Physical Examination Of Mood Disorder

Assess mood during the interview by exploring the patient's own perceptions of it. Find out about the patient's usual mood level and how it has varied with life events. "How did you feel about that?", for example, or, more generally, "How are your spirits?" The reports of relatives and friends may be of great value.

What has the patient's mood been like? How intense has it been? Has it been labile or fairly unchanging? How long has it lasted? Is it appropriate to the patient's circumstances? In case of depression, have there also been episodes of an elevated mood, suggesting a bipolar disorder?

If you suspect depression, assess its depth and any associated risk of suicide. A series of questions such as the following is useful, proceeding as far as the patient's positive answers warrant.

Do you get pretty discouraged (or depressed or blue)?

How low do you feel?

What do you see for yourself in the future?

Do you ever feel that life isn't worth living? Or that you would just as soon be dead? Have you ever thought of doing away with yourself? How did (do) you think you would do it? What would happen after you were dead?

Asking about suicidal thoughts does not implant the idea in the patient's mind, and it may be the only way to get the information. Although many

Moods include sadness and deep melancholy; contentment, joy, euphoria, and elation; anger and rage; anxiety and worry; and detachment and indifference.

For depressive and bipolar disorders, see Table 16-1, Disorders of Mood, p. 599.

student clinicians feel uneasy about exploring this topic, most patients can discuss their thoughts and feelings about it freely with you, sometimes with considerable relief. By such discussion, you demonstrate your interest and concern for what may well be the patient's most serious and threatening problem. By avoiding the issue, you may miss the most important feature of the patient's illness.

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