Altman Self-Rating Mania Scale (ASRM)

Abstract

The Altman Self-Rating Mania Scale (ASRM) is a concise, five-item, self-report instrument designed by Altman and colleagues in 1997 to rapidly assess the presence and severity of manic or hypomanic symptoms. Utilizing a simple Likert-type response format, the ASRM measures key dimensions of mania, including mood elevation, grandiosity, decreased need for sleep, pressured speech, and increased activity level. It serves as a vital screening tool in both clinical and research settings, particularly for patients with suspected or diagnosed Bipolar Disorder. Its brevity and ease of administration make it highly practical for longitudinal monitoring of symptom fluctuations and evaluating treatment efficacy.

Keywords

Mania, Hypomania, Bipolar Disorder, Self-Report Scale, Affective Disorders, Mood Assessment, ASRM, Clinical Screening.

Authors

Altman. EG, Hedeker. D, Peterson. JL, Davis. JM.

Purpose

The primary purpose of the Altman Self-Rating Mania Scale (ASRM) is to provide a rapid, patient-administered measure for the detection and quantification of symptoms associated with mania and hypomania. Developed to be highly accessible, the scale allows for efficient screening in busy clinical environments where time constraints may limit the use of extensive clinician-administered interviews.

The ASRM is particularly useful for longitudinal assessment. By tracking score changes over time, clinicians can objectively determine the efficacy of a particular treatment regimen in a clinical setting and qualify whether the severity of a manic episode is increasing or decreasing. Scores above a threshold of 5 are indicative of mania or hypomania, with the severity of symptoms increasing proportionally with higher scores.

Construct

The ASRM measures the psychological construct of acute manic symptomatology as defined by core diagnostic criteria for mood disorders. It operationalizes five essential behavioral and affective features central to manic and hypomanic episodes. These features are assessed relative to the individual’s typical baseline functioning, capturing the critical component of change that defines an episode.

The five measured dimensions—Positive Mood, Self-Confidence, Sleep Patterns, Speech, and Activity Level—collectively represent the behavioral activation and mood dysregulation characteristic of a manic state. The scale is designed to be unidimensional, focusing on the overall severity of the manic episode rather than differentiating between specific sub-factors of the disorder.

Validity

The ASRM has demonstrated strong clinical utility and validity across numerous studies. It exhibits robust convergent validity, showing significant correlation with established, longer clinician-rated scales such as the Young Mania Rating Scale (YMRS). This confirms that the ASRM accurately measures the same underlying construct of manic severity as gold-standard instruments.

Furthermore, the scale possesses good discriminant validity, successfully distinguishing between patients experiencing an acute manic episode and those who are euthymic, depressed, or suffering from other psychiatric conditions. This makes the ASRM a valuable tool for differential diagnosis and treatment monitoring in populations affected by Bipolar Disorder.

Reliability

The reliability of the ASRM has been established through measures of internal consistency, indicating that the scale items are highly related and measure the same core construct. The original validation study by Altman et al. (1997) reported strong internal consistency for the primary construct.

• Mania: Cronbach’s Alpha = 0.79
• Psychosis: Cronbach’s Alpha = 0.65
• Irritability: Cronbach’s Alpha = 0.65

The internal consistency value of 0.79 for the total Mania score is considered acceptable for a brief screening instrument. The instrument also demonstrates good test-retest reliability, ensuring that scores remain stable when the patient’s clinical state has not changed, which is crucial for monitoring efficacy in therapeutic trials.

Factor Analysis

Factor analytic studies of the ASRM typically support a highly cohesive, unidimensional structure. This means that all five items load significantly onto a single factor representing global manic severity. This clean factor structure confirms the scale’s intended function as a rapid index of overall manic state rather than a tool for dissecting complex symptom profiles.

The strong intercorrelation among the items, particularly those relating to increased energy/activity and elevated mood, reinforces the concept that the ASRM successfully captures the simultaneous presentation of core manic symptoms, justifying its use as a single severity score ranging from 0 to 20.

Instrument

Test Type: Self-report symptom severity scale

Format: 5 items, each scored on a 5-point Likert scale (0 to 4). Total score ranges from 0 to 20.

Language Available: English (original), with numerous translations available for clinical use.

Population Group: Clinical and research populations, particularly those with mood disorders.

Age Group: Typically utilized with adults and adolescents (with appropriate validation).

Population Details: Used for inpatient and outpatient assessment and monitoring of individuals suspected of or diagnosed with Bipolar I or Bipolar II Disorder.

Test Methodology: Patients rate how they have felt or behaved over a specified period (usually the past week or 7 days). Administration time is typically less than five minutes.

Keywords

ASRM, Mood Instability, Affective Assessment, Clinical Screening, Mania Severity, Bipolar I, Bipolar II, Self-Assessment.

Authors

Author ORCID Identifier: Not specified in the source material.

Affiliation Email addresses: Not specified in the source material.

Correspondence Address: Not specified in the source material.

Permissions & Fee and Test Year

The ASRM was first published and validated in 1997. As a widely utilized, brief clinical screening tool, it is often available for use without specific fees in non-commercial clinical and academic research settings. Users seeking formal permission for commercial use should consult the original authors or the journal publisher, Biological Psychiatry.

Test Year: 1997

Reference’s

• Altman. EG, Hedeker. D, Peterson. JL, Davis. JM. (1997). The Altman Self-Rating Mania Scale. Biol Psychiatry, 15; 42(10): 948-955.
• Altman. EG, Hedeker. D, Peterson. JL, Davis. JM. (2001). A Comparative Evaluation of Three Self-Rating Scales for Acute Mania. Biol Psychiatry, 50(6):468-471.

Items of the Altman Self-Rating Mania Scale (ASRM)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

1. Positive Mood

I do not feel happier or more cheerful than usual.

I occasionally feel happier or more cheerful than usual.

I often feel happier or more cheerful than usual.

I feel happier or more cheerful than usual most of the time.

I feel happier or more cheerful than usual all of the time.

2. Self-Confidence

I do not feel more self-confident than usual.

I occasionally feel more self-confident than usual.

I often feel more self-confident than usual.

I feel more self-confident than usual.

I feel extremely self-confident all of the time.

3. Sleep Patterns

I do not need less sleep than usual.

I occasionally need less sleep than usual.

I often need less sleep than usual.

I frequently need less sleep than usual.

I can go all day and night without any sleep and still not feel tired.

4. Speech

I do not talk more than usual.

I occasionally talk more than usual.

I often talk more than usual.

I frequently talk more than usual.

I talk constantly and cannot be interrupted.

5. Activity Level

I have not been more active (either socially, sexually, at work, home or school) than usual.

I have occasionally been more active than usual.

I have often been more active than usual.

I have frequently been more active than usual.

I am constantly active or on the go all the time.

Please note: The word “occasionally” when used here means once or twice; “often” means several times or more and “frequently” means most of the time.