OVERVIEW The Young Menia Rating Scale (YMRS) is one of the most frequently utlized rating scales to assess manic symptoms. The scale has 11 items and is based on the patient's subjective report of his or her clinical condition over the previous 48 hours. Additional information is based upon clinical observations made during the course of the clinical interview. The items are selected based upon published descriptions of the core symptoms of mania. The YMRS follows the slyle of the Hamilton Rating Seale for Depression (HAM-D} with each item given a severity raling. There are four items that are graded on a 0 to 8 scale [ritabily, speech, thought content, and disruptive/aggressive behavior), while the remaining seven items are graded on a 0 to 4 scale. These four items are given twice the weight ofthe others to compensate for poor cooperation from severely ill patents. There are well described anchor points for each grade of severity. The authors encourage the use of whole or half point ratings once experience with the scale is acquired. Typical YMRS baseline scores can vary a lot. They depend on the patients clinical features such as mania (YMRS = 12), depression (YMRS = 3), or euthymia (YMRS = 2). Sometimes a clinical study entry requirement of YMRS > 20 generates a mean YMRS baseline of about 30, Strengths of the YMRS include its breviy, widely accepted use, and ease of administration, The usefulness ofthe scale is limited in populations with diagnoses other than mania The YMRS is a rating scale used to evaluate monic symptoms ot baseline ond overtime in individuals with mania. The scale is generally done by a clinician or other trained rater with expertise with monic patients and fakes 15-30 minutes to complete REFERENCES. Young RC, Biggs J, Zigler VE, Meyer DA. A rating scale for mania: reliability, validity and sensitviy. Br J Puychiary. 1978;133:429-435, ‘Melniyre RS, Mancini DA, Srinivasan J, MeCann S, Kenarsk JZ, Kennedy SH. The anidepresset effects of risperdene ond elanzapne in bipelar dsorder. Can J Clin Pharmacol 2004;11:6218-226 Young RC, Biggs J, Zigler VE, Mayer DA. Young Monts Rating Scale. n: Hondbook ofPrychiarc Mearures. Wathnglon, DC: American Prychitrie ‘Assocation; 2000:540-542, Eeoeereily PUUUSTRUTUTREPETLA THEY Sepered by = Fhsonse foundation ras AetravereceYoung Mania Rating Scale (YMRS) GUIDE For SCORING ITEMS: ‘The purpose of each item is fo rale the severily ofthat abnormality in he patient. When several keys ore given for a particular grade of severity the presence of only one is required to quelify for that rating ‘The keys provided are guides. One can ignore the keys if that is necessary to indicate severity, alhough this should be the exception rather than the rule. Scoring between the points given (whole or half points) is possible and encouraged after experience with the seale is acquired, Ths is particularly useful when severity ofa particular item in a patient does not follow the progression indicated by the keys 1. Elevated Mood 0 Absent 1 Mildly or possibly inereased on questioning 2 Definite subjective elevation; optimistic, selFconfident; cheerful; appropriate fo content 3 Elevated; inappropriate to content; humorous 4 Euphoric; inappropriate laughter; singing 2. Increased Motor Activty-Eneray © Absent 1 Subjectively increased 2 Animated; gestures increased 3. Excessive energy; hyperactive at times; resiless (can be calmed) 4 Motor excitement; continuous hyperactivity (cannot be calmed) 3. Sexual Interest 0 Normal; not increased 1 Mildly or possibly inereased 2 Definite subjective increase on questioning 3. Spontaneous sexual content; elaborates on sexval motters; hypersexval by self-report 4 Over! sexval acts (toward patients, staff, or interviewer) 4. Sleep 0 Reports no decrease in sleep 1 Sleeping less thon normal amount by up to one hour 2 Sleeping less than normal by more than one hour 3. Reports decreased need for sleep 4 Denies need for sleep 5. Irritability 0 Absent 2 Subjectively increased 4 Irritable at times during interview; recent episodes of anger or annoyance on ward 6 Frequently irritable during interview; short, curt throughout 8 Hoste, uncooperative; interview impossible Sparse iy PUUUSTRUTUTREPETLA THEY Sper = FisEerpse zeatation eT ro RevaveneesYoung Mania Rating Scale (YMRS) 6. Speech (Rate and Amount) 0 No increase 2 Feels talkative 4 Increased rate or amount at times, verbose at Himes & Push; consistenlly increased rate and amount; difficult fo interrupt 8 Pressured; uninterruptible, continuous speech 7. Language-Thought Disorder © Absent 1 Circumstantial; mild distractibility; quick thoughts 2 Disractible, loses goal of thought; changes topics frequently; racing thoughts 3 Flight of ideas; tingentialty; difficult o fellow; rhyming, echolalia 4 Incoherent; communication impossible 8, Content © Normal 2 Questionable plans, new interests 4 Special project(s); hyper-religious & Grandiose or paranoid ideas; ideas of reference 8 Delusions; hallucinations 9. Disruptive-Aggressive Behavior © Absent, cooperative 2 Sarcastic; loud at times, guarded 4 Demanding; threats on ward & Threatens interviewer; shouting; interview difficult 8 Assaulive; destructive; interview impossible 10. Appearance © 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 11. Insight © Present; admits illness; agrees with need for realment 1 Possibly ill 2. Admits behavior change, but denies illness 3. Admits possible change in behavior, but denies illness 4 Denies any behavior change Reprinted wth permission from The Royal Calloge of Peychiatrie. Sparse iy PUUUSTRNTUTUEPATLA THEY Sper = FisEerpse zeatation 2 www.MEASUREcme.org Reavenees