> ## Documentation Index > Fetch the complete documentation index at: https://docs.getrivet.ca/llms.txt > Use this file to discover all available pages before exploring further. # YMRS — Young Mania Rating Scale > The 11-item clinician-administered mania severity scale — the standard outcome in bipolar treatment trials. 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. ## 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. ## 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) | Total | Band | | ----- | ------------------ | | `<12` | Minimal / euthymic | | 12-19 | Mild mania | | 20-25 | Moderate mania | | ≥26 | Severe mania | ### 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](/clinical-templates/screening/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](/clinical-templates/clinician-administered/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 Hamilton Depression Rating Scale. Pair with YMRS for mixed-state assessment in bipolar depression with manic features. Why these six measures don't ship to clients, and how solo fill works.