Abbreviated Mood Diary (For Patients)

10/5/06
12:49 PM
Page 1
Bipolar Disorder
ABBREVIATED MOOD DIARY
Abbr Mood Dairy 210x100.qxd
10/5/06
12:49 PM
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PERSONAL DETAILS
PERSONAL DETAILS
Name:
Telephone number:
Postal address:
Dr name:
Telephone number:
Person to contact in an emergency

Name:
Telephone number:
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12:49 PM
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HOW TO USE YOUR DAILY MOOD DIARY?
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
HOW TO USE YOUR MOOD DIARY
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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12:49 PM
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MONTH: August
YEAR: 2006
1
DAY
Mood rating
Down/depression
Events or
comments
Xyz 25mg twice daily

Abc 10mg once daily
Doctors comments:
5
X
Medication side-effects
Medication
Medication
Medication
4
3
2
1
0
-1
-2
-3
-4
-5
Worst ever / Slegste ooit

Extremely severe / Extreem erg
Very severe / Baie erg
Severe / Erg
Mildly / Gering
NORMAL
Mildly / Gering
Severe / Erg
Office
party
MOOD DIARY - EXAMPLE
Mood rating
Elevated/mania
Psychiatry
appoint.
s
seou
Nau
4 August, include Abc 10mg once daily
X
X
X
X
10/5/06
12:49 PM
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EXAMPLE
MOOD DIARY - EXAMPLE
Next appointment date:
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
Medication
Medication
Doctors comments:

Severe / Erg
Mildly / Gering
NORMAL
Mildly / Gering
Severe / Erg
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
Medication
Medication
Doctors comments:

Severe / Erg
Mildly / Gering
NORMAL
Mildly / Gering
Severe / Erg
10/5/06
12:50 PM
Page 9
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
Medication
Medication
Doctors comments:

Severe / Erg
Mildly / Gering
NORMAL
Mildly / Gering
Severe / Erg
10/5/06
12:50 PM
Page 11
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
Medication
Medication
10
Doctors comments:

Severe / Erg
Mildly / Gering
NORMAL
Mildly / Gering
Severe / Erg
10/5/06
12:50 PM
Page 13
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
Medication
Medication
12
Doctors comments:

Severe / Erg
Mildly / Gering
NORMAL
Mildly / Gering
Severe / Erg
10/5/06
12:50 PM
Page 15
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
Medication
Medication
14
Doctors comments:

Severe / Erg
Mildly / Gering
NORMAL
Mildly / Gering
Severe / Erg
10/5/06
12:50 PM
Page 17
MOOD DIARY
Time:
15
10/5/06
MONTH:
12:50 PM
Page 18
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
Medication
Medication
16
Doctors comments:

Severe / Erg
Mildly / Gering
NORMAL
Mildly / Gering
Severe / Erg
10/5/06
12:50 PM
Page 19
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
Medication
Medication
18
Doctors comments:

Severe / Erg
Mildly / Gering
NORMAL
Mildly / Gering
Severe / Erg
10/5/06
12:50 PM
Page 21
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
Medication
Medication
20
Doctors comments:

Severe / Erg
Mildly / Gering
NORMAL
Mildly / Gering
Severe / Erg
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
Medication
Medication
22
Doctors comments:

Severe / Erg
Mildly / Gering
NORMAL
Mildly / Gering
Severe / Erg
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
Medication
Medication
24
Doctors comments:

Severe / Erg
Mildly / Gering
NORMAL
Mildly / Gering
Severe / Erg
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
Medication
Medication
26
Doctors comments:

Severe / Erg
Mildly / Gering
NORMAL
Mildly / Gering
Severe / Erg
10/5/06
12:50 PM
Page 29
MOOD DIARY
Time:
27
10/5/06
12:50 PM
Page 30
SUPPORT GROUPS
BIPOLAR SUPPORT GROUP
South African Anxiety and Depression Support Group

Steps Call Centre Programme
Contact number: 08600 STEPS or 08600 78377
28
10/5/06
12:50 PM
Page 31
NOTES
NOTES
29
10/5/06
12:50 PM
Page 32
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

Abbreviated Mood Diary (For Patients)

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10/5/06

ABBREVIATED MOOD DIARY

Abbr Mood Dairy 210x100.qxd

Abbr Mood Dairy 210x100.qxd

Person to contact in an emergency

Abbr Mood Dairy 210x100.qxd

HOW TO USE YOUR DAILY MOOD DIARY?

HOW TO USE YOUR MOOD DIARY

Xyz 25mg twice daily

Worst ever / Slegste ooit

MOOD DIARY - EXAMPLE

Abbr Mood Dairy 210x100.qxd

4 August, include Abc 10mg once daily

Abbr Mood Dairy 210x100.qxd

MOOD DIARY - EXAMPLE

Next appointment date:

Abbr Mood Dairy 210x100.qxd

Worst ever / Slegste ooit

Abbr Mood Dairy 210x100.qxd

Next appointment date:

Abbr Mood Dairy 210x100.qxd

Worst ever / Slegste ooit

Abbr Mood Dairy 210x100.qxd

Next appointment date:

Abbr Mood Dairy 210x100.qxd

Worst ever / Slegste ooit

Abbr Mood Dairy 210x100.qxd

Next appointment date:

Abbr Mood Dairy 210x100.qxd

Worst ever / Slegste ooit

Abbr Mood Dairy 210x100.qxd

Next appointment date:

Abbr Mood Dairy 210x100.qxd

Worst ever / Slegste ooit

Abbr Mood Dairy 210x100.qxd

Next appointment date:

Abbr Mood Dairy 210x100.qxd

Worst ever / Slegste ooit

Abbr Mood Dairy 210x100.qxd

Next appointment date:

Abbr Mood Dairy 210x100.qxd

Worst ever / Slegste ooit

Abbr Mood Dairy 210x100.qxd

Next appointment date:

Abbr Mood Dairy 210x100.qxd

Worst ever / Slegste ooit

Abbr Mood Dairy 210x100.qxd

Next appointment date:

Abbr Mood Dairy 210x100.qxd

Worst ever / Slegste ooit

Abbr Mood Dairy 210x100.qxd

Next appointment date:

Abbr Mood Dairy 210x100.qxd

Worst ever / Slegste ooit

Abbr Mood Dairy 210x100.qxd

Next appointment date:

Abbr Mood Dairy 210x100.qxd

Worst ever / Slegste ooit

Abbr Mood Dairy 210x100.qxd

Next appointment date:

Abbr Mood Dairy 210x100.qxd

Worst ever / Slegste ooit

Abbr Mood Dairy 210x100.qxd