Young Mania Rating Scale (YMRS)

Young Mania Rating Scale (YMRS)
Young RC‚ Biggs JT‚ Ziegler VE‚ Meyer DA (1978)

The Young Mania Rating Scale (YMRS) is a Clinician administered tool used to rate the severity of symptoms of mania (Young, Biggs, Ziegler & Meyer, 1978) across clinical and research settings. The YMRS was originally developed in 1978 and normed with psychiatric inpatients based on a semi structured interview and observations over an 8 hour period. Today the YMRS combines the clients self-report of symptoms of mania over the past 48 hours with the clinician observations during interview (Miller, Johnson & Eisner, 2009) and is now a commonly used tool to screen for manic symptoms and monitor the severity of manic symptoms (Lukasiewicz et al., 2013). Used to assess the severity of manic symptoms, this tool is often used to monitor the progress of interventions (Miller, Johnson & Eisner, 2009).

It is an 11 item scale assessing mood, motor activity/ energy levels, interest in sex, sleep, irritability, rate and frequency of speech, flight of ideas, grandiosity, aggressive behaviour, appearance, and insight into current presentation. It should be noted that the YMRS does not map onto the DSM 5 criteria for mania as it does not account for distractibility, increases in goal directed activity or excessive involvement in pleasurable activities that have a potential fir painful consequences (DSM-5). As such this tool is not a diagnostic assessment.

Each item is composed of 5 explicitly defined levels of severity.  Severity ratings for 7 items are scored on a scale of 0 -4. The remaining 4 items are double weighted to account for poor cooperation of client when unwell and are scored on a scale of 0 – 8. Item ratings are sum to produce a total score between 0 -60. A score <29 indicates that the person is experiencing “severe” mania (Wciorka et al., 2011).

Although weighting items increases the complexity of scoring and interpreting, it has not affected the psychometric properties of the scale. The YMRS is reported to have high interrater reliability for total scores (0.93) and individual item scores (0.66 -0.92) (Young et al., 1978). It also has been found to have good internal reliability, with Cronback alpha coefficients ranging from 0.8 – 0.91. The YMRS has demonstrated high convergent validity with other assessment measures of mania including the Bech-Rafaelsen Mania Rating Scale (Spearman’s Rho = 0.90). Furthermore, the YMRS statistically differentiates between clients; before and 2 weeks after treatment (Young et al., 1978); mania from symptoms of ADHD (Serrano, Ezpeleta, Alda, Matalí, & San, L., 2011). Finially, the YMRS has demonstrated validity across cultural populations including Korea (Seon-Cheol & Joonjo, 2016) and Poland (Wciorka et al., 2011).


             I.        Elevated Mood
0)   Absent
1)   Mildly or possibly increased
2)   Definite subjective elevation; optimistic‚ self-confident; cheerful; appropriate to content
3)   Elevated‚ inappropriate to content; humorous
4)   Euphoric‚ inappropriate laughter‚ singing
           II.        Increased Motor Activity or Energy
0)   Absent
1)   Subjectively increased
2)   Animated; gestures increased
3)   Excessive energy; hyperactive at times; restless (can be calmed)
4)   Motor excitement; continuous hyperactivity (cannot be calmed)
         III.        Sexual Interest
0)   Normal; not increased
1)   Mildly or possibly increased
2)   Definite subjective increase
3)   Spontaneous sexual content; elaborates on sexual matters; hypersexual
4)   Overt sexual acts
          IV.        Sleep
0)   No decrease in sleep
1)   Sleeping less than normal amount by up to one hour
2)   Sleeping less than normal by more than one hour
3)   Decreased need for sleep
4)   No need for sleep at all
            V.        Irritability
0) Absent
2) Subjectively increased
4) Irritable at times; recent episodes of anger or annoyance
6) Frequently irritable; short‚ curt
8) Hostile‚ uncooperative
          VI.        Speech: Rate & Amount
0) No increase
2) Feel talkative
4) Increased rate or amount at times‚ verbose at times
6) Push; consistently increased rate and amount;
8) Pressured; uninterruptedly‚ continuous speech
        VII.        Language: Thought Disorder
0)   Absent
1)   Circumstantial; mild distractibility; quick thoughts
2)   Distractible; loses goal of thought; change topics frequently; racing thoughts
3)   Flight of ideas; tangentially; difficult to follow; rhyming‚ echolalia
4)   Incoherent; communication impossible
      VIII.        Content
0) Normal
2) Questionable plans‚ new interests
4) Special project(s); hyper religious
6) Grandiose or paranoid ideas; ideas of reference
8) Delusions; hallucinations
          IX.        Disruptive or Aggressive Behavior
0) Absent
2) Sarcastic; loud at times‚ guarded
4) Demanding; threats
6) Threats‚ shouting
8) Assaultive; destructive
            X.        Appearance
0)   Appropriate dress and grooming
1)   Minimally unkempt
2)   Poorly groomed; moderately disheveled; overdressed
3)   Disheveled; partly clothed; garish make-up
4)   Completely unkempt; decorated; bizarre garb
          XI.        Insight
0)   Present; admits illness; agrees with need for treatment
1)   Possibly ill
2)   Admits behavior change‚ but denies illness
3)   Admits possible change in behavior‚ but denies illness
4)   Denies any behavior change
The YMRS is typically administered by a third-party clinician‚ but it is provided here‚ in a slightly reworded form‚ as a self-assessment. This may not be as accurate when self-administered‚ as people suffering from mania are often unable to properly assess relevant outward symptoms.
This instrument can be found at: https://scales.arabpsychology.com/
Scoring between the points given (whole or half points) is possible and encouraged after experience with the scale is acquired. This is particularly useful when severity of a particularitem in a patient does not follow the progression indicated by the keys.
 In scoring the YMRS‚ the following items are graded on a 0 to 8 scale:
• Irritability
• Speech
• Thought content
• Disruptive/aggressive behavior
 The following items are graded on a 0 to 4 scale:
• Elevated mood
• Increased motor activity/energy
• Sexual interest
• Sleep
• Language/thought disorder
• Appearance
• Insight

References

Lukasiewicz, M., Gerard, S., Besnard, A., Falissard, B., Perrin, E., Sapin, H., Tohen, M., Reed, C., Azorin, J.-M. and The emblem study group (2013), Young Mania Rating Scale: how to interpret the numbers? Determination of a severity threshold and of the minimal clinically significant difference in the EMBLEM cohort. Int. J. Methods Psychiatr. Res., 22: 46–58. doi:10.1002/mpr.1379

Miller, C. J., Johnson, S. L., & Eisner, L. (2009). Assessment Tools for Adult Bipolar Disorder. Clinical Psychology : A Publication of the Division of Clinical Psychology of the American Psychological Association16(2), 188–201. http://doi.org/10.1111/j.1468-2850.2009.01158.x

Seon-Cheol, P., & Joonjo, C. (2016). Using the Young Mania Rating Scale for Identifying Manic Symptoms in Patients with Schizophrenia. Yonsei medical Journal, 57, 1298-1299.

Serrano, E., Ezpeleta, L., Alda, J., Matalí, J., & San, L. (2011). Psychometric Properties of the Young Mania Rating Scale for the Identification of Mania Symptoms in Spanish Children and Adolescents with Attention Deficit/Hyperactivity Disorder. Psychopathology, 44(2), 125-132.

Wciorka, J., Schaeffer, E., Switaj, P., Waszkiewicz, J., Krasuska, K., Wegrzyn, J., & Wozniak, P. (2011). Bech-Rafaelsen Mania Scale and Young Mania Rating Scale–comparison of psychometric properties of the two instruments for rating a manic syndrome. Psychiatry Poland, 45, 61-78.

Young, R.C., Biggs, J.T., Ziegler, V.E., & Meyer, D.A. (1978). The rating scale for mania: reliability, validity and sensitivity. British Journal of Psychiatry, 133, 429-435.

Young RC‚ Biggs JT‚ Ziegler VE‚ Meyer DA (1978). "A rating scale for mania: reliability‚ validity and sensitivity". Br J Psychiatry 133 (5): 429–35.