ASRM: Altman Self-Rating Mania Scale

What this assessment is

The Altman Self-Rating Mania Scale, or ASRM, is a five-item self-report measure of manic symptoms during the past week.

Each item is scored from 0 to 4. The five values add to a total from 0 to 20.

Higher totals indicate more self-reported manic symptoms.

A score of 6 or more is often used as a signal for further clinical review. It is not a diagnosis of mania or bipolar disorder.

The ASRM is brief. That makes it useful for repeated measurement, but it also means it covers only part of the clinical picture.

Who it was designed for

Altman and colleagues developed the ASRM for adults with manic symptoms. The original validation study compared the self-report total with clinician-rated mania measures.

The scale is used in mental health care and research with adults who have bipolar disorder or possible mood elevation.

It is a self-report measure. The person's understanding, insight, current state, and willingness to report symptoms can affect the result.

Someone may describe increased energy as productive or positive even when other people see impairment. Another person may report distress that is not visible during a short appointment.

Both perspectives matter.

ASRM should support, not replace, a clinical interview and collateral information when available.

How it is administered

The person selects one response for each of five symptom areas based on the past week.

It usually takes about two minutes.

Use the same seven-day period at each assessment. Do not switch between today, the past 48 hours, and the past week without recording the change.

Before interpreting the result, consider:

• sleep and recent sleep loss
• alcohol or other substance use
• medicine changes
• acute medical or neurological illness
• usual personality and activity level
• whether someone else has observed a change

Complete all five items. The original scoring method does not provide a general prorating rule for missing responses.

Do not guess a missing value.

What it measures

ASRM samples five features associated with mania: mood elevation, increased confidence, reduced need for sleep, increased speech, and greater activity.

The scale does not cover every diagnostic feature. It gives limited information about irritability, impairment, risky behavior, psychosis, mixed symptoms, and duration beyond the past week.

The YMRS is an 11-item clinician-rated measure that combines interview report and observed behavior. ASRM records the person's own view in a shorter format.

These perspectives can differ.

A mismatch is not proof that either result is wrong. It is a reason to review the symptoms, context, and change from usual behavior.

Do not compare the ASRM and YMRS totals directly. They use different items, ranges, timeframes, and raters.

How scoring works

Each of the five items receives a value from 0 to 4.

Add the five values to produce a total from 0 to 20.

Higher totals indicate more self-reported manic symptoms during the past week.

There are no reverse-scored items. Do not reverse the values a second time.

Do not divide the total by 20 and describe it as a percentage of mania. The score is not a percentage scale.

The original study found that a cutoff above 5, usually written as 6 or more, separated manic from non-manic clinical participants with useful sensitivity and specificity in that sample.

That cutoff is a screening threshold.

It does not turn the scale into a diagnostic test.

How to interpret an ASRM score

Interpret the total as a brief report of recent manic symptoms.

A result of 6 or more supports further clinical review. A result below 6 does not rule out hypomania, mania, mixed symptoms, or clinically important change.

Context matters.

The original cutoff came from a clinical development sample. Performance can differ in primary care, community screening, younger groups, or people with substance use and other psychiatric conditions.

A review of adult bipolar measures describes the five-item 0-to-20 structure and the 5.5 statistical threshold, which is applied as an integer score of 6 or more.

For follow-up, compare the result with the person's own earlier score and usual functioning. Keep the timeframe and method stable.

Review which symptom areas changed. The total alone can hide the pattern.

What the score cannot tell you

ASRM cannot diagnose bipolar disorder, hypomania, or mania.

It cannot establish symptom duration beyond the past week or show whether a change caused marked impairment.

The scale cannot determine whether symptoms come from bipolar disorder, substance use, a medicine, sleep deprivation, attention problems, trauma, personality, or a medical condition.

A high result does not identify the treatment needed. A low result does not prove that no episode is developing.

The score also cannot replace a direct assessment of judgment, function, psychosis, risky behavior, or immediate safety.

Use the result with a clinical interview, history, observed behavior, collateral information, and diagnostic criteria.

It is a signal, not a conclusion.

Evidence and limitations

ASRM is short, easy to repeat, and focused on symptoms that people can report directly.

Its brevity is also its main limitation. Five items cannot represent the full range of manic, hypomanic, depressive, and mixed features.

Self-report can be affected by insight. Elevated confidence and activity may feel beneficial to the person even when others observe risk or impairment.

The scale is most useful when repeated scores are interpreted with sleep, function, behavior, and clinician assessment.

Report the timeframe, total, item pattern, relevant context, and reason for assessment.

Keep the person's account central, but do not make it the only evidence.