Recognizing the early signs of mania

— In the fast-paced world of mental health care, where mood swings can upend lives overnight, a compact questionnaire from nearly three decades ago can be used for self-management for those with bipolar disorder. 

The Altman Self-Rating Mania Scale, or ASRM, offers a quick snapshot of manic or hypomanic episodes, helping patients and clinicians spot trouble early and adjust treatments before crises erupt.

Developed in 1997 by psychiatrist Edward G. Altman and colleagues at the University of Illinois at Chicago, the ASRM emerged from a need for accessible screening tools amid limited options for self-reported mania assessments. 

Published in the journal Biological Psychiatry, the scale was tested on 105 patients, including those with schizophrenia, schizoaffective disorder, depression and acute mania. 

It demonstrated strong reliability, with scores above 5 showing 85.5% sensitivity and 87.3% specificity for detecting mania when compared to clinician-rated scales like the Clinician-Administered Rating Scale for Mania.

Unlike lengthier clinician-led evaluations, the ASRM’s five items — covering mood, self-confidence, sleep, speech and activity — take just minutes to complete, rating experiences over the past week on a 0-4 scale. 

Total scores range from 0 to 20, with anything over 6 signaling potential hypomania or mania, and scores above 10 indicating moderate to severe symptoms. This brevity makes it ideal for outpatient visits, telehealth sessions or even daily journaling, experts say.

As awareness of bipolar disorder grows, fueled by high-profile disclosures from celebrities like Selena Gomez and Mariah Carey, tools like the ASRM underscore a shift toward patient empowerment. In an era of apps and wearables tracking everything from steps to sleep, this low-tech staple reminds us that sometimes, a few honest questions can light the path to stability.

Easy-to-Use Guide: How to Complete and Interpret the ASRM

The ASRM is a free, self-administered tool for adults. It’s best used weekly or during suspected mood shifts, but always discuss results with a mental health professional. Step 1: Prepare

• Find a quiet spot and reflect on the past 7 days.
• Rate based on how you’ve felt compared to your usual baseline (e.g., if you normally need 8 hours of sleep, note changes from that).
• Each of the 5 items has 5 response options. Circle or note the one that best fits — no “in-between” choices.

Step 2: Answer the Questions

Rate each on a scale where higher numbers mean more severe symptoms (scoring: 0 = minimal/none, 4 = extreme).

1. Mood (Unusually happy or cheerful)
   • 0: I do not feel happier or more cheerful than usual.
   • 1: I sometimes feel happier or more cheerful than usual.
   • 2: I often feel happier or more cheerful than usual.
   • 3: I feel happier or more cheerful than usual most of the time.
   • 4: I feel happier or more cheerful than usual all of the time.
2. Self-Confidence (Increased self-esteem)

1. 0: I do not feel more self-confident than usual.
2. 1: I sometimes feel more self-confident than usual.
3. 2: I often feel more self-confident than usual.
4. 3: I feel more self-confident than usual most of the time.
5. 4: I feel more self-confident than usual all of the time.
6. Sleep (Decreased need for sleep)

1. 0: I do not get less sleep than usual.
2. 1: I sometimes get less sleep than usual.
3. 2: I often get less sleep than usual.
4. 3: I get much less sleep than usual.
5. 4: I hardly sleep at all.
6. Speech (More talkative or speak faster)

1. 0: I do not talk more or faster than usual.
2. 1: I sometimes talk more or faster than usual.
3. 2: I often talk more or faster than usual.
4. 3: I talk much more or faster than usual.
5. 4: I talk constantly or much too fast.
6. Activity (Increased activity or restlessness)

1. 0: I am no more active or restless than usual.
2. 1: I am sometimes more active or restless than usual.
3. 2: I am often more active or restless than usual.
4. 3: I am constantly active or on the go all the time.
5. 4: I am extremely restless and unable to sit still.

Step 3: Score It

• Assign points: Option 1 = 0, Option 2 = 1, Option 3 = 2, Option 4 = 3, Option 5 = 4.
• Add up all 5 items for a total score (range: 0-20).

Score Range	Interpretation	Next Steps
0-5	Minimal or no manic symptoms (normal range)	Continue routine monitoring; no immediate action needed.
6-10	Mild hypomania possible	Track daily; share with your doctor if persistent. Consider lifestyle tweaks like consistent sleep.
11-14	Moderate mania symptoms	Contact your clinician promptly for evaluation; may need medication adjustment.
15-20	Severe mania likely	Seek urgent care — call your provider, crisis line (e.g., 988 in the U.S.), or go to ER if safety is at risk.

Tips for Success

• Track trends: Log scores over time to spot patterns (e.g., in a journal or app).
• Limitations: This screens for symptoms but doesn’t diagnose. Factors like medications or stress can influence results.
• When to seek help: If scores rise suddenly or you feel out of control, prioritize professional support. The ASRM shines in combo with therapy or meds.
• Resources: APA’s DSM-5 tools (psychiatry.org); PubMed for studies; or apps like Daylio for mood logging.

Remember, this guide is informational — consult a qualified professional for personalized advice.

Comment from a reader: This is a great tool to use, if you have a decent amount of self-awareness about yourself during a manic episode. If you score high, please take it as a warning. While everything may feel great now, there will be a crash. It is hard to see it coming. Please seek professional help for an evaluation to get yourself on the right track.