Young Mania Rating Scale YMRS
Young Mania Rating Scale YMRS overview
Creator and Context
The Young Mania Rating Scale (YMRS) is the standard clinician rated measure of mania severity.
It was published by Robert Young, John Biggs, Veronika Ziegler and Dolores Meyer in the British Journal of Psychiatry in 1978, and remains the primary outcome measure in almost every acute mania trial. Copyright sits with the Royal College of Psychiatrists.
Presenting Conditions
Eleven items cover the clinical features of mania, including elevated mood, increased motor activity and energy, sexual interest, sleep, irritability, speech, language and thought disorder, thought content, disruptive or aggressive behaviour, appearance and insight.
Administration
Clinician administered. The rating draws on the person's report of the previous 48 hours together with the clinician's observations during the interview. Where the two conflict, clinician observation takes precedence.
Desired Audience
Adults and adolescents with known or suspected mania. It is a severity and change measure, not a case finding tool.
If you need to demonstrate that treatment for an acute manic episode is working, the YMRS is the measure everyone recognises. It is the currency of the evidence base, and it is sensitive to change over days rather than weeks.
Considerations
It is not a screener. It measures severity in people already suspected of mania.
Four items are double weighted: irritability, speech, thought content, and disruptive or aggressive behaviour. These score 0 to 8 while the other seven score 0 to 4. This is the most common scoring error in digital implementations.
The 48 hour recall window makes it unsuitable for episode history or longer term monitoring.
The original paper defines no severity bands. Widely circulating band tables are not traceable to an authoritative source and should be treated with caution.
How to score the Young Mania Rating Scale YMRS
Conducting the assessment
The clinician rates 11 items. Seven items score 0 to 4 and four items are double weighted at 0 to 8.
Interpretation
Items are summed to give a total from 0 to 60.
Interpretive anchors derived from the EMBLEM cohort of 3,459 people with acute manic or mixed episodes (Lukasiewicz et al., 2013):
A score of 25 or above corresponds to the severity threshold against clinician global impression ratings
A score of 20 or above is the typical entry threshold used in randomised trials
The minimal clinically significant difference is 6.6 points
A reduction of 50 percent or more from baseline is the conventional definition of treatment response in trials.
Clinical Considerations
Check the double weighting before you trust any digital total.
Track change from baseline rather than reading a single score against a threshold.
Rater training matters. Reliability depends on consistent anchoring across clinicians.
Young Mania Rating Scale YMRS use cases
Measuring the severity of an acute manic episode
Tracking response to treatment over days and weeks
Establishing remission at the end of an episode
Clinical trials in bipolar disorder
Category
Depression
Research Summary
Young, R. C., Biggs, J. T., Ziegler, V. E., & Meyer, D. A. (1978). A rating scale for mania: Reliability, validity and sensitivity. British Journal of Psychiatry, 133, 429 to 435.
Lukasiewicz, M., Gerard, S., Besnard, A., et al. (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. International Journal of Methods in Psychiatric Research, 22(1), 46 to 58.
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Note on Assessment licensing
Some assessments are copyright protected and require a licence or the copyright holder's permission for clinical, commercial or digital use. Where that applies, obtaining and maintaining that permission is the responsibility of the practice or organisation using the assessment. Tacklit provides the digital administration, scoring and reporting. We do not grant, transfer or supply rights to the underlying instrument.
