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OVERVIEW

This page is used to organize CRG work and brainstorming on clinical findings and observable entities related to emotion and affect.

Major issues to consider here are:

  • Whether and how concepts of motivation and drive are related to emotion (currently no relationship modeled in SNOMED; concepts related to motivation and drive need review and cleanup)
  • Need to distinguish between 'psychomotor' and 'motor' concepts; this came up in the context of modeling the motor component of affect



MAJOR FUNCTION, PROCESS, AND OTHER OBSERVABLE ENTITY CONCEPTS

Major Concepts

Commonly Used TermsWorking Definition
Affect

Emotion

Mood

DEFINITIONS 

Affect

  • Zajonc describes affect as “the manifestation of an emotion as perceived by an observer (objective experience of the emotion)”.
  • Trzepacz & Baker describe affect as the “external and dynamic manifestation of a person’s internal emotional state”(Trzepacz & Baker, 1993).
  • Nussbaum describes affect as the “observable behaviors that are expressions of emotion” (Nussbaum, 2013).
  • The APA defines affect as “a pattern of observable behaviors that is the expression of a subjectively experienced feeling state (emotion)… In contrast to mood, which refers to a pervasive and sustained emotional “climate”, affect refers to more fluctuating changes in emotional “weather” (APA, 2013).

Brainstorming/synthesis of above sources:

Feeling

  • Wikipedia defines feelings this way: “Feelings are best understood as a subjective representation of emotions, private to the individual experiencing them” (Wikipedia, 2015).

Emotion

  • Emotion is a subjectively experienced state – associated with activation (arousal) of specific brain regions, neurotransmitters, physiological response and mental states including “appraisal of situations and contexts” (Thoits).
  • Wikipedia describes an emotion as “a subjective, conscious experience characterized primarily by psychophysiological expressions, biological reactions, and mental states” (Wikipedia, 2015).

Emotional State

Think about the constructs of emotional state versus emotion versus feeling.

  • An emotional state exists regardless of conscious awareness of the state; this is the neurophysiological reaction involving parts of the brain known to produce the experience of emotion.
  • The experience of an emotional state is an emotion or feeling (subjectively experienced emotion)

Mood

  • Mood is a longer-lasting emotional state; it’s believed the while neurotransmitters play a primary role in emotion, mood is controlled more by neuro-peptides in the brain; less intense state than emotion.
  • Wikipedia describes mood as “diffuse affective states that generally last for much longer durations than emotions and are also usually less intense than emotions” (Wikipedia, 2015).
  • The DSM-5 defines mood as “a pervasive and sustained emotion that colors the perception of the world… In contrast to affect, which refers to more fluctuating changes in emotional “weather,” mood refers to a pervasive and sustained emotional “climate” (APA, 2013).
  • The MSE manual describes mood as “a person’s predominant internal feeling state at a given time” and distinguishes mood from affect in terms of subjective experience (mood) versus objectively observable manifestations. They go on to describe mood as a “consistent, sustained feeling state” that is “more likely to vary over hours and days than minutes and seconds” and affect as the “moment-to-moment expression of feelings” (Trzepacz & Baker, 1993). They define mood as being “what the patient reports as his or her predominant emotional state”.
  • DSM-5 guidebook defines mood as “sustained and pervasive feeling states” (Black & Grant, 2014)

Attributes of emotion

Attributes of emotion and affect

  • Latency (time to onset of detectable or consciously experienced emotion relative to evoking stimulus)
  • Lability (measure of a refractory period during which certain – opposite? – emotions can or cannot be evoked)
  • Valence (negatively or positively valanced)
    • Quality (e.g., sad, happy, content, hopeful, afraid)
  • Intensity (measure of strength of emotion from absent to all-encompassing)
  • Range (breath of emotion; negatively to positively valanced; variation in qualities; variation in intensity?)
  • Reactivity (threshold of eliciting stimulus required for activation of specific emotion; can be emotion-specific or general emotional reactivity).

Attributes of mood

  • Duration
  • Quality
  • Valence
  • Intensity
  • Lability(?) (the definition of mood implies that lability is not relevant; shorter durations – i.e., is there such a thing as rapid cycling moods or is there only labile emotion states that overshadow moods?; at a neurophysiological level do the neuropeptides implicated in mood exist at only very low levels, or are they just overshadowed by neurotransmitters; do levels of neuropeptides fluctuate rapidly thus leading to rapid changes in neurotransmitter levels? Seems that this can only be assessed at neurochemical level)

Patterns of emotional experience and/or expression

  • Lability - a short refractory period for any given emotion, allowing a different emotion to be elicited in a smaller-than-typical elapsed time period
  • Emotion can also be regulated through processes most authors describe using terms like (f) 

    • Maintaining
    • Amplifying
    • Attenuating

This table is based on a terms used the forms (questions, picklist values) of an EHR of one health system

Summary of RDoC conceptualization of concepts related to emotion (Research Domain Criteria) (see https://www.nimh.nih.gov/research/research-funded-by-nimh/rdoc/index.shtml)

STAKEHOLDER GROUPS AND SUBJECT MATTER EXPERTS

NameTypeDescriptionNotes












RESOURCES

NameTypeDescriptionNotes
DSM-I, DSM-II, DSM-III, DSM-III-R, DSM-IV, DSM-IV-RNosologyPrevious editions of the the Diagnostic and Statistical Manual of Mental Disorders (DSM)Useful for understanding the evolution concepts and specific terms used at different points in time
DSM-5, DSM-5 SCIDNosologyCurrent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM)Useful for understanding terms and concepts as they are currently designed to be used by clinicians
ICD-10, ICD-10-CMNosologyPreview editions of the the International Classification of Disorders (ICD)Useful for understanding the evolution concepts and specific terms used at different points in time
ICD-11NosologyCurrent edition of the the International Classification of Disorders (ICD)Useful for understanding terms and concepts as they are currently designed to be used by clinicians
UMLSMeta-TerminologyUnified Medical Language System (UMLS)
RDoC


EARL

Annotation language/tool

HUMAINE Emotion Annotation and Representation Language (EARL): Proposal - http://emotion-research.net/projects/humaine/earl/proposal

PROJECT MILESTONES AND STATUS

IDObjectiveAction Item
1Define scope of work
  • Identify the major concept(s) around which to organize a manageable project (scope of work) (artifact: mabh-crg concept plan)
  • Complete the major concept table and iteratively update as project progresses (CRG to finalize the definition for SNOMED once all research has been completed) 
2Understand uses cases
  • Identify any non-standard use cases or pain points in research domain  (artifact: mabh-crg use case document)
  • Identify any non-standard use cases or pain points in clinical domain  (artifact: mabh-crg use case document)
3Understand major conceptualizations of the concept
  • Perform environmental scan to identify major theoretical models of construct/concept domain (artifact: mabh-crg theoretical model document)
  • Perform environmental scan to identify disorders and clinical variables relevant to the concept domain  (artifact: mabh-crg clinical model document)
  • Perform environmental scan to identify existing explicit representations of concepts in the domain in terminologies (nomenclatures, nosologies, classification systems, controlled vocabularies, and ontologies) (artifact: mabh-crg umls analysis matrix, mabh-crg terminology matrix)
4Establish contact with key stakeholders and other potential project contributors
  • Perform and environmental scan to Identify key stakeholders in the basic research, clinical research, clinical practice, and patient advocacy domain (artifact: mabh-crg stakeholder document)
  • Create and implement a plan for engaging stakeholders willing to participate in the CRG for the duration of the specific concept review, either on calls or via discussion forum, or to provide the following:
    • Stakeholder experience related to specific pain points or use cases in the domain
    • Copies or screenshots of note templates, clinical notes, flowsheets, order sets, research protocols, other (question)
5Understand how concepts in the domain are currently represented in SNOMED
  • Review concepts in observable entity hierarchy
    • Create dot diagram of current state
    • Create observable entity spreadsheet
  • Review concepts in clinical finding hierarchy
    • Create dot diagram of current state
    • Create observable entity spreadsheet
6Perform gap analysis 
  • Analyze concepts in observable entity hierarchy
    • Create observable entity spreadsheet
    • Create dot diagram of current state
    • Perform review of dot diagram to identify potential duplicate, outdated, missing or inaccurately modeled concepts
    • Update spreadsheet with changes including all defining relationships
  • Analyze concepts in clinical finding hierarchy
    • Create observable entity spreadsheet
    • Create dot diagram of current state
    • Perform review of dot diagram to identify potential duplicate, outdated, missing or inaccurately modeled concepts
    • Update spreadsheet with additions or changes to concepts, including all defining relationships
  • Identify missing concepts in other hierarchies (e.g., qualifier value, body structure) required to completely and accurately model observable entity and clinical finding concepts
  • Create explicit, narrative definitions for all concepts
7Create new and modify existing concepts in SNOMED
  • Submit request for changes through CRS system or via template worksheet
8Disseminate information about changes to SNOMED for concepts in the domain
  • (question)

LINKS TO SITE MATERIALS

WORK PAGES

DISCUSSION THREADS

GRAPHICS AND GLOSSARIES

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