This is an adaptation of a mood chart used at the MGH Bipolar Clinic. Download this form (a Word document) and keep it handy for printing out for use with complex bipolar patients. (You can also print the instructions on this page by clicking the "print" icon on your browser right now.)
There is a line for each date of the month. In the columns for medications the total number of pills actually taken each day should be entered (not just the dose the patient is supposed to take - emphasize the importance of honesty here regarding missed doses, etc.).
The section on mood includes columns for rating anxiety and irritability, each 0-3. The columns for rating depression versus activation should be reviewed carefully with the patient; two check marks should be entered for each day representing the worst and best (or most depressed and most activated) the patient felt during that day. This is easy if the patient becomes euphoric when activated; it is less clear when the mania is dysphoric. In this case, tell the patient to pay attention to the degree of internal pressure and raciness, which is often but not always correlated with irritability. Rating +++ (depressed or activated) means extreme enough that the patient cannot work; ++ means some impairment but not enough to prevent working; + means noticeable but without impairment.
The previous night's sleep is charted by noting hypersomnia, normal sleep, or insomnia. There are columns for other symptoms (e.g., cognitive changes, hallucinations, paranoid thoughts) and comments (most useful for noting events that might influence mood). Once a month, weight can be noted. The dates of a female patient's menses are circled.
If the importance of the charting is emphasized to the patient, s/he will usually do it conscientiously. After the process becomes familiar, it takes only a minute or two each evening. The patient should bring the most recent mood chart(s) in at every visit. Completed forms can be filed in the patient's mental health chart. It is useful to transform the depression/activation columns into a graph, by connecting the "worst" check marks together, and the "best" check marks together, so there are two graphs, the left-most one representing degree of depression, and the right-most one representing degree of activation. In this way frequency and amplitude of cycling (along with the presence of mixed states) can in many cases be seen at a glance. By reference to the other columns, changes in meds, dosages, menstrual cycling, sleep patterns, and life events can be correlated with changes in mood and cycling.
Download mood chart