Usage conditions apply. Dr Altman retains copyright, but the scale may be reproduced without permission by researchers and clinicians for use with their patients.
Choose the one statement in each group that best describes the way you have been feeling for the past week.
01
Happiness
Item score-
02
Self-confidence
Item score-
03
Sleep
Item score-
04
Speech
Item score-
05
Activity
Item score-
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ASRM0 / 5
Choose the one statement in each group that best describes the way you have been feeling for the past week.
The Altman Self-Rating Mania Scale (ASRM) measures the presence and severity of manic and hypomanic symptoms over the past week. Its five items cover the classic core of elevated mood: positive mood, self-confidence, reduced need for sleep, amount and speed of speech, and motor activity. For each area the respondent picks one of five statements, scored 0-4, describing how they have felt compared with their usual self, giving a total of 0-20.
The ASRM is one of very few brief self-report measures of current manic symptoms - most mania scales are clinician-rated. That makes it useful for between-visit monitoring in people with known bipolar disorder, where a rising score can flag an emerging episode early. It has been adopted by the American Psychiatric Association as the DSM-5 Level 2 severity measure for mania in adults.
02 - Origin & purpose
Where it comes from.
Edward Altman and colleagues at the University of Illinois at Chicago published the scale in Biological Psychiatry in 1997, aiming to give patients themselves a compact, five-minute instrument for rating manic symptoms that could parallel clinician measures such as the Clinician-Administered Rating Scale for Mania (CARS-M).
Its purpose was never diagnosis but severity rating and change detection: the original study anchored each item to the respondent's own baseline ("more than usual"), and a 2001 follow-up study showed the scale tracks symptom change across weeks of treatment. It was designed for adults with mood disorder, completed unaided in clinic or at home.
03 - Scoring & cutoffs
How scoring works.
Sum the five items (each 0-4) for a total of 0-20. A score of 6 or above indicates a high probability of a manic or hypomanic condition and warrants clinical assessment; scores of 5 or below make current mania or hypomania less likely. Higher scores indicate greater severity, and within-person change over repeated administrations is the most informative signal - the anchoring to the person's usual self means the same score can reflect different absolute states in different people.
Score
Severity
Interpretation
0–5
Low probability
Below the screening cutoff. Low probability of a manic or hypomanic condition.
6–20
High probability
At or above the cutoff (6 or more). High probability of a manic or hypomanic condition; further assessment is recommended.
04 - Validation evidence
How well it performs.
In the original 1997 validation, a cutoff of 6 or more discriminated patients with manic or mixed episodes from other groups with 85.5% sensitivity and 87.3% specificity. ASRM scores correlated strongly with clinician-rated mania (r = 0.766 with the CARS-M mania subscale; r = 0.718 with the Mania Rating Scale), and short-interval test-retest reliability was r = 0.86. In a 2001 head-to-head comparison of three self-rating mania scales in 44 acutely manic inpatients, the ASRM correctly identified 93% of acute cases, against 86% for the Self-Report Manic Inventory and 45% for the Internal State Scale, and was sensitive to symptom change over 4-6 weeks of pharmacotherapy.
Reach for it when a structured clinician severity rating is needed, e.g. in trials or inpatient care; the ASRM is the patient-completed counterpart.
MDQ
13 (+2)
~5 min
Screens for lifetime history of manic symptoms rather than current severity; reach for it when the question is has this person ever been hypomanic?
SRMI
47
~15 min
More thorough symptom inventory; reach for it in research settings where breadth matters more than brevity.
ISS
15
~5 min
Captures mixed states and wellbeing dimensions, but identified only 45% of acute mania in the 2001 comparison.
PHQ-9 / MADRS
9
~2-5 min
Pair the ASRM with a depression measure when monitoring bipolar disorder - the ASRM covers only the manic pole.
06 - When to use it
Right tool, wrong tool.
Reach for it when
-Between-visit monitoring of people with established bipolar disorder.
-Detecting emerging hypomania early in maintenance treatment.
-Tracking response to anti-manic treatment week by week.
-A quick current-state check before prescribing decisions (e.g. before starting an antidepressant).
-DSM-5 Level 2 cross-cutting severity assessment.
Reach for something else when
-Diagnosing bipolar disorder - no questionnaire can, and the ASRM does not screen for lifetime history (use the MDQ for that question).
-Assessing predominantly irritable or mixed presentations, which its elated-mood items capture poorly.
-Acute severe mania, where impaired insight undermines self-report.
-Assessing the depressive pole (pair it with PHQ-9 or MADRS).
07 - Confidence & precision
Reading the score with care.
No standard error of measurement or minimal clinically important difference has been established for the ASRM. In practice, single-point fluctuations should not drive decisions; a rise of several points, or a crossing of the >=6 threshold from a stable baseline, is the more meaningful signal. Because items are anchored to the respondent's usual self, precision depends on the person's insight at the time of completion - scores obtained during escalating episodes should be corroborated clinically.
08 - Limitations
What it cannot tell you.
Self-report of mania is inherently limited by the insight impairment that mania itself causes, so sensitivity is best earlier in an episode and falls as severity rises. The items centre on elated mood and energy, so predominantly irritable, dysphoric or mixed presentations may score deceptively low. The one-week window can miss brief hypomanic periods. The five items do not cover psychotic symptoms, risk-taking or impaired judgement. And a score of >=6 is a prompt for assessment, not a diagnosis.
09 - Licensing, explained
How licensing works.
Dr Altman retains copyright, but the scale may be reproduced without permission by researchers and clinicians for use with their patients.
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