YMRS

Assess severity of mania in bipolar disorder. Used for baseline, monitoring treatment response, and research. Clinician-administered.

Indication

Assess severity of mania in bipolar disorder. Used for baseline, monitoring treatment response, and research. Clinician-administered.

Criteria

id: elevated_mood; label: 1. Elevated mood; type: options; options: value: 0; label: 0 — Absent; value: 1; label: 1 — Mildly/possibly elevated on questioning; value: 2; label: 2 — Definite, optimistic, confident; value: 3; label: 3 — Elevated, inappropriate to content; value: 4; label: 4 — Euphoric, inappropriate laughter/singing
id: motor_activity; label: 2. Increased motor activity/energy; type: options; options: value: 0; label: 0 — Absent; value: 1; label: 1 — Subjectively increased; value: 2; label: 2 — Animated, gestures increased; value: 3; label: 3 — Excessive energy, hyperactive, restless; value: 4; label: 4 — Motor excitement, continuous hyperactivity
id: sexual_interest; label: 3. Sexual interest; type: options; options: value: 0; label: 0 — Normal; value: 1; label: 1 — Mildly increased; value: 2; label: 2 — Definite increase on questioning; value: 3; label: 3 — Spontaneous sexual content; value: 4; label: 4 — Overt sexual acts/requests
id: sleep; label: 4. Sleep; type: options; options: value: 0; label: 0 — No decrease; value: 1; label: 1 — Up to 1 hr less; value: 2; label: 2 — More than 1 hr less; value: 3; label: 3 — Decreased need for sleep; value: 4; label: 4 — Denies need for sleep
id: irritability; label: 5. Irritability (0–8); type: options; options: value: 0; label: 0 — Absent; value: 2; label: 2 — Subjectively increased; value: 4; label: 4 — Irritable at times, recent anger; value: 6; label: 6 — Frequently irritable, short/curt; value: 8; label: 8 — Hostile, uncooperative, interview impossible
id: speech; label: 6. Speech rate and amount (0–8); type: options; options: value: 0; label: 0 — No increase; value: 2; label: 2 — Feels talkative; value: 4; label: 4 — Increased rate/amount at times, verbose; value: 6; label: 6 — Push, consistently increased; value: 8; label: 8 — Pressured, uninterruptible, continuous
id: language_thought; label: 7. Language/thought disorder; type: options; options: value: 0; label: 0 — Absent; value: 1; label: 1 — Circumstantial, mildly distractible; value: 2; label: 2 — Distractible, loses goal, changes topics; value: 3; label: 3 — Flight of ideas, tangential; value: 4; label: 4 — Incoherent, communication impossible
id: content; label: 8. Content (0–8); type: options; options: value: 0; label: 0 — Normal; value: 2; label: 2 — Questionable plans, new interests; value: 4; label: 4 — Special project, hyperreligious; value: 6; label: 6 — Grandiose/paranoid ideas, ideas of reference; value: 8; label: 8 — Delusions, hallucinations
id: aggressive; label: 9. Disruptive/aggressive behavior (0–8); type: options; options: value: 0; label: 0 — Absent, cooperative; value: 2; label: 2 — Sarcastic, loud at times, guarded; value: 4; label: 4 — Demanding, threats on ward; value: 6; label: 6 — Threatens interviewer, shouting; value: 8; label: 8 — Assaults, destructive, interview impossible
id: appearance; label: 10. Appearance; type: options; options: value: 0; label: 0 — Appropriate, well-groomed; value: 1; label: 1 — Minimally unkempt; value: 2; label: 2 — Poorly groomed, moderately disheveled; value: 3; label: 3 — Disheveled, partly clothed, garish makeup; value: 4; label: 4 — Completely unkempt, bizarre garb
id: insight; label: 11. Insight; type: options; options: value: 0; label: 0 — Present, acknowledges illness; value: 1; label: 1 — Possibly ill; value: 2; label: 2 — Acknowledges behavior change, denies illness; value: 3; label: 3 — Acknowledges possible change, denies illness; value: 4; label: 4 — Denies any change

Interpretation

function(score) { if (score <= 12) return { risk: score + '/60', tier: 'No mania / remission', action: 'Below treatment threshold. Continue maintenance therapy.', color: 'green' }; if (score <= 19) return { risk: score + '/60', tier: 'Mild mania', action: 'Some functional impairment. Optimize mood stabilizer; close follow-up.', color: 'yellow' }; if (score <= 25) return { risk: score + '/60', tier: 'Moderate mania', action: 'Significant impairment. Mood stabilizer +/- antipsychotic.', color: 'red' }; if (score <= 37) return { risk: score + '/60', tier: 'Moderate-severe mania', action: 'Marked impairment. Combination therapy; consider hospitalization.', color: 'red' }; return { risk: score + '/60', tier: 'Severe mania', action: 'Hospitalization typically required. Aggressive pharmacotherapy.', color: 'red' }; }

Clinical pearls

YMRS ≥20 is commonly used as the entry criterion for mania treatment trials
A decrease of ≥50% from baseline is the standard definition of treatment response
Insight (item 11) predicts willingness to accept treatment voluntarily
Grandiosity and decreased need for sleep are the most sensitive early indicators of emerging mania

Source and review

Young RC et al. Br J Psychiatry 1978. Last reviewed: 2025-01-01