Psychotropic medication monitoring

PSYCHOTROPIC MEDICATION MONITORING Medication: Name: Dose: Number of weeks of treatment: Scores: Use the score that best describes how you were on average for that week 0 = not present - I have not noticed this 1 = a little - it does not bother me 2 = a moderate amount - it bothers me 3 = a severe amount - it bothers me a lot Symptoms of depression: 0 : Feeling things are hopeless 0 : Feeling tired throughout the day 0 : Guilty feelings (like you let yourself or someone else down) 0 : Irritable mood 0 : Little interest or pleasure in things you usually like 0 : Low mood or feeling sad 0 : Moving or speaking very slowly 0 : Not able to complete tasks (school work or home) 0 : Trouble concentrating or focussing on a task 0 : Overeating (eating more than 3 meals per day) 0 : Poor appetite (eating less than 2 regular meals per day) 0 : Sleeping too much (more than 12 hours per day) 0 : Trouble falling or staying asleep 0 : Thoughts of harming yourself or that you are better off dead 0 : Avoidance behaviours 0 : Compulsive habits 0 : Feeling overly worried 0 : Panic attacks 0 : Worried about social situations 0 : Unusual unexplained body aches and pains Possible side effects: 0 : Increased appetite 0 : Weight gain 0 : Decreased appetite 0 : Constipation 0 : Diarrhoea 0 : Loss of libido 0 : Dry mouth 0 : Feeling agitated 0 : Feeling dizzy or lightheaded 0 : Nausea or vomiting 0 : Feeling overly excited or happy 0 : Feeling overly tired or sleepy 0 : Headaches 0 : Feeling restless 0 : Racing heart beat 0 : Seizures or fits 0 : Skin rash 0 : Stomach aches 0 : Strange dreams 0 : Twitching muscles or tremor 0 : Unusual bleeding or bruising 0 : Urinary problems Comments:

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Patient record sheet

PSYCHOTROPIC MEDICATION MONITORING Patient: Date: Medication: Name: Dose: Number of weeks of treatment: Scores: Use the score that best describes how you were on average for that week 0 = not present - I have not noticed this 1 = a little - it does not bother me 2 = a moderate amount - it bothers me 3 = a severe amount - it bothers me a lot Symptoms of depression: ___ Feeling things are hopeless ___ Feeling tired throughout the day ___ Guilty feelings (like you let yourself or someone else down) ___ Irritable mood ___ Little interest or pleasure in things you usually like ___ Low mood or feeling sad ___ Moving or speaking very slowly ___ Not able to complete tasks (school work or home) ___ Trouble concentrating or focussing on a task ___ Overeating (eating more than 3 meals per day) ___ Poor appetite (eating less than 2 regular meals per day) ___ Sleeping too much (more than 12 hours per day) ___ Trouble falling or staying asleep ___ Thoughts of harming yourself or that you are better off dead ___ Avoidance behaviours ___ Compulsive habits ___ Feeling overly worried ___ Panic attacks ___ Worried about social situations ___ Unusual unexplained body aches and pains Possible side effects: ___ Increased appetite ___ Weight gain ___ Decreased appetite ___ Constipation ___ Diarrhoea ___ Loss of libido ___ Dry mouth ___ Feeling agitated ___ Feeling dizzy or lightheaded ___ Nausea or vomiting ___ Feeling overly excited or happy ___ Feeling overly tired or sleepy ___ Headaches ___ Feeling restless ___ Racing heart beat ___ Seizures or fits ___ Skin rash ___ Stomach aches ___ Strange dreams ___ Twitching muscles or tremor ___ Unusual bleeding or bruising ___ Urinary problems Comments:

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