Altman Self-Rating Mania Scale

The Altman Self-Rating Mania Scale (ASRM) is a validated, brief self-report instrument that captures the core symptoms of mania and hypomania.

Questions: 5
Duration: 5 min
Original title: Altman Self-Rating Mania Scale
Adaptation: Altman Self-Rating Mania Scale
Authors: Altman E.G., Hedeker D., Peterson J.L., Davis J.M.
Created: 1997

The Altman Self-Rating Mania Scale (ASRM) is a validated, brief self-report instrument that captures the core symptoms of mania and hypomania. Developed to provide clinicians with a rapid, reliable measure of acute mood elevation, it evaluates five fundamental domains: positive mood, self-confidence, sleep patterns, speech, and activity levels. This scale is particularly valuable when assessing patients who may be experiencing a shift toward the manic pole of bipolar disorder.

Relying on a 7-day retrospective window, the ASRM allows clinicians to continuously track fluctuating symptoms and identify early prodromal warning signs before a full episode emerges. Because self-reported insight can sometimes be compromised during severe mania, this measure is best utilized alongside clinical observation. When integrated into routine care, it offers a standardized metric to evaluate treatment response, distinguishing genuine hypomanic acceleration from the healthy return of energy seen after treating depressive episodes.

Example result

Fictitious result, computed from a sample set of answers.

Overall score

10/ 20

The ASRM is a brief self-report questionnaire (5 items) designed to assess the presence and severity of manic and hypomanic symptoms over the past 7 days. It is primarily used in patients with or suspected of having bipolar disorder, for screening purposes, monitoring symptom progression, and assessing response to mood-stabilizing treatment. The 5 items explore positive/elevated mood, self-confidence, need for sleep, speech rate, and activity level.

0–5

None or low

6–20

Probable mania or hypomania

A score of 6 or higher indicates a greater than chance probability of mania or hypomania. Consider assessing further for mania and hypomania and corresponding treatment.

Scoring

Sum, total score from 0 to 20, each item is scored on a 5-point scale (from 0 to 4).

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What the test measures

The ASRM quantifies the severity of manic symptomatology by asking patients to rate their highest level of functioning or disruption over the past week. It captures five core criteria of elevated episodes:

Elevated mood: The degree of subjective euphoria or unusually positive affect.
Grandiosity: Inflated self-esteem and uncharacteristic levels of self-confidence.
Decreased need for sleep: The perceived capacity to function fully despite significantly reduced rest.
Pressured speech: Self-reported increases in talkativeness or the feeling of being unable to stop talking.
Psychomotor agitation: Heightened baseline activity levels across social, sexual, academic, or occupational domains.

This instrument is primarily designed for adult and adolescent psychiatric populations to gauge acute manic severity.

When and why to use it

Clinicians typically deploy the ASRM during intake assessments, ongoing mood tracking, and phase-of-illness transitions. It provides a structured way to formalize symptom reports without disrupting the flow of the session.

Intake screening: To quickly assess for baseline manic symptoms when a patient presents with mood dysregulation or agitation.
Monitoring phase shifts: To detect early hypomanic acceleration and prevent full relapse, especially when conducting a broader case formulation.
Evaluating interventions: To track whether pharmacological or psychotherapeutic adjustments successfully stabilize mood.
Differential support: To distinguish pathological hyperactivity from healthy engagement, ensuring interventions like behavioral activation are not inadvertently prescribed during an escalating manic phase.
Risk assessment: To help contextualize impulsive or reckless actions, differentiating them from isolated maladaptive coping strategies.

Using a validated cut-off score adds an objective anchor to clinical impressions, ensuring that mild but significant hypomanic elevations are not dismissed as mere improvements in mood.

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The questions

There are 5 groups of statements in this questionnaire. Read each group of statements carefully. Choose the one statement in each group that best describes the way you have been feeling for the past week. Please note: The word "occasionally" when used here means once or twice; "often" means several times or more; "frequently" means most of the time.
1. Positive mood / euphoria — choose the statement that best describes you over the past 7 days:
This item assesses the subjective experience of euphoria and unusually elevated affect.
- 0 — I do not feel happier or more cheerful than usual.
- 1 — I occasionally 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 the time.
2. Self-confidence — choose the statement that best describes you over the past 7 days:
This item measures the presence of grandiosity and inflated self-esteem.
- 0 — I do not feel more self-confident than usual.
- 1 — I occasionally feel more self-confident than usual.
- 2 — I often feel more self-confident than usual.
- 3 — I frequently feel more self-confident than usual.
- 4 — I feel extremely self-confident all the time.
3. Need for sleep — choose the statement that best describes you over the past 7 days:
This item targets a hallmark physiological sign of mania by quantifying the reduced requirement for rest without corresponding fatigue.
- 0 — I have not needed less sleep than usual.
- 1 — I have occasionally needed less sleep than usual.
- 2 — I have often needed less sleep than usual.
- 3 — I have frequently needed less sleep than usual.
- 4 — I can go all day and all night without sleep and not feel tired.
4. Rate of speech (talking) — choose the statement that best describes you over the past 7 days:
This item captures self-awareness of pressured speech and significantly increased talkativeness.
- 0 — I do not talk more than usual.
- 1 — I occasionally talk more than usual.
- 2 — I often talk more than usual.
- 3 — I frequently talk more than usual.
- 4 — I talk constantly and cannot be interrupted.
5. Activity level — choose the statement that best describes you over the past 7 days:
This item screens for psychomotor agitation and heightened engagement in goal-directed or impulsive behaviors.
- 0 — I have not been more active (socially, sexually, at work, at home, or at school) than usual.
- 1 — I have occasionally been more active than usual.
- 2 — I have often been more active than usual.
- 3 — I have frequently been more active than usual.
- 4 — I am constantly active, non-stop.