Mood Chart - Speedy Template
Mood Chart
Adapted from Sachs, G (1996): J. Clin. Psychopharm. 16:2(suppl 1) p47S
|Date |Exercise /Medication |Energy/Mood |Sleep |Irritability |Events/Notes/Observations |
| |(enter amounts, note dose changes) | | | | |
(circle for menses) |Exercise type
Walk
Swim
Run
Bike
Etc. |How long
|med 1
mg |med 2
mg |med 3
mg |med 4
mg |(can use two check marks:
worst and best for each day) |check one, or hours |0-3 scale |Questions to ask, connections you suspect; | | | | | | | | |Low energy/mood |nl |Agitation/
anxiety/ “up” |increased sleep |normal sleep |insomnia | |or significant events that might affect mood — interactions, successes, disappointments, anniversaries, illness, losses, etc. | | | | | | | | |cannot work |impaired |not impaired |normal mood |not impaired |impaired |cannot work | | | | | | | | | | | | | |+++ |++ |+ | |+ |++ |+++ | | | | | | |1 | | | | | | | | | | | | | | | | | | | |2 | | | | | | | | | | | | | | | | | | | |3 | | | | | | | | | | | | | | | | | | | |4 | | | | | | | | | | | | | | | | | | | |5 | | | | | | | | | | | | | | | | | | | |6 | | | | | | | | | | | | | | | | | | | |7 | | | | | | | | | | | | | | | | | | | |8 | | | | | | | | | | | | | | | | | | | |9 | | | | | | | | | | | | | | | | | | | |10 | | | | | | | | | | | | | | | | | | | |11 | | | | | | | | | | | | | | | | | | | |12 | | | | | | | | | | | | | | | | | | | |13 | | | | | | | | | | | | | | | | | | | |14 | | | | | | | | | | | | | | | | | | | |15 | | | | | | | | | | | | | | | | | | | |16 | | | | | | | | | | | | | | | | | | | |17 | | | | | | | | | | | | | | | | | | | |18 | | | | | | | | | | | | | | | | | | | |19 | | | | | | | | | | | | | | | | | | | |20 | | | | | | | | | | | | | | | | | | | |21 | | | | | | | | | | | | | | | | | | | |22 | | | | | | | | | | | | | | | | | | | |23 | | | | | | | | | | | | | | | | | | | |24 | | | | | | | | | | | | | | | | | | | |25 | | | | | | | | | | | | | | | | | | | |26 | | | | | | | | | | | | | | | | | | | |27 | | | | | | | | | | | | | | | | | | | |28 | | | | | | | | | | | | | | | | | | | |29 | | | | | | | | | | | | | | | | | | | |30 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |31 | | | | | | | | | | | | | | | | | |weight = | |
Adapted by Peter M. Brigham, MD 1997-8
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