Month/Weekday 3/8

At the end of each

week, rate your mood
with the two scales on

Start lithium
the back. Then shade
the boxes up to your
total score for the each
scale (0-27). Use one
color for high energy
20–27
and another for low.
15–19

10–14
Write the month/day
of your rating in the
5–9
top box.
0–4

0–4
In the Life Changes,
column, include major
5–9
events, stresses, and –
10–14 importantly – when
15–19 you started or stopped
a therapeutic routine
20–27
(such as therapy,
exercise, or diet).

Start walking routine

In the example at right,
high energy was rated
14 and low energy
rated 2 on March 8th.

Life Changes
 Several days

Several days
More than

More than
every day

every day
Not at all

Not at all
half the

half the
Nearly

Nearly
days

days
Over the past week, how often have you been Over the past week, how often have you been
bothered by any of the following... bothered by any of the following...

Feeling unusually good; or having emotions that

Little interest or pleasure in doing things 0 1 2 3 0 1 2 3
swing rapidly from one to another
Hyped up, energized, physically restless, agitated,
Feeling down, depressed, or hopeless 0 1 2 3 0 1 2 3
or wired with anxious energy

Trouble falling or staying asleep, or sleeping too

0 1 2 3 Irritable, impatient, or argumentative 0 1 2 3
much

Feeling more confident, sure of your ideas, or self

Feeling tired or having little energy 0 1 2 3 important; or being demanding, pushy, or overly 0 1 2 3
stubborn
Sleeping less than usual but still able to do a lot
Poor appetite or overeating 0 1 2 3 during the day; or irregular sleep patterns that 0 1 2 3
swing from sleeping excessively to up all night
Feeling bad about yourself − or that you are a More talkative than usual, interrupting others, or
0 1 2 3 0 1 2 3
failure or have let yourself or your family down speech that is rapid, loud, or pressured

Trouble concentrating on things, such as reading Easily distracted, racing thoughts, or thoughts that
0 1 2 3 0 1 2 3
the newspaper or watching television jump from topic to topic

Moving or speaking so slowly that other people More active, social, or sexual than usual; doing
could have noticed? Or the opposite − being so more projects or making more plans than usual; or
0 1 2 3 0 1 2 3
fidgety or restless that you have been moving shifting tasks frequently, or driven to do something
around a lot more than usual but you don’t know what to do
Acting on impulse or doing things that others might
think are excessive, foolish, or risky. For example:
Thoughts that you would be better off dead or overspending, sexual indiscretions, sudden travel,
0 1 2 3 0 1 2 3
of hurting yourself in some way reckless driving, suddenly starting or ending
relationships or jobs, breaking things, violence,
dangerous behavior, binge eating, addictions.

Total score (0-27): Total score (0-27):