There are a number of charts for doing this. With one method, the patient makes a time line across the page and a vertical line on the left side of the time line with a range from -5 to +5:
- -5 to -1 indicate the depressive phase. Minus five is the most severe depressive state and requires hospitalization. At this score, the patient's psychomotor responses are almost entirely negative. The patient is unable to function, has no appetite, and can barely get out of bed. As the scale moves up to zero, the depressive state lessens, so that -1 indicates a subdued mood with slightly less energy than normal.
- Zero is normal.
- +1 to +5 indicate the manic phase. For example, +1 indicates a slightly more active and energetic state than normal. Plus five is the most severe manic state, where the patient is incapable of slowing down, experiences impaired thinking and judgment, and sleeps at least 2 hours less than normal.
To fill out the graph, the patient takes the following steps:
- Using a diary, the patient describes each day, the mood, and its effect on physical activities.
- Using this information, the patient makes a mark on the scale that roughly reflects each day's mood and its effect on function. The patient then connects the mark with that of the previous day's state.
- The patient also describes any significant emotional or physical events, menstruation, medications, and dosages taken, or any factor that may be relevant in influencing mood or activities.
- After several months, the therapist and patient may be able to detect a pattern and possibly identify triggers of bipolar disorder episodes.
- Such information helps the patients to make adjustments that might reduce the severity of mood swings. For example, if a predictor for either manic or depressive episodes is insomnia, the doctor might use sleep-inducing methods or medications that might reduce the severity of the emerging mania.
Family Therapy
It is very important that partners, family members, or both be involved in therapy. CBT can help them learn how to accept the condition, the need for medications, and how to protect themselves and the patient financially during manic episodes. In fact, one study indicated that when a spouse of a patient learned ways of coping with the illness, the partner's chances of sticking to a prescribed treatment improved.
Supporting the Patient. Recommendations for supporting the patient include:
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