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The YMRS is the dominant outcome measure in bipolar treatment trials. You fill it about the client after a clinical interview — often during inpatient hospitalization for acute mania, or at follow-up visits during a mood-stabilizer trial. The client never sees the form.

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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)
Young et al. 1978 identified items 5, 6, 8, and 9 (irritability, speech, content, disruptive-aggressive behavior) as the items most distinguishing of mania severity, and assigned them double weight to reflect that diagnostic significance. Total range is 0-60.

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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

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How you fill it

Solo fill. Open Templates, pick YMRS, 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.

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How Rivet scores it

Total = weighted sum of all 11 items, range 0-60.

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Severity bands (Young et al. 1978)

TotalBand
<12Minimal / euthymic
12-19Mild mania
20-25Moderate mania
≥26Severe mania

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Clinical change thresholds

  • Response: ≥50% reduction in total from baseline (Tohen 2009 consensus)
  • Remission: total ≤7 sustained

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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+.

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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.

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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.

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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.

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.