Mrs. Y has bipolar disorder. Historically, she has responded well to lithium and her mood state has been stable for almost a year. About two months ago, she became extremely sad and withdrawn, expressed the wish that she were dead and stopped eating. She was transferred to a psychiatric hospital for evaluation and treatment. Since her return to the nursing facility three weeks ago, her mood and appetite have improved while on a new lithium dose and an additional antidepressant drug. She is back to her old self of 90 days ago. Code 0 if no change, 1 if improved, or 2 if deteriorated as compared to status of 90 days ago. E3. Change in Mood (90 days ago) Intent: To document change in the resident's mood as compared to his or her status of 90 days ago (or since last assessment,if less than 90 days ago). This item asks for a snapshot of the resident's status in the current observation period as compared to 90 days ago (i.e., a comparison of 2 points in time). If the resident is a new admission to the facility, this item includes changes during the period prior to admission. Definition: Change in Mood -- Refers to status of any of the symptoms (new onset, improvement, worsening) described in Item E1 (verbal expressions of distress, sleep cycle issues, sad apathetic, anxious appearance, loss of interest or other signs) and Item E2 (mood persistence). Source: Example and information from the RAI User's Manual, chapter 3.