Makindo Medical Notes Comprehensive Medical Encyclopedia | Education for Healthcare Professionals

Makindo Medical Notes "One small step for man, one large step for Makindo"
Download all this content in the Apps now Android App and Apple iPhone/Pad App

MEDICAL DISCLAIMER: The contents are under continuing development and improvements and despite all efforts may contain errors of omission or fact. This is not to be used for the assessment, diagnosis, or management of patients. It should not be regarded as medical advice by healthcare workers or laypeople. It is for educational purposes only. Please adhere to your local protocols. Use the BNF for drug information. If you are unwell please seek urgent healthcare advice. If you do not accept this then please do not use the website. Makindo Ltd.

Elation/elated mood

About

Anaesthetics and Critical Care

Obstetrics Gynaecology

Oncology

Ophthalmology

Oral Medicine and Dentistry

Statistics and Research

Stroke

Surgery

Toxicology

Trauma and Orthopaedics

Twitter

Urology

😀 Elated mood (or “elation”) describes a persistently elevated, expansive, or unusually happy state of mood, disproportionate to circumstances. While mild elation may be normal (e.g., after success), sustained or inappropriate elation often indicates underlying psychiatric or organic illness.

📊 About

Elated mood is a mood abnormality seen in psychiatry, often in the context of bipolar affective disorder (mania/hypomania).
It may also arise in neurological conditions (e.g., temporal lobe epilepsy, frontal lobe tumours), substance use, or as a medication side effect (e.g., corticosteroids).
Important to distinguish between normal joy and pathological elation which affects function, judgement, or risk-taking.

🧬 Basic Physiology & Pathophysiology

Mood is regulated by limbic and prefrontal circuits, with key neurotransmitters: dopamine, serotonin, and noradrenaline.
Excess dopaminergic activity (especially in mesolimbic pathways) is linked to mania and pathological elation.
Neuroendocrine links: dysregulated cortisol and circadian rhythm disturbances are often seen in mania.

🩺 Clinical Features of Elated Mood

😃 Persistently elevated or expansive mood.
⚡ Increased energy and overactivity.
🗣️ Pressured speech, flight of ideas, distractibility.
💡 Inflated self-esteem or grandiosity.
💸 Risk-taking behaviours (spending, sex, gambling).
😴 Reduced need for sleep without fatigue.

🔍 Causes of Elated Mood

Category	Examples	Clues
🧠 Psychiatric	Bipolar affective disorder (mania/hypomania), cyclothymia	Episodic, family history, alternating with depression
💊 Substance/Medication	Stimulants (cocaine, amphetamines), steroids, levodopa	Temporal link to drug initiation or misuse
🧲 Neurological	Temporal lobe epilepsy, multiple sclerosis, frontal lobe tumours	Focal neurological signs, seizures, personality change
⚕️ Medical	Thyrotoxicosis, Cushing’s syndrome	Systemic symptoms (weight loss, tremor, hypertension)
🙂 Normal variants	Post-success, spiritual experiences, hypomanic personality traits	Brief, proportional, no functional impairment

🧪 Assessment

📚 History: Duration, impact on function, risk-taking, family history of bipolar disorder.
🧠 Mental State Exam: Mood congruence, thought form (flight of ideas), psychotic symptoms, insight.
🩸 Bloods: TFTs, cortisol, drug screen, FBC/U&E/LFTs.
🧲 Imaging: Brain MRI if atypical/late onset.

🛠️ Management

🏥 Mania/Hypomania: Mood stabilisers (lithium, valproate, carbamazepine), antipsychotics (olanzapine, risperidone).
💊 Substance-induced: Stop offending drug, supportive care, addiction services referral.
⚕️ Medical/neurological causes: Treat underlying disorder (e.g., antithyroid drugs, AEDs).
🗣️ Psychoeducation: Importance of sleep hygiene, relapse warning signs, adherence to meds.
👨‍👩‍👧 MDT involvement: Psychiatry, GP, social support, crisis planning.

🚩 Red Flags

Dangerous risk-taking (e.g., reckless driving, financial ruin).
Psychotic features (grandiose or religious delusions, auditory hallucinations).
Refusal of food/fluids, exhaustion from insomnia.
Suicidal risk in “mixed affective states” (elation with depressive symptoms).

🧑‍⚕️ Case Scenarios — Mania and Mimics

Case 1 (Acute mania): A 21-year-old student presents after five nights with virtually no sleep. He describes feeling “on top of the world,” has rapid, pressured speech, and has been spending excessively on clothes and electronics. His mood is elevated and he shows poor insight into his behaviour. The picture is typical of acute mania in bipolar disorder. He requires urgent psychiatric referral for risk assessment, initiation of antipsychotic therapy, and support from the crisis team to stabilise mood and prevent financial and social harm.

Case 2 (Steroid-induced mania): A 40-year-old woman on prolonged high-dose corticosteroids for autoimmune disease suddenly becomes euphoric, energetic, and grandiose, with markedly reduced sleep. The abrupt onset in the context of steroid therapy suggests steroid-induced mania. Management includes careful review and reduction of steroid dose where possible, psychiatric input, and the short-term use of an antipsychotic or mood stabiliser to manage acute symptoms, while balancing the risks of disease flare against psychiatric side effects.

Case 3 (Frontal lobe tumour presenting with behavioural change): A 65-year-old man develops new-onset elation, disinhibition, and impaired judgement over several weeks. On neurological examination, frontal release signs are elicited. While the behaviour resembles mania, the late onset and neurological findings point strongly to an organic cause such as a frontal lobe tumour. He requires urgent neuroimaging, followed by referral to neurology and oncology for diagnosis and management, illustrating the importance of excluding structural brain disease in new psychiatric presentations in older adults.

✅ Conclusion

😀 Elated mood may be benign or pathological. 🌟 Always consider psychiatric (bipolar), organic, or drug-related causes. ⚠️ Assess risk, protect the patient and others, and treat underlying pathology with specialist input.

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

Edit