Young Mania Rating Scale (YMRS)

Instructions: For each item below, circle the response that best describes how you felt or behaved during the past 48 hours.

1. Elevated Mood 0 Absent 1Mildly or possibly increased on questioning 2Definite subjective elevation; optimistic; self- confident; cheerful; appropriate to content 3 Elevated, inappropriate to content; humorous 4Euphoric; inappropriate laughter, singing 2. Increased Motor Activity/Energy 0 Absent 1Subjectively increased 2Animated; gestures increased 3Excessive energy; hyperactive at times; restless (can be calmed) 4Motor excitement; continuous hyperactivity (cannot be calmed) 3. Sexual Interest 0Normal; not increased 1Mildly or possibly increased 2Definite subjective increase on questioning 3Spontaneous sexual content; elaborates on sexual matters; hypersexual by self-report 4Overt sexual acts (toward patients, staff, or interviewer) 4. Sleep 1Sleeping less than normal amount by up to one hour 2Sleeping less than normal by more than one hour 3 Reports decreased need for sleep 4 Denies need for sleep 5. Irritability 0 Absent 2Subjectively increased 4Irritable at times during interview; recent episodes of anger or annoyance on ward 6Frequently irritable during interview; short or curt throughout 8Hostile, uncooperative; interview impossible 6. Speech (Rate and Amount) 0 No increase 2 Feels talkative 4Increased rate or amount at times, verbose at times 6Push; consistently increased rate and amount; difficult to interrupt 8Pressured; uninterruptible, continuous speech

0 Reports no decrease in sleep

7. Language/Thought Disorder 0 Absent 1Circumstantial; mild distractibility; quick thoughts 2Distractible; loses goal of thought; changes topics frequently; racing thoughts 3Flight of ideas; tangentiality; difficult to follow; rhyming; echolalia 4Incoherent; communication impossible 8. Thought Content 0 Normal 2 Questionable plans; new interests 4Special project(s); hyper-religious 6 Grandiose or paranoid ideas; ideas of reference 8 Delusions; hallucinations 9.Disruptive/Aggressive Behavior 0Absent, cooperative 2Sarcastic; loud at times, guarded 4Demanding; threats on ward 6 Threatens interviewer; shouting; interview difficult 8Assaultive; destructive; interview impossible 10. Appearance 0Appropriate dress and grooming 1Minimally unkempt 2Poorly groomed; moderately disheveled; overdressed 3Disheveled; partly clothed; garish makeup 4Completely unkempt; decorated; bizarre garb 11. Insight 0 Present; admits illness; agrees with need for treatment 1 Possibly ill 2Admits behavior change, but denies illness 3Admits possible change in behavior; but denies illness 4Denies any behavior change

Scoring the YMRS The purpose of each item is to rate the severity of that abnormality in the patient. When several keys are given for a particular grade of severity, the presence of only one is required to qualify for that rating. A severity rating is assigned to each of the eleven items, based on the patient's subjective report of his or her condition over the previous forty-eight hours and the clinician's behavioral observations during the interview, with the emphasis on the latter. 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 particular item 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

Citation: Young RC, Biggs JT, Ziegler VE, Meyer DA: A rating scale for mania: reliability, validity and sensitivity. British Journal of Psychiatry 133:429-435, 1978.