and further studies are warranted.

Most of the research revolves around the thoughts of seasonal affective disorder (SAD).

SAD is clearly a real disorder that has shown to affect 10 million Americans (Viner, 2014).

Notably, three quarters of the those affected have been females that mostly live in northern

climates (Viner, 2014). The weather’s daily influence has more of an impact on an individual’s

negative mood instead of improving one’s positive thoughts (Denissen, et al., 2008).

Middle Range Theory

The middle range theory, The Theory of Unpleasant Symptoms was applied to the

concept of mood and affect. The theory was developed by a group of nurses interested in a

variety of nursing issues including symptom management, theory development and nursing

science (Lee, Vincent, Finnegan, 2017). The Theory of Unpleasant Symptoms was originally

published into nursing literature around 1995 and two years later revised ( Lee, Vincent,

Finnegan, 2017). The Theory of Unpleasant Symptoms was based on the idea that there are

commonalities in experiencing different symptoms among different groups and in different

situations (Lenz, Suppe, Gift, Pugh, & Milligan, 1995). The purpose of the theory was to aid

nurses in managing symptoms after integrate existing knowledge with causes of symptoms

(Lenz, Suppe, Gift, Pugh, & Milligan, 1995). The hypothesis behind the theory and the

conceived understanding of mood and affect are very similar. The theory further is understood

by three major components that identified the symptoms that the individual is experiencing,

influences factors that produce or affect the symptom experience and the consequences of the

symptoms are then felt (Lenz, Suppe, Gift, Pugh, & Milligan, 1995). The Theory of Unpleasant

Symptoms can be applied to the concept of mood and affect as mood is similarly structured.

Mood is generated from influencing factors that yield a response from neurotransmitters

fostering biological responses.

Teaching Tool

A teaching tool that could be utilized to educate the assessment and understanding of

mood and affect is the Commonwealth of Massachusetts (2017), STORC model. The model

stands for Situation, Thoughts, Organ Experience, Consequences of Response, and Reaction to

Response (Commonwealth of Massachusetts, 2017). The model is intended to help individuals

gain understanding of thought process that effects mood and affect. As an educational aid, the
MOOD & AFFECT 11

model is a valuable tool for student nurses and professional nurses to understand the importance

of assessing mood and affect. The STORC model is broke down into five components of

assessment and analysis. The situation references the environmental components that surround

the individual at a certain point in time (Commonwealth of Massachusetts, 2017). The impact of

sustained exposure to low conditions can lead overtly negative outcomes for example if a person

is anxious with no support network to positively boost mood. Thoughts represent the cognitive

component of positive and negative emotions and that they are not direct reactions to reality but

rather responses to how a person perceives that world (Commonwealth of Massachusetts, 2017).

Simplified, thoughts can be negatively or positively impacted by the current state of mind. An

event that typically would be stressful may not be when so unmanageable with a positive attitude

and vice versa. The organ experience is reflective of the physical response one has when in a

particular mood (Commonwealth of Massachusetts, 2017). A students understanding of the

autonomic response by the body and its association to a particular emotion is important when

caring for patients. An individual may experience physical changes such as dry mouth, cold

hands, a hot face, stomach cramps or even nausea (Ekkekakis, 2012). Gaining understanding of

what physical symptoms are associated with the feelings they are experiencing (e.g., upset,

angry, sad, afraid) is informative to the plan of care. A response pattern is how the individual

reacts to particular event driving behavioral changes (Commonwealth of Massachusetts, 2017).

A person may display avoidance when dealing with particular events that are recognized as

stressful or depressing. The last component, consequences or environmental reactions references

a social environment lacking sufficient positive reinforcement that can nurture negative mood

and depression (Commonwealth of Massachusetts, 2017). The teaching tool is valuable in

breaking down events that allows the nurse and patient to be aware of how a patient may respond
MOOD & AFFECT 12

and create coping strategies to facilitate positive thought processes to potentiate a positive

outcome.

Self-Reflection

Mood and affect have inconsistencies in definition when reviewing literature. According

to Dr. Michael Serby (2003), confusion about these terms can result in an overly literal approach

to the interview. Consideration of a patient’s verbal response to mood should not be taken at

face value. During exam, the objective assessment of subtle unstated ques or feelings should be

taken into consideration. A two-dimensional approach of evaluation of the subjective and

objective should be understood to appropriately assess and manage mood and affect.

Furthermore, understanding that the most consistent definition of mood as the sustained

emotional state and affect as transient effects of the emotional state. After exploring the concept

of mood and affect, it was noted that there are varying opinions and research on the effect mood

and affect has on everyday functioning and achieving life goals. Many nurses disregard the

importance of understanding the difference of mood and affect. Both concepts are very

important to the nursing assessment and the overall outcome of the patient.

Conclusion

Mood and affect is an important concept that presents a significant impact to health

outcomes. The magnitude of understanding the difference between mood and affect is important

in recognition of potential instability in individuals. Furthermore, comprehension of an

appropriate assessment of mood and affect is detrimental to identifying the appropriate treatment

plan and minimizing harm to those individuals. Consideration that environmental stimuli, plays

a significant role in the assessment of mood during the examination and to not always take the

subjective response at face value. A mood and affect assessment should be done for all age
MOOD & AFFECT 13

groups and sensitivity to the non-verbal ques for those unable to communicate effectively.

Cultural awareness is valuable to the assessment process. Regardless of the lack of

understanding of mood regulation it is important to learn to conduct a thorough assessment and

comprehension of mood. Teaching tools are available to aid in further understanding and may

guide the individual to gain internal perspective of how one responds and the ability to control

responses to negative stimuli.

References

Burchum-Rosenjack, J. & Rosenthal, L. D. (2016). Lehne’s Pharmacology for nursing care (9th

ed). St. Louis, MO: Elsevier

Carniaux-Moran, C. (2008). The psychiatric nursing assessment. In P. G. O’Brien, W. Z.

Kennedy, & K. A. Ballard (eds.), Pschiatric Mental Health Nursing: An Introduction to

Theory and Practice (p. 46-47). Sudbury, MA: Jones & Bartlett Publishing

Commonwealth of Massachusetts. (2017). Module 9: Mood management. Retrieved from

http://www.mass.gov/eohhs/docs/dph/substance-abuse/sbirt/bt-manual-module9.pdf

Connelly, M. (2012). Some like it mild and not too wet: The influence of weather on subjective

well-being. J Happiness Stud, 14(2), 457-473. doi:10.1007/s10902-012-9338-2

Denissen, J. J. A., Butalid, L., Penke, L., Van Aken, M. A. (2008). The effects of weather on

daily mood: A multilevel approach. Emotion, 8(1), 662-667. doi: 10.1037/a0013497

Ekkekakis, P. (2012). Affect, Mood and Emotion. In G. Tenenbaum & R. C. Eklund (eds.),

Measurement in sport and exercise psychology. Champaign, IL: Human Kinetics

Giddens, J. F. (2017). Concepts for nursing practice (2nd ed). St. Louis, MO: Elsevier

Jarvis, C. (2016). Physical examination & health assessment (7th ed). St. Louis, MO: Elsevier

Kivumbi. (2017). Difference between mood and affect. Retrieved from

http://www.differencebetween.net/language/difference-between-mood-and-affect

Lee, S. E., Vincent, C., & Finnegan, L. (2017). An analysis and evaluation of the theory of

unpleasant symptoms. ANS Adv Nurs Sci, 40(1), E16-E39.

doi:10.1097/ANS.000000000000141
MOOD & AFFECT 15

Lenz, E. R., Suppe, F., Gift, A. G., Pugh, L. C., & Milligan, R. A. (1995). Collaborative

development of middle-range nursing theories: Toward a theory of unpleasant symptoms.

ANS Adv Nurs Sci., 17(3), 1-13. doi:10.1188/09.ONF.E1-E10

McCance, K. L. & Huether, S. E. (2014). Pathophysiology: The biologic basis for disease in

adults and children (7th ed). St. Louis, MO: Elsevier

McCoy, K. (2015). Mood stabilizers for bipolar disorder. Retrieved from

https://www.everydayhealth.com/bipolar-disorder/mood-stabilizers.aspx

McEwen, M. (2014). Overview of selected middle range nursing theories. In K. Masters (ed.),

Nursing Theories: A framework for professional practice (p. 258-260). Sudbury, MA:

Jones & Bartlett Publishing

McInnis, M. G. (2014). Lithium for bipolar disorder: A re-emerging treatment for mood

instability. Current Pshychiatry, 13(6), 39-44. Retrieved from

http://www.mdedge.com/currentpsychiatry/article/82687/bipolar-disorder/lithium-

bipolar-disorder-re-emerging-treatment-mood

National Alliance for Mental Illness. (2012). Lithium. Retrieved from

https://www.nami.org/Learn-More/Treatment/Mental-Health-Medications/Lithium

National Institute of Mental Health. (2017). Brain basics. Retrieved from

https://www.nimh.nih.gov/health/educational-resources/brain-basics/brain-basics.shtml

Serby, M. (2003). Psychiatric resident conceptualizations of mood and affect within the mental

status examination. The American Journal of Psychiatry, 160(8), 1527-1529.

doi:10.1176/app.ajp.160.8.1527
MOOD & AFFECT 16

Spritzer, R. L., Williams, J. B. W., & Kroenke, K. (2010). Patient health questionnaire-9.

Retrieved from http://www.phqscreeners.com/sites/g/files/g10016261/f/201412/PHQ-

9_English.pdf

Viner, J. (2014). The surprising facts about seasonal affective disorder(SAD) [online blog].

Retrieved from https://psychcentral.com/blog/archives/2014/12/11/surprising-facts-

about-seasonal-affective-disorder-sad/