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Mood Chart 3

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Mood Chart 3
Mood Chart 3
Mood Chart
Adapted from Sachs, G (1996): J. Clin. Psychopharm. 16:2(suppl 1) p47S
Date
Exercise /Medication
(enter amounts, note dose changes)
Energy/Mood
Sleep
Irritability
Events/Notes/Observations
(circle for
menses)
Exercise
type
Walk
Swim
Run
Bike
Etc.
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”
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
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7
8
9
10
11
12
13
14
15
16
17
18
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Mood Chart 3
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