Med Logs versus Signs and Symptoms Logs versus Mood Logs

When trying to assist a family member to receive good treatment or good care from a psychiatrist/treatment team, one of the most important things is to know and understand is what is happening and what isn't happening due to psychotropic medications, stress or a sign/symptom.

There is a line in the NAMI Michigan Families in Action class that says:

The signs and symptoms of a mental illness are often the same as the side effects of medications which are also the same as the signs and symptoms of stress.

It is important to know what started when. Which came first? Is what is happening a sign that a person is totally stressed out?  Is it a sign that a medication is too strong? Or is it a symptom that someone needs medication to help them get the quality of life they desire?

If you don't keep a medication (med) log, you won't ever know what you don't know. If you don't keep some type of a sign and symptom log, once again you won't ever know what you don't know. If you don't keep some kind of a mood log, the same thing is true.

Many people feel that the person who is taking the medications should be keeping the med log. That person can keep a med log also, but it can be helpful to have this information from a family member's (or friend's) perspective as well. Many people feel the person having the mood swings, or other signs and symptoms, should be keeping the logs for those items as well. The same thing about a different perspective is true with each of these logs.

There are times when a person who happens to have a mental illness/psychiatric diagnosis is so wrapped up in feeling unwell, that they may miss things that could or should be added to a medication log, a signs and symptoms log or a mood log. Yes, as a parent or friend you can say, “You should add that to your med log or your sign and symptoms log;” and that might or might not work. What does work is when there are multiple observations that are recorded and can be reviewed as a whole.

Some people keep the logs they have separate. There are advantages to having the logs separate, just as there are advantages to keeping them all together. It is helpful to organize logs by noticeable colors, or to keep them on a computer or a phone where they are readily available.  A spiral notebook can work, a small pocket sized notebook that you can carry with one or a three ring binder that has different sections can work also. Some people carry a small notebook and later transfer the items into a big control log. The logs are not something that you always needs to keep daily, but you do want to use them when behaviors change, when a new medication is started, when a medication is stopped or during times of extra stress. When you use a phone or a computer to keep the various logs, back-up is necessary.

When a medication is started or stopped it can be very helpful to have a 6 to 8 week record of what happened, physically, emotionally and mentally. In a medication log it is helpful to have a list of what medications a person has been on that have worked, and a list of those that haven't worked. Some families keep in the medication log records of other family members’ psychotropic meds that have and haven't worked, as they feel that what works for one may work for another, but more importantly, what doesn't work for some, may also not work for others. In a time of crisis, try to go with the best knowledge or the best informed choice available.

When new symptoms start it is incredibly helpful to know if stress exacerbated the symptom or if it occurred without a cause or reason. The same is true for moods. If a mood changes for no cause or reason, then you need to keep a log about it so you can contact and inform the treatment team.

Logs such as these can help you discern whether there is a problem with Seasonal Affective Disorder (SAD) or another problem that may otherwise have been missed. Over the course of a year or two you may notice seasonal or yearly cycles.

One personal example from the life of my family was a symptom of shoulder shrugs that my granddaughter said she couldn't stop. The family doctor hadn't noticed the shoulder shrugs or realized what they were. When I saw the movements, I said, “Call the psychiatrist. Ask if J can safely stop the medication.” It was the same kind of involuntary movements that happen with Tardive Dyskenesia. I had seen them before, but they hadn't been noticed before with J. Things like that shouldn't get missed. If a sign and symptom log had been being maintained at that time, it would have been mentioned, less time would have gone by with J being miserable, and the chance of permanent damage could have been reduced.

Basic things to keep track of:

When a med was started, how it worked and when it was stopped. What problems were there? Was it continually taken as prescribed? When did a mood start and stop, is it a cyclical occurrence? How often does the cycle occur? When did the sign or symptom start? When did it end?I Is it a positive or negative symptom? Did medications help? Did things start happening during a time of stress (new job, final exams, etc.)?

These things should help you get started on what to log. There is more information available on different types of logs on the internet. Click here for one example.