Calculators / Bipolar spectrum

YMRS

Young Mania Rating Scale. Clinician-rated mania severity and change.

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The YMRS calculator is in the Library.

Every rating scale calculator comes with the Library, along with the prescribing guides, medication handouts, DSM-5 criteria and sheets, and the Guide Builder.

Use it for

  • Rating the severity of mania or hypomania in a person with bipolar disorder.
  • Following response and remission during treatment, with the same rater each time.
  • Trial and research work, where it is the standard comparator.

Do not use it for

  • Screening or diagnosing bipolar disorder. Use a screen such as the Modified RMS, the HCL-32 or the MDQ, and an interview.
  • Rating depression or mixed features. It does not capture them.
  • Self-report. It is built to be rated by a trained clinician.

The YMRS was published in the British Journal of Psychiatry, and the Royal College of Psychiatrists holds the copyright. The published anchors are therefore not reproduced on this page. Interview the person with the published scale, covering the past 48 hours, and enter the 11 ratings here.

Seven items are rated 0 to 4. Irritability, speech, content and disruptive or aggressive behavior (items 5, 6, 8 and 9) are rated 0 to 8, with the published anchors at 0, 2, 4, 6 and 8. Use an in-between number for a rating between two anchors. 0 is normal or absent, and a higher number is more severe.

1Elevated moodHow high, expansive or euphoric the mood is.
2Increased motor activity and energyActivity level and how energetic the person feels and looks.
3Sexual interestLevel of sexual interest and activity compared with usual.
4SleepLoss of sleep, and how much the person feels the need for it.
5IrritabilityRated 0 to 8. How irritable, short-tempered or hostile the person is.
6Speech: rate and amountRated 0 to 8. How fast and how much the person talks, and how hard they are to interrupt.
7Language and thought disorderDisorganization of thinking, from distractibility to loss of the thread to incoherence.
8ContentRated 0 to 8. What the person is preoccupied with and how realistic it is, from new plans and interests up to delusions and hallucinations.
9Disruptive and aggressive behaviorRated 0 to 8. How cooperative the person is in the interview and on the unit, from guarded or loud to threatening or assaultive.
10AppearanceGrooming and dress, from neat to disheveled or bizarre.
11InsightHow far the person accepts that they are ill. A higher number means less insight.

YMRS

Answer the questions to see the result.

This calculator adds up the score in your browser. Nothing you enter is stored or sent.

More about the YMRS

About the YMRSWhat it is and what it is for

Young and colleagues published the YMRS in 1978. A clinician interviews the person and rates 11 items, based on the person's report of the past 48 hours and on what the clinician sees during the interview. Seven items are rated 0 to 4. Four items, irritability, speech, content and disruptive or aggressive behavior, are rated 0 to 8, because they are given twice the weight to make up for poor cooperation in severely ill people. The total runs from 0 to 60.

It is the most widely used outcome measure in mania trials. It rates severity and change in a person who already has the diagnosis.

How to use itGiving it and scoring it

Interview the person, and use what staff or family report, covering the past 48 hours. Rate the 11 items from the published anchors: seven from 0 to 4 and four from 0 to 8. Add them for a total from 0 to 60. This page does the addition. Do not double the four 0 to 8 items again, because their 0 to 8 range already carries the extra weight.

Use the same rater at each follow-up, so the change means something.

Interpreting the scoreScore ranges and what they suggest
YMRS totalWhat it suggestsUsual response
0 to 12Remission rangeFew or no manic symptoms. The usual trial remission cutoff is 12 or below.If in treatment, continue it and plan maintenance.
13 to 19MildSome manic or hypomanic symptoms, below the usual trial entry threshold.Check adherence, sleep and substances. Optimize treatment.
20 to 24ModerateAt or above the usual trial entry threshold of 20.Active treatment of an acute episode. Assess safety and the level of care.
25 to 60SevereAt or above the severity threshold of 25 found in a large naturalistic cohort.Treat urgently. Consider hospitalization, psychotic features and safety.

The original scale has no severity bands. These ranges combine three conventions: a remission cutoff of 12 or below, the usual trial entry score of 20, and a severity threshold of 25 (Lukasiewicz 2013, against a global clinical rating of mania). Remission cutoffs differ between trials, with 11 and 12 both common. Say which you use.

Pearls and pitfallsTips and common mistakes
  • Record the baseline total at the start. Response and remission both depend on it.
  • Do not double items 5, 6, 8 and 9 a second time. They are rated 0 to 8 as they stand.
  • Rate what you see and what is reported over 48 hours, not the whole episode.
  • Look at the pattern: a score driven by irritability and aggression is a different problem from one driven by elevated mood and energy.
  • Rate depression too. A low YMRS with a high MADRS or PHQ-9 can mean a mixed state or a depressive turn.
EvidenceAccuracy and reliability
  • Young and colleagues (1978) developed the scale and showed good interrater reliability and sensitivity to change. It is now the standard outcome measure in mania trials.
  • In the EMBLEM cohort of about 3,500 people with acute manic or mixed episodes (Lukasiewicz 2013), a YMRS score of 25 was the best threshold for severe mania against a global clinical rating, and a score of 20 was the usual trial entry cutoff. A change of about 6.6 points matched a one-point change on the global rating.
  • Remission is usually a score of 12 or below, and response a fall of 50% or more. Trials differ on the exact cutoffs.
Source, license and referencesWhere it comes from

The YMRS was published by Young, Biggs, Ziegler and Meyer in the British Journal of Psychiatry in 1978, and the Royal College of Psychiatrists is credited as the copyright holder in several listings. This page does not reproduce the published anchors. It only adds up the 11 ratings you give from the published scale, and the item descriptions here are written in our own words. For the full scale, use the original paper.

  1. Young RC, Biggs JT, Ziegler VE, Meyer DA. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry. 1978;133:429-435.
  2. Lukasiewicz M, Gerard S, Besnard A, et al. Young Mania Rating Scale: how to interpret the numbers? Determination of a severity threshold and of the minimal clinically significant difference in the EMBLEM cohort. Int J Methods Psychiatr Res. 2013;22(1):46-58.
  3. Yatham LN, Kennedy SH, Parikh SV, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord. 2018;20(2):97-170.

Clinical decision support, not a diagnosis. Each calculator scores a published scale the way its authors intended. A score informs a clinical interview and examination and never replaces them. If you are a patient using this page, please review the result with your clinician. In an emergency, call 911 or call or text 988 in the United States.