Professional Documents
Culture Documents
12:49 PM
Page 1
Bipolar Disorder
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PERSONAL DETAILS
PERSONAL DETAILS
Name:
Telephone number:
Postal address:
Dr name:
Telephone number:
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Step 1
Fill in the month
Step 2
List the medications you have been prescribed indicating the strengths
Step 3
On a daily basis, note the number of tablets taken for each medication
Step 4
On a daily basis, rate your mood on a scale -5 to 0 (down/depression), or 0 to 5 (up/ mania)
Step 5
On a daily basis, list any significant events that may have contributed to your mood
A mood diary should help you and your doctor monitor your condition, by tracking your moods, the medicines that you are taking, any
medication side-effects that you may be experiencing and important events that happen from time to time. Furthermore, patterns may
emerge, helping your doctor to adjust your medication to better control the bipolar disorder.
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MONTH: August
YEAR: 2006
1
DAY
Mood rating
Down/depression
Events or
comments
Doctors comments:
5
X
Medication side-effects
Medication
Medication
Medication
4
3
2
1
0
-1
-2
-3
-4
-5
Office
party
Mood rating
Elevated/mania
Psychiatry
appoint.
s
seou
Nau
X
X
X
X
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EXAMPLE
28 August 2006
Time:
11:30
10/5/06
MONTH:
12:49 PM
Page 6
YEAR:
DAY
MOOD DIARY
Mood rating
Elevated/mania
Mood rating
Down/depression
5
4
3
2
1
0
-1
-2
-3
-4
-5
Events or
comments
Medication side-effects
Medication
Medication
Medication
Doctors comments:
10/5/06
12:49 PM
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MOOD DIARY
Time:
10/5/06
MONTH:
12:50 PM
Page 8
YEAR:
DAY
MOOD DIARY
Mood rating
Elevated/mania
Mood rating
Down/depression
5
4
3
2
1
0
-1
-2
-3
-4
-5
Events or
comments
Medication side-effects
Medication
Medication
Medication
Doctors comments:
10/5/06
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MOOD DIARY
Time:
10/5/06
MONTH:
12:50 PM
Page 10
YEAR:
DAY
MOOD DIARY
Mood rating
Elevated/mania
Mood rating
Down/depression
5
4
3
2
1
0
-1
-2
-3
-4
-5
Events or
comments
Medication side-effects
Medication
Medication
Medication
Doctors comments:
10/5/06
12:50 PM
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MOOD DIARY
Time:
10/5/06
MONTH:
12:50 PM
Page 12
YEAR:
DAY
MOOD DIARY
Mood rating
Elevated/mania
Mood rating
Down/depression
5
4
3
2
1
0
-1
-2
-3
-4
-5
Events or
comments
Medication side-effects
Medication
Medication
Medication
10
Doctors comments:
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MOOD DIARY
Time:
11
10/5/06
MONTH:
12:50 PM
Page 14
YEAR:
DAY
MOOD DIARY
Mood rating
Elevated/mania
Mood rating
Down/depression
5
4
3
2
1
0
-1
-2
-3
-4
-5
Events or
comments
Medication side-effects
Medication
Medication
Medication
12
Doctors comments:
10/5/06
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MOOD DIARY
Time:
13
10/5/06
MONTH:
12:50 PM
Page 16
YEAR:
DAY
MOOD DIARY
Mood rating
Elevated/mania
Mood rating
Down/depression
5
4
3
2
1
0
-1
-2
-3
-4
-5
Events or
comments
Medication side-effects
Medication
Medication
Medication
14
Doctors comments:
10/5/06
12:50 PM
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MOOD DIARY
Time:
15
10/5/06
MONTH:
12:50 PM
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YEAR:
DAY
MOOD DIARY
Mood rating
Elevated/mania
Mood rating
Down/depression
5
4
3
2
1
0
-1
-2
-3
-4
-5
Events or
comments
Medication side-effects
Medication
Medication
Medication
16
Doctors comments:
10/5/06
12:50 PM
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MOOD DIARY
Time:
17
10/5/06
MONTH:
12:50 PM
Page 20
YEAR:
DAY
MOOD DIARY
Mood rating
Elevated/mania
Mood rating
Down/depression
5
4
3
2
1
0
-1
-2
-3
-4
-5
Events or
comments
Medication side-effects
Medication
Medication
Medication
18
Doctors comments:
10/5/06
12:50 PM
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MOOD DIARY
Time:
19
10/5/06
MONTH:
12:50 PM
Page 22
YEAR:
DAY
MOOD DIARY
Mood rating
Elevated/mania
Mood rating
Down/depression
5
4
3
2
1
0
-1
-2
-3
-4
-5
Events or
comments
Medication side-effects
Medication
Medication
Medication
20
Doctors comments:
10/5/06
12:50 PM
Page 23
MOOD DIARY
Time:
21
10/5/06
MONTH:
12:50 PM
Page 24
YEAR:
DAY
MOOD DIARY
Mood rating
Elevated/mania
Mood rating
Down/depression
5
4
3
2
1
0
-1
-2
-3
-4
-5
Events or
comments
Medication side-effects
Medication
Medication
Medication
22
Doctors comments:
10/5/06
12:50 PM
Page 25
MOOD DIARY
Time:
23
10/5/06
MONTH:
12:50 PM
Page 26
YEAR:
DAY
MOOD DIARY
Mood rating
Elevated/mania
Mood rating
Down/depression
5
4
3
2
1
0
-1
-2
-3
-4
-5
Events or
comments
Medication side-effects
Medication
Medication
Medication
24
Doctors comments:
10/5/06
12:50 PM
Page 27
MOOD DIARY
Time:
25
10/5/06
MONTH:
12:50 PM
Page 28
YEAR:
DAY
MOOD DIARY
Mood rating
Elevated/mania
Mood rating
Down/depression
5
4
3
2
1
0
-1
-2
-3
-4
-5
Events or
comments
Medication side-effects
Medication
Medication
Medication
26
Doctors comments:
10/5/06
12:50 PM
Page 29
MOOD DIARY
Time:
27
10/5/06
12:50 PM
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SUPPORT GROUPS
28
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NOTES
NOTES
29
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Brought to you by
Psychiatry
GlaxoSmithKline South Africa (Pty) Ltd., (Co. reg. no. 1948/030135/07), 57 Sloane Street, Bryanston, 2021.
Tel.+27 11 745 6000. Fax. +27 11 745 7000.
08.06