Altman Self-Rating Mania Scale (ASRM)

Key Takeaways

The Altman Self-Rating Mania Scale (ASRM) is a validated 5-item screening tool for assessing manic and hypomanic symptoms in bipolar disorder.

A score of 6 or higher indicates probable mania; the scale is designated as the DSM-5 Level 2 Mania measure for adults.

The ASRM takes 2-3 minutes to complete and covers mood, confidence, sleep, speech, and activity level over one week.

Pabau’s digital forms and mental health practice management software enables clinicians to administer and track ASRM scores within secure clinical records.

The Altman Self-Rating Mania Scale (ASRM) is one of the fastest ways to screen for manic and hypomanic symptoms in routine practice. This guide reproduces the full five-item scale, explains how the 0–20 score is interpreted, reviews the evidence behind it, and shows how to fold it into psychiatric assessment workflows. You can download a ready-to-use copy above.

What is the Altman self-rating mania scale (ASRM)?

The Altman Self-Rating Mania Scale (ASRM) is a 5-item self-administered questionnaire designed to assess the presence and severity of manic and hypomanic symptoms. Developed in 1997 by Dr. Edward Altman and colleagues, the ASRM provides clinicians and researchers with a quick, validated screening tool for detecting mood elevation in patients with bipolar disorder, schizoaffective disorder, and other conditions characterized by manic episodes.

The scale asks patients to rate five dimensions of mania — elevated mood, increased self-confidence, reduced need for sleep, increased talkativeness, and increased activity level — over a one-week period. Each item is scored 0-4, for a total possible score of 20. The ASRM is now officially designated as the DSM-5 Level 2 Cross-Cutting Measure for Mania in Adults by the American Psychiatric Association, cementing its role in standardized clinical assessment.

Unlike the clinician-administered Young Mania Rating Scale (YMRS), the ASRM is self-rated, making it ideal for routine screening, repeated symptom monitoring, and treatment response tracking in psychiatry practice management workflows.

The 5 items of the Altman Self-Rating Mania Scale

The ASRM is in the public domain as part of the American Psychiatric Association’s DSM-5 cross-cutting measures, so you can reproduce and use it freely. Patients read each group of statements and choose the one that best describes how they have felt over the past week. Score each item from 0 to 4, then add the five items for a total of 0–20.

A note on wording: “occasionally” means once or twice, “often” means several times or more, and “frequently” means most of the time.

Item 1: Mood

• 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 of the time.

Item 2: Self-confidence

• 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 feel more self-confident than usual.
• 4 — I feel extremely self-confident all of the time.

Item 3: Sleep

• 0 — I do not need less sleep than usual.
• 1 — I occasionally need less sleep than usual.
• 2 — I often need less sleep than usual.
• 3 — I frequently need less sleep than usual.
• 4 — I can go all day and night without any sleep and still not feel tired.

Item 4: Speech

• 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.

Item 5: Activity level

• 0 — I have not been more active (socially, sexually, at work, home, or 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 or on the go all the time.

Add the five item scores for a total of 0–20. A total of 6 or higher indicates a high probability of a manic or hypomanic condition and warrants further clinical assessment. Permission for use granted by E.G. Altman, MD.

How to use the Altman Self-Rating Mania Scale in clinical practice

Administering the ASRM involves five straightforward steps that fit seamlessly into routine practice workflows:

1. Introduce the measure at intake or follow-up. Present the ASRM as part of the psychiatric assessment process, explaining that it helps track mood symptoms over time. Frame it as a standard screening questionnaire, not a diagnostic label.
2. Have the patient complete the 5-item form in the waiting area or during the appointment. The ASRM typically takes 2-3 minutes. Digital administration via digital assessment forms reduces transcription errors and supports immediate score calculation.
3. Calculate the total score by summing item responses. Scores range from 0-20. A score of 6 or higher suggests probable manic or hypomanic symptoms; scores below 6 typically indicate euthymic (normal) or subsyndromal mood states.
4. Document the score and date in the patient’s clinical record. Record the ASRM result alongside the appointment date and clinical context (e.g., “ASRM 8, patient reports elevated mood and racing thoughts; currently on lithium 1200 mg daily”).
5. Use the result to inform treatment decisions. Escalating scores may warrant medication adjustment, increased appointment frequency, or specialist referral. Declining scores suggest treatment response and support de-escalation planning.

Integration into secure clinical records allows clinicians to track ASRM trends over months and years, supporting long-term bipolar disorder management.

ASRM scoring and interpretation thresholds

The Altman Self-Rating Mania Scale scoring system is straightforward and clinically meaningful. Each of the five items is rated on a 0-4 scale, yielding a total score between 0 and 20.

The threshold of 6 or higher has demonstrated good sensitivity and specificity for detecting probable mania in research and clinical populations. However, the ASRM is a screening tool, not a diagnostic instrument — a high score requires clinical confirmation through structured diagnostic interviews and assessment of functional impairment.

Who is the ASRM helpful for?

The Altman Self-Rating Mania Scale is applicable across multiple clinical settings and patient populations:

• Adults with diagnosed bipolar I or bipolar II disorder requiring routine symptom monitoring and treatment tracking.
• Patients in psychiatric or psychology practices undergoing initial assessment for suspected mood disorder.
• Individuals in mental health or counseling settings presenting with mood concerns or family history of bipolar illness.
• Patients in general medical practices or integrated care settings where mental health screening is part of holistic assessment.
• Research cohorts evaluating manic symptom severity in clinical trials or epidemiological studies.

An adapted version for adolescents (ages 11-17) is also available via the APA DSM-5 portal, enabling psychology practice software to standardize assessment across pediatric and adult populations.

Benefits of using the ASRM in your practice

Integrating the ASRM into routine psychiatric and psychological care delivers multiple clinical and operational benefits:

• Rapid screening. The 5-item format takes 2-3 minutes, reducing appointment time burden while maintaining clinical rigor.
• Validated measurement. Published validation studies confirm the ASRM’s reliability and concurrent validity against clinician-administered scales (CARS-M, MRS).
• Longitudinal tracking. Serial ASRM administrations over weeks and months create objective trends that guide medication adjustments and treatment planning.
• DSM-5 alignment. Official designation as the Level 2 Mania measure supports diagnostic accuracy and regulatory compliance in clinical documentation.
• Patient engagement. Self-rating empowers patients to report their own mood experiences, improving patient engagement in their mental health care.
• Workflow efficiency. Digital administration and automated scoring via automated clinical workflows reduces manual data entry and errors.

Reliability, validity, and clinical evidence

The Altman Self-Rating Mania Scale has been rigorously tested in peer-reviewed research. The original validation study (Altman et al., 1997) evaluated the ASRM in a sample of 105 patients (22 schizophrenic, 13 schizoaffective, 36 depressed, and 34 manic). The scale demonstrated strong internal consistency (Cronbach’s alpha 0.79) and excellent concurrent validity against the Clinician-Administered Rating Scale for Mania (CARS-M, r = 0.77) and the Mania Rating Scale (MRS, r = 0.70).

Subsequent international studies, including Greek (2021) and Persian (2025) validations, have confirmed the ASRM’s reliability and applicability across diverse populations and healthcare systems. In the original validation, a cutoff score of 6 or higher produced a sensitivity of 85.5% and a specificity of 87.3% for detecting manic or hypomanic episodes.

A 14-item extended version (ASRM-14) has also been developed for research contexts requiring more detailed symptom assessment, though the 5-item version remains the standard for routine clinical use.

Limitations and important considerations

While the ASRM is a valuable screening tool, clinicians should understand its constraints:

• Self-report bias in acute mania. During severe manic episodes, patients may lack insight into their symptoms (anosognosia), leading to underestimation of manic severity on self-report scales. Clinician observation and collateral history are essential during acute presentations.
• Not a diagnostic tool. The ASRM screens for probable mania but does not confirm a bipolar disorder diagnosis. Clinical interviews, duration assessment (manic episodes require ≥7 consecutive days of symptoms), and functional impairment evaluation remain necessary.
• Limited coverage of depressive symptoms. The ASRM focuses exclusively on mania and hypomania. Comprehensive bipolar assessment requires parallel depression screening tools (e.g., PHQ-9) to capture the full mood spectrum.
• Comorbidity considerations. Elevated ASRM scores can also be observed in attention-deficit/hyperactivity disorder (ADHD), anxiety disorders, and substance use, requiring clinical differentiation.
• Cultural and linguistic adaptation needed. While validated translations exist, clinicians should verify that their patient populations have access to culturally adapted ASRM versions.

Best practice integrates the ASRM with clinical documentation best practices, including structured diagnostic interviews and contextual clinical notes supporting interpretation.

ASRM in clinical practice: a workflow example

Consider a typical outpatient psychiatry scenario: A 34-year-old patient with bipolar II disorder presents for monthly medication monitoring. At check-in, the front desk staff provide a digital ASRM questionnaire via the practice’s secure patient portal. The patient completes it in the waiting room (2 minutes). The score (7) appears in the clinician’s notes before the appointment, prompting a focused assessment of recent mood fluctuations.

The clinician reviews the score during the visit, asks targeted follow-up questions about sleep and goal-directed activity, and adjusts lamotrigine dosing based on the combination of ASRM score, clinical interview, and patient-reported functional status. The result is documented in the clinical record, creating a longitudinal dashboard that tracks mood stability over 12 months of treatment.

This workflow becomes seamless when mental health teams adopt patient care management systems supporting standardized assessment integration.

ASRM vs. other mania rating scales

Several clinician- and self-rated mania scales exist. The ASRM differs from alternatives in important ways: