Elation/elated mood

Specialties > Mental health

Differential Diagnosis Schema 🧠

Primary Psychiatric Disorders

Bipolar affective disorder (manic episode): Elevated mood, increased energy, grandiosity, reduced need for sleep
Cyclothymia: Persistent instability of mood, with periods of mild elation and mild depression
Schizoaffective disorder: Features of both schizophrenia and mood disorder (e.g., mania with psychotic features)
Major depressive disorder with mixed features: Predominantly depressive symptoms with occasional episodes of elevated mood
Personality disorders (e.g., borderline, histrionic): May present with episodic elation linked to interpersonal stressors

Substance-Related Causes

Substance intoxication (e.g., amphetamines, cocaine): Elevated mood, increased energy, often with risk-taking behaviors
Alcohol use: Initially may cause disinhibition and elation, though often followed by depressive symptoms
Medication-induced (e.g., corticosteroids, antidepressants): Can cause mood elevation as a side effect, particularly in susceptible individuals
Withdrawal states (e.g., benzodiazepines, alcohol): Paradoxical elevation of mood during early withdrawal

Organic Causes

Hyperthyroidism: Elevated mood, increased energy, weight loss, heat intolerance
Cushing’s syndrome: Elevated mood, weight gain, central obesity, striae, hypertension
Neurodegenerative disorders (e.g., Huntington’s disease): Mood changes including elation, alongside motor symptoms
Frontal lobe tumors or head injury: Disinhibition and mood elevation, with possible cognitive changes
Delirium: Fluctuating mood, which may include periods of elation, often with confusion and disorientation
Vitamin B12 deficiency: Mood changes including elation, with possible neurological signs

Key Points in History 🥼

Onset and Course

Acute vs chronic: Acute onset may suggest substance intoxication or delirium, while chronic or episodic elation is more typical of bipolar disorder
Triggers: Recent life events, stressors, or substance use may precipitate episodes of elation
Progression: Rapid escalation of symptoms may indicate a manic episode, while gradual onset suggests an organic cause

Associated Symptoms

Sleep patterns: Reduced need for sleep is common in mania, while insomnia may accompany other causes
Energy levels: Increased energy and activity levels are key features of mania or substance-related elation
Risk-taking behaviors: Impulsivity, spending sprees, or increased libido suggest a manic or hypomanic episode
Psychotic symptoms: Hallucinations or delusions may accompany mania or schizoaffective disorder
Physical symptoms: Weight loss, tremor, or heat intolerance may point to hyperthyroidism
Cognitive changes: Disinhibition, poor concentration, or confusion may suggest organic causes
Mood variability: Rapid mood swings may indicate a mixed affective state or cyclothymia

Background

Past psychiatric history: Previous episodes of mood disorder, particularly bipolar affective disorder
Family history: Family history of mood disorders or substance abuse
Substance use history: Recent or past use of recreational drugs, alcohol, or prescribed medications
Medical history: History of endocrine disorders (e.g., hyperthyroidism), head trauma, or neurodegenerative disease
Social history: Consider psychosocial stressors, support systems, and impact on daily functioning

Possible Investigations 🌡️

Laboratory Tests

Thyroid function tests: To assess for hyperthyroidism
Cortisol levels: If Cushing’s syndrome is suspected
Toxicology screen: To detect substance use, particularly stimulants like amphetamines or cocaine
Vitamin B12 and folate levels: To rule out deficiency states
Electrolytes and renal function: To assess for metabolic causes
Full blood count: To check for anemia or infection that could contribute to mood changes

Imaging and Specialist Tests

MRI brain: If there is suspicion of a structural lesion, such as a tumor or frontal lobe injury
EEG: If there is concern about seizure activity contributing to mood changes
Dexamethasone suppression test: If Cushing’s syndrome is suspected
Neuropsychological testing: To assess cognitive function, particularly if an organic cause is suspected
Psychiatric assessment: Comprehensive mental health evaluation to assess for primary psychiatric disorders

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