Figure 1. Life-chart graph of phases in illness evolution and treatment response in woman with bipolar II disorder. Chart illustrates illness progression, probable antidepressant-induced cycle acceleration, lack of response to lithium in rapid cycler, response to combination therapy of lithium and carbamazepine, development of loss of responsiveness to this treatment regimen via tolerance, and eventual re-response to carbamazepine after time off this medication.

Figure 2. Schema for graphing course of affective illness. This schema outlines retrospective and prospective life-chart tools and methods for recording episodes (including ultra-rapid and ultradian cycling) and for entering and tracking medications, comorbidities, and significant life events, with optional impact ratings.

Figure 3. Sample NIMH-LCM^TM 5-year retrospective completed life chart. Abbreviated example of 5-year retrospective patient LCM^TM depicting past episodes at 3 levels of severity, dysphoric mania, cycling, medications, and illness response to treatment, comorbidities, and life events.

Figure 4a. The NIMH-LCM^TM Self/Prospective Ratings: The LCM^TM-S/P. Sample of completed Life Chart as filled in by individual. Patient took carbamazepine and fluoxetine, with discontinuation of fluoxetine on day 16. Drug was resumed at reduced dosage on day 27, dosage of carbamazepine was increased on day 21. Mood switches, life events, comorbid symptoms, and menstrual period are also noted.

Figure 4b. Episode severity section of Life Chart. Shaded area shows hospitalization for mania, days 6 through 8.

Figure 4c. Mood scale section of Life Chart shows individual was in depressed range (score 32) one day and mildly hypomanic (score 54) on following day.

Figure 4d. Functional impairment indicating episode severity. Section of Life Chart allows individual to record depression or mania according to 4 levels of severity.

Figure 4e. Mood switches between mania and depression. Recording for this individual shows 4 mood switches, ranging from manic (score 75) to depressed (score 16) within same day.

Figure 4f. Mood switches within same mood state. Chart shows split-mood rating of 85/54 (85 indicating moderately manic state and 54 indicating mildly manic state). Note: Typical diurnal variation (worse in morning and very gradual improvement during day or better in morning with gradual worsening as day goes on) should not be counted as mood switch.

Figure 4g. Functional impairment as related to ultradian mood switches. Vertical lines on chart indicate patient experienced impairment from both mania and depression on day 2, with mood switch from 63 (in manic range) to 27 (in depressive range).

Figure 4h. Medication section of Life Chart. Medications and doses in left columns; number of tablets taken daily recorded in appropriate area.

Figure 4i. Comorbid symptoms section of Life Chart allows individual to record other illnesses or symptoms. Patient reported anxiety on days 1 through 5 and alcohol abuse on days 8 through 11.

Figure 4j. Life Event Checklist contains examples of life events that can be experienced as stressful. Life events recorded by patient. Events not on list may be added as well.

Figure 5. Prophylactic response to valproate in nonresponder to lithium/carbamazepine. Sample Life Chart for patient with rapid cycling course of illness and ultimately good response to another mood stabilizer.