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Mental Illness Guide: Care, Support, and Education
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How to keep a diary

Who should keep a diary?

It is equally important for the person with serious mental illness, as well as a family member, to each keep a diary of important information and events as they relate to the person with serious mental illness’s progress on a daily basis.

The person with serious mental illness

It is helpful for people with serious mental illness to keep a diary of medication use, appointment schedules, notes regarding thoughts to be shared with mental health professionals and other information related to their illness, since it is often difficult to remember important things that mental health professionals should be made aware of. 

A family member of the person with schizophrenia

It is also very helpful for family members of people with serious mental illness to keep a separate diary regarding their relative’s medication use, behavioral patterns and any observations they make regarding their relative’s progress to wellness.  Observations made by family members can sometimes be different than those of the person with schizophrenia, so these observations can be very useful in letting mental health professionals get a broader picture of the relative’s progress and needs.

Why should I keep a diary?

After some time has gone by, or during an emergency, it is hard to remember certain information that may be important for those trying to help you.

Your diary will:

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Help you remember events and issues you want to talk about with your mental health professionals and workers.

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Prepare you for meetings, phone calls or conferences about your treatment and your concerns.

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Remind you about certain things that you want to talk about with people involved in your treatment.

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Show that you are prepared for your appointments and what issues are important to you.

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Give the mental health professionals and workers the opportunity to check their records and find out who was involved in the situations you have brought to their attention.

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Help the mental health professionals and workers to keep more complete records.

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Be a quick reference in emergency situations and a reminder of things you want and need to do.

A sample weekly diary page has been included at the end of this article. 

What kinds of information go into a diary?

A diary will help you to remember important information, strange behaviors and thoughts to share and discuss with mental health workers and professionals and others involved with treating or caring for you.

You could use a notebook or loose-leaf paper.  Put your name, current address, phone number and birth date in the front of the diary to identify it as yours.  Update your diary on a regular basis so that you can share the information with different doctors, mental health workers and others involved in the treatment plan. 

On an ongoing basis, your diary can be used to write down strange behaviors, questions, or thoughts that you would like to share and talk about with mental health workers and professionals.  The information may also be shared with family members and others involved with treating or caring for you.  Most importantly, try to include the following information in your diary.

1.  List your medications

On a separate sheet in the front of your diary, list the mental health medications you currently take and the reason each medicine is being taken.  Include when and how you should take the medication and any special instructions, because some medicines react badly with each other if they are taken at the same time.  This will serve as a quick and handy reference.  It will help the mental health workers and professionals to be aware of medication issues.  Remember to update the information as needed.  This is especially important if your medications or treatment plan are changed in any way.

You will also want to list other medications you may be taking, such as over-the-counter products, vitamins and supplements, or herbal medications you take.  It is important to show this list to anyone who is prescribing medication for you.

Each day, record which medications you have taken.  Remember to include all prescription medications you are currently taking, as well as those purchased over the counter.  Include things such as heart medications, birth control pills, vitamins, aspirin and any other medications you are taking.  Be sure to share this information with your doctors and pharmacist.

Write down how you are feeling and any problems or possible side effects that happen.  Share this information with your treatment team members.  This will help them see how much you have improved or whether you need to change any of your medications.

2.  List all appointments/dates

Write down the dates of appointments with mental health professionals and members of your treatment team or any other appointment date that is of importance to you.  Enter dates for your medication refills and any laboratory tests that may be required by your treatment team.  You might want to include names and dates of programs you attend, including addresses and phone numbers, and all insurance-related information, including dates of claims.

You should also include results of phone calls, meetings and general information, including dates, such as:

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1/15/03 – 10:00 a.m. Spoke to nurse Jane Smith about side effects from my new medication, Thorazine

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1/16/03 - 9:00 a.m. ACCESS van will pick me up at home to keep my appointment with Dr. Lewis

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1/20/03 - 9:30 a.m. Ask mother to meet with me and the Community Advocate at the Mental Health Association to discuss my right to refuse medication

3.  Keep a checklist of warning signs that you are getting sick again

Include a checklist of warning signs that you may have experienced.  The list will help you to remember which signs to discuss with your mental health professionals and workers.

Write down your own warning signs and behaviors as you become aware of them, and list any new signs that you have not had before.  It will help you to be aware of these things when they happen so that you can get help and hopefully avoid getting sick.

There are often warning signs before a person with serious mental illness gets sick again.  These signs may be clear to the person experiencing the illness or to people familiar with the individual.

People who have serious mental illness may get sick many times.  There are many reasons why a person may get sick.  Here are some of the reasons.

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Sometimes the person with serious mental illness has stopped taking medication for a long enough period to get sick again.

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Sometimes the dosage of medication is not high enough to prevent the person from getting sick.

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Perhaps the person with serious mental illness is not receiving enough support, either at home or from community services.

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Perhaps the person is experiencing an unusual amount of stress.

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Perhaps the individual has recently experienced an event causing a lot of stress, for example, the death of a loved one, the loss of a job or moving to a new place to live.

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Maybe the individual is simply worn out, or needs more sleep.

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Maybe the person is using alcohol or street drugs.

Knowing your personal warning signs can help get you the attention you need quickly.  Sometimes getting sick again can be avoided or its harshness lessened.  If you know any of your individual signs, use this list to note them.  We have included different kinds of warning signs.  But remember, your signs may be different, so be sure to list them.  Ask for help from your family, friends, and treatment team members.  You may wish to share this list with them so the people around you can better help you handle your illness.

Remember, if you think that your situation is getting worse, you should contact the mental health professionals immediately.

Following is a list of some of the warning signs that a person is getting sick again.  Remember, your warning signs might be different, so be sure to list the ones that apply to you.  Each person must determine what the warning signs of getting sick again are for them.

Common warning signs that a person with schizophrenia is getting sick again:

  1. Hearing, seeing, tasting, smelling, or feeling things others do not.

  2. Problems with continuing to take your medication or staying on your treatment plan.

  3. Sudden changes in your ordinary plans, sleeping or eating patterns, or keeping clean habits. 

  4. Problems with physical or mental activities, including coordination, speaking, and remembering things.

  5. Having mood swings or behaving incorrectly, including thoughts or acts of violence toward yourself or others.

  6. Feeling down or unable to express your emotions, not being able to make decisions, or not wanting to be around people.

  7. Starting to abuse alcohol or drugs, spending time with people who use drugs and alcohol.

  8. Other feelings, emotions, or behaviors that happen to you before the symptoms begin again.

For more specific information see: How do I know if my relative is getting sick again?  Forewarning symptoms and Early warning symptoms of depression.

4.  Other information about you

In your diary, enter a record of your personal and medical history, including previous hospital admissions, names of hospitals, and dates that you were admitted and discharged.  If there is medication that you have taken in the past that is no longer being prescribed for you, list the names of the medications and the reasons they were discontinued from your treatment plan.

Separately record places you have lived in the past, including dates you lived there, addresses, and with whom you were living at the time.  Also record things people should generally know about you, such as, you will not attend drug programs, or you are not able to manage money, you are extremely afraid of the police, etc.  If you have a history of police involvement, include that information as well.

A diary for family members

When your family member is first starting medications for mental illness, or changes are being made in the medication schedule, your observations can be very useful.  This is also true following a relapse or crisis situation.

This information will be very useful to the treatment team in determining if the medications are working effectively for the person with schizophrenia. 

By having your observations, which may differ from those of the person taking the medication, the treatment team has a fuller picture.  If kept routinely, the diary can track your family member’s progress to wellness or help identify emerging relapse patterns.  Be sure to alert the treatment team to any disturbing changes.  If your family member reacts negatively to your record keeping, discuss the situation with the team.

Information that may be included in a family member’s diary of their relative’s illness

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Enter the appropriate dates and the medications taken by your relative each day.  If you are not sure, put in a question mark.  If the schedule was not followed, make a note.

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Record any behavior or dominating symptom that emerged that day, for example, “seemed extremely agitated” or “more withdrawn than usual.”  Be sure to include the positive as well.  Note any contributing factors that seem relevant.

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Write down any unusual complaints by your family member or observations that might be linked to medication side effects, for example, “complained of blurry vision” or “unusually thirsty.”

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 Jot down any treatment team appointments or other related activities, such as having a prescription refilled or having blood work done.

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Note any additional comments or questions you would like to have answered.  Bring them up at the next treatment appointment or call the appropriate team member.

A sample weekly diary page is included below.

WEEKLY DIARY      Dates__________ To__________

Sunday, ____________

Medications taken:________________________________________________________

Appointments:___________________________________________________________

Comments on how I feel today:  _____________________________________________

Monday, ____________

Medications taken:________________________________________________________

Appointments:___________________________________________________________

Comments on how I feel today:  _____________________________________________

Tuesday, ____________

Medications taken:________________________________________________________

Appointments:___________________________________________________________

Comments on how I feel today:  _____________________________________________

Wednesday, ____________

Medications taken:________________________________________________________

Appointments:___________________________________________________________

Comments on how I feel today:  _____________________________________________

Thursday, ____________

Medications taken:________________________________________________________

Appointments:___________________________________________________________

Comments on how I feel today:  _____________________________________________

Friday, ____________

Medications taken:________________________________________________________

Appointments:___________________________________________________________

Comments on how I feel today:  _____________________________________________

Saturday, ____________

Medications taken:________________________________________________________

Appointments:___________________________________________________________

Comments on how I feel today:  _____________________________________________

HOW A WEEKLY DIARY MIGHT LOOK

Dates: 5/4 To 5/10/2003

Sunday, May 4, 2003

Medications taken: Ativan, Risperdal

Appointments:

Comments on how I feel today: Woke up with a headache.  Happy Grandma is coming to stay for a few days.

Monday, May 5, 2003

Medications taken: Ativan, Risperdal 

Appointments: 10:00AM – Mary Reynolds, social worker, WPIC

Comments on how I feel today: Angry – Mom keeps talking to Grandma about my illness

Tuesday, May 6, 2003

Medications taken: Ativan, Risperdal

Appointments: 

Comments on how I feel today: Grandma keeps looking at me funny – she makes me nervous I started smoking again – 1-1/2 packs just today

Wednesday, May 7, 2003

Medications taken: Ativan, Risperdal

Appointments: 11:15AM – Joe Simone, Psychologist, WPIC

Comments on how I feel today: Told Joe about Grandma watching me.  He told me to call him if it doesn’t stop.  He told me to start taking 2 tablets of Ativan every day(1 mg each) instead of the 1 milligram I have been taking

Thursday, May 8, 2003

Medications taken: Ativan, Risperdal

Appointments: Grandma went back home today.  I hope she doesn’t keep talking about me back home.

Friday, May 9, 2003

Medications taken: Ativan, Risperdal

Appointments: 2:00PM – Dr. Jones, dentist, check-up, downtown  (Mom is going to take me)

Comments on how I feel today: I’m still smoking a lot, but I feel happier today

Saturday, May 10, 2003

Medications taken: Ativan, Risperdal

Appointments:

Comments on how I feel today: I took a long bike ride along the lake this morning – I feel really good when I get exercise