Altman Self-Rating Mania Scale (ASRM): A Full Guide for Researchers and Clinicians
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The Altman Self-Rating Mania Scale (ASRM) is a 5-item self-report measure of manic symptoms. Learn its scoring, cut-off, reliability and clinical uses.
Introduction
The Altman Self-Rating Mania Scale (ASRM) is a brief self-rating scale that measures the presence and severity of manic symptoms. Edward G. Altman, Donald Hedeker, James L. Peterson and John M. Davis published it in 1997. With just five items, it serves clinical care and research, including tracking change after treatment.
The authors were based at the University of Illinois at Chicago, and the original study appeared in Biological Psychiatry. Since then, the ASRM has received more than 1,140 citations. This guide explains its items, scoring, cut-off, psychometric evidence and practical uses.
Key Features of the Altman Self-Rating Mania Scale (ASRM)
Purpose and Use
The developers designed the ASRM to measure the presence and severity of manic symptoms for clinical and research purposes. In addition, it helps assess how symptoms change after treatment.
Target Population
The ASRM targets adults aged 18 and older, including:
Young adults (18–24 years)Middle-aged adults (25–44 years)Older adults (45–64 years)Seniors (65+ years)Structure
The final ASRM contains 5 items, each covering a core manic symptom:
Elevated or euphoric moodIncreased self-esteemDecreased need for sleepPressured speechPsychomotor agitationNotably, the original 14-item version also included psychotic and irritability-related items. However, the developers dropped them because they did not adequately differentiate manic from nonmanic patients.
Scoring Method
For each item, respondents choose one of five statements describing their symptoms during the past week. Each item scores from 0 to 4.
Total score: the sum of the five items, ranging from 0 to 20.Development study: the original analysis used the mania subscale as a 0–15 score.Cut-off: a score greater than 5 (that is, 6 or more) distinguished manic from nonmanic patients, with 85.5% sensitivity and 87.3% specificity.Administration Format
The ASRM is self-administered and needs no special training. Most respondents finish it in less than 5 minutes. Moreover, it works in several formats:
Paper-basedDigital (online)In-person interviewPhone or video callApplications of the Altman Self-Rating Mania Scale (ASRM)
The ASRM supports four main uses:
Screening: identifying the presence of manic symptoms.Monitoring: tracking symptom severity over time and after treatment.Treatment planning: informing decisions with a brief measure of current symptoms.Research: rating manic symptom severity in clinical studies.Languages and availability
Besides English, researchers have adapted and studied the ASRM in several languages:
Spanish: translation and adaptationGreek: reliability and validity studyPersian: psychometric assessment in bipolar spectrum disorderKorean: preliminary validation in a non-clinical sampleThe ASRM is free for researchers, and clinicians can reproduce it for use with their patients without permission. However, Elsevier holds the copyright, so any other use requires permission from Elsevier.
Reliability and Validity
The ASRM is considered highly reliable and valid. It shows a Cronbach's alpha of 0.79, and test–retest correlations were 0.86, 0.89 and 0.89 for the three original subscales. Furthermore, the final five-item scale showed good concurrent validity in the original inpatient psychiatric sample.
Validation studies:
The Altman Self-Rating Mania Scale (1997): study linkTranslation and adaptation in the Spanish environment (2005): study linkReliability, validity and psychometric properties of the Greek version (2021): study linkLimitations and Considerations
Keep these points in mind when using the ASRM:
Not a diagnostic tool: the authors caution against using it alone to diagnose bipolar disorder.Mixed states: it is not suitable for assessing mixed states without an additional depression measure.Self-report measure: scores reflect how respondents rate their own symptoms.Narrow focus: five items cover core manic symptoms only.Age restrictions: it targets adults aged 18 and older.Other Versions And Related Questionnaires
An earlier, longer version also exists: the 14-Item Altman Self-Rating Mania Scale (ASRM-14). In addition, these questionnaires are similar or complementary:
Internal State Scale (ISS)Mania Rating Scale (MRS)For hypomanic symptoms, see the ResRef guide to the Hypomania Checklist-32 (HCL-32)Additional Resources
The original study on PubMed: linkYou can access the ASRM as a PDF through this linkFor inquiries, contact Edward Altman, PsyD, University of Illinois at Chicago, 1601 West Taylor Street, Chicago, IL 60612, at ealtman@ameritech.net.Browse more psychiatry questionnaires in the ResRef database.Frequently Asked Questions (FAQ)
What does the Altman Self-Rating Mania Scale measure?The ASRM measures the presence and severity of manic symptoms over the past week. Its five items cover elevated mood, self-esteem, need for sleep, speech and psychomotor agitation.
How is the ASRM scored?Each item scores 0 to 4, and the five items add up to a total of 0 to 20. In the development study, a score above 5 separated manic from nonmanic patients with 85.5% sensitivity.
Can the ASRM diagnose bipolar disorder?No. The authors caution against using the ASRM alone to diagnose bipolar disorder. It also needs an additional depression measure when mixed states are a concern.
Is the ASRM free to use?Yes, for research and for clinicians using it with their patients, who can reproduce it without permission. Elsevier holds the copyright, so other uses need permission from Elsevier.
A Word from ResRef About the Altman Self-Rating Mania Scale (ASRM)
The ASRM is a brief self-report instrument designed to assess the presence and severity of manic symptoms, particularly in clinical and research settings. The final five-item scale demonstrated good test-retest reliability and concurrent validity in the original inpatient psychiatric sample. The authors caution that it should not be used alone to diagnose bipolar disorder and is not suitable for assessing mixed states without an additional depression measure.
References
Altman, E. G., Hedeker, D., Peterson, J. L., & Davis, J. M. (1997). The Altman Self-Rating Mania Scale. Biological Psychiatry, 42(10), 948–55. https://doi.org/10.1016/S0006-3223(96)00548-3Alvarez Mas, P., Benavent Rodríguez, P., García Valls, J. M., Livianos Aldana, L., & Rojo Moreno, L. (2005). [Translation and adaptation in the Spanish environment of the Altman Self-Rating Mania Scale]. Actas Espanolas de Psiquiatria, 33(3), 180–7. https://pubmed.ncbi.nlm.nih.gov/15918086/Skokou, M., Asimakopoulou, R., Andreopoulou, O., Kolettis, G., Perrou, S., Gourzis, P., & Daskalaki, S. (2021). Reliability, validity and psychometric properties of the Greek version of the Altman self rating mania scale. Comprehensive Psychiatry, 109, 152243. https://doi.org/10.1016/j.comppsych.2021.152243Kim, B. N., & Kwon, S. M. (2017). Initial Psychometric Properties of the Korean Altman Self-Rating Mania Scale: Preliminary Validation Study in a Non-Clinical Sample. Psychiatry Investigation, 14(5), 562–567. https://doi.org/10.4306/pi.2017.14.5.562