What it measures
Eleven items covering elevated mood, motor activity, sexual interest, sleep, irritability, speech, language-thought disorder, content, disruptive-aggressive behavior, appearance, and insight. The YMRS uses mixed item weighting — the distinctive feature of the scale:- Items 1, 2, 3, 4, 7, 10, 11 score 0-4 (single weight)
- Items 5, 6, 8, 9 score 0-8 (double weight)
When to use it
- Bipolar mania severity tracking — primary outcome in lithium, valproate, lamotrigine, and atypical antipsychotic trials
- Mood-stabilizer treatment-response measurement
- Inpatient unit acute mania monitoring — daily or weekly during hospitalization
- Mixed-state assessment — often paired with HAM-D in bipolar depression with manic features
How you fill it
Solo fill. Open YMRS from the templates picker and tap New response. The renderer presents each item with the Young 1978 severity anchors. The double-weighted items (5, 6, 8, 9) display the 0-2-4-6-8 score values directly in the answer-option codes so you see the weighting explicitly as you score. Typical administration is 15-30 minutes. The form never goes to the client.Scoring and severity cutoffs
Total = weighted sum of all 11 items, range 0-60.Severity bands (Young et al. 1978)
Clinical change thresholds
- Response: ≥50% reduction in total from baseline (Tohen 2009 consensus)
- Remission: total ≤7 sustained
Rater training
YMRS scoring requires familiarity with manic phenomenology — flight of ideas vs. tangentiality, irritability vs. anger, content disorder across the spectrum. Inter-rater reliability with trained raters typically reaches ICC 0.93+.What we render vs. the source
Verbatim Young 1978 items with the published severity anchors. The double-weighted items display their actual score values (0, 2, 4, 6, 8) in the answer-option labels so the rater sees the weighting explicitly rather than mentally multiplying.Known limitations
- Item 11 (insight) is the only item rated based on patient denial. Distinguish defensive insight from poor insight from euthymic patient denial — clinical judgment required.
- The scale doesn’t capture mixed features well. For mania with depressive features, pair with HAM-D in the same visit.
- Item 4 (sleep) can be confounded by sleep restriction in inpatient settings — note in the clinical context.
YMRS vs MDQ
Different questions and different points in the work. The MDQ is a self-report screen asking whether there has ever been a hypomanic or manic period — an intake question, and the one that catches a bipolar history before someone is treated for unipolar depression. The YMRS is rated by you and measures how severe mania is right now, which is why it’s the outcome measure in mood-stabiliser trials and the scale used to track an acute episode. The YMRS also doesn’t capture mixed features well. Where there are depressive symptoms alongside the mania, pairing it with the HAM-D gives you the half of the picture the YMRS alone will miss.Is it free to use?
Yes. Free clinical use, and the standard outcome measure in bipolar treatment trials.Citations
- 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: 429-435.
- Tohen, M., Frank, E., Bowden, C. L., et al. (2009). “The International Society for Bipolar Disorders (ISBD) Task Force report on the nomenclature of course and outcome in bipolar disorders.” Bipolar Disorders, 11(5): 453-473.
Related articles
HAM-D
Hamilton Depression Rating Scale. Pair with YMRS for mixed-state
assessment in bipolar depression with manic features.
Clinician-administered overview
Why these six measures don’t ship to clients, and how solo fill works.