Monthly Mood Chart
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1MONTH___________
YEAR________
Client Name
_____________________________
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Frequency
Activity
Record Hours of Nighttime Sleep
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DYSPHORIC MANIA (X) IF YES
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M
SEVERE
A
Essentially incapacitated or HOSPITALIZED
N
HIGH MODERATE
GREAT difficulty with goal-oriented activity
I
LOW MODERATE
SOME difficulty with goal-oriented activity
A
MILD
More energized & productive; usual routine not affected much
STABLE
MILD
Usual routine not affected much
D
E
P
LOW MODERATE
Functioning with SOME effort
R
E
S
HIGH MODERATE
Functioning with GREAT effort
S
I
O
SEVERE
Essentially incapacitated or HOSPITALIZED
N
0= Most depressed ever
50= Balanced 100= Most
MOOD (0-100)
manic (activated) ever
NUMBER OF MOOD CHANGES/ DAY
MENSTRUAL PERIOD (X) IF YES
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Parent category: Medical