Altman Self-Rating Mania Scale [ASRM]
Study Notes: Disorder‑Specific Severity Measures for Adults
Focus: Level 2—Mania—Adult (Altman Self‑Rating Mania Scale [ASRM])
1. Introduction
Disorder‑specific severity measures are standardized tools used to assess the intensity of symptoms for particular psychiatric conditions.
They provide quantitative data that supports diagnosis, treatment planning, monitoring progress, and evaluating outcomes.
For adults, one important tool is the Altman Self‑Rating Mania Scale (ASRM), developed to measure the severity of manic symptoms in individuals with bipolar disorder.
Mania is a hallmark feature of Bipolar I Disorder, characterized by elevated mood, increased energy, decreased need for sleep, and impulsive behaviors.
The ASRM is a brief, validated, self‑report measure that captures the severity of manic symptoms in adults.
2. Understanding Mania
Definition
Mania is a distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least one week (or requiring hospitalization).
It is accompanied by increased activity or energy and significant impairment in functioning.
Key Symptoms
Elevated or irritable mood.
Inflated self‑esteem or grandiosity.
Decreased need for sleep.
Increased talkativeness or pressured speech.
Flight of ideas or racing thoughts.
Distractibility.
Increased goal‑directed activity or psychomotor agitation.
Excessive involvement in risky behaviors (spending sprees, sexual indiscretions, reckless driving).
Impact
Mania can cause severe impairment in occupational, academic, and social domains.
Associated with hospitalization, financial/legal problems, and strained relationships.
Frequently comorbid with substance use disorders and anxiety disorders.
3. The Altman Self‑Rating Mania Scale (ASRM)
Purpose
Designed to quantify severity of manic symptoms in adults.
Used for screening, diagnosis support, and monitoring treatment progress.
Provides a patient‑centered perspective on mood and behavior changes.
Structure
Self‑report questionnaire aligned with DSM criteria.
Contains 5 items assessing frequency and intensity of manic symptoms.
Response scale (0–4 per item):
0 = Absent
1 = Mild
2 = Moderate
3 = Marked
4 = Severe
Domains Assessed
Mood elevation.
Self‑confidence/grandiosity.
Sleep patterns.
Speech patterns.
Activity levels.
4. Scoring and Interpretation
Raw Scores
Each item scored 0–4; total raw score range = 0–20.
Clinical Interpretation
Total Score Severity Level Clinical Interpretation
0–5 Minimal No significant mania symptoms
6–9 Mild Monitor; may not require treatment
10–13 Moderate Consider therapy or medication
≥ 14 Severe Active treatment recommended
Clinical Use
Higher scores indicate greater impairment.
Scores guide treatment planning (e.g., mood stabilizers, psychotherapy).
Repeated administration tracks progress over time.
5. Advantages
Brief and easy to administer (2–3 minutes).
Validated across diverse populations.
Self‑report format empowers patients.
Disorder‑specific: focuses on mania rather than general mood.
Useful for monitoring treatment outcomes longitudinally.
6. Limitations
Relies on self‑report, which may be influenced by bias.
May not capture mixed states (mania + depression).
Requires clinical judgment to interpret results.
Not a substitute for a comprehensive diagnostic interview.
7. Clinical Applications
Screening
Identifies adults at risk for mania in primary care or psychiatric settings.
Monitoring
Tracks symptom changes during pharmacotherapy (e.g., lithium, valproate) or psychotherapy.
Research
Provides standardized data for clinical trials and epidemiological studies.
8. Integration with Value‑Based Care
Aligns with value‑based care models by providing measurable outcomes.
Supports quality improvement initiatives in mental health services.
Facilitates population health management by identifying high‑risk groups.
9. Alignment with IOM Six Aims
Safe: Identifies severe mania early, preventing harm.
Effective: Evidence‑based tool validated in multiple studies.
Patient‑Centered: Self‑report respects patient voice.
Timely: Quick administration reduces delays in diagnosis.
Efficient: Minimizes resource use compared to lengthy interviews.
Equitable: Adaptable to diverse populations and languages.
10. Country Comparison: United States vs Kenya
United States
Mania severity measures integrated into electronic health records.
Used in primary care, psychiatry, and psychology.
Supported by insurance reimbursement for screening.
Kenya
Growing recognition of bipolar disorder as a public health issue.
Challenges: limited mental health professionals, stigma, resource constraints.
ASRM valuable for task‑shifting to community health workers.
Translation and cultural adaptation ongoing.
11. Case Example
Patient M: 36‑year‑old reporting decreased need for sleep, increased energy, and excessive spending.
ASRM score = 15 → Severe mania.
Intervention: Mood stabilizer (lithium) + psychoeducation.
Follow‑up score after 8 weeks = 7 → Mild mania, showing improvement.
12. Future Directions
Digital administration via apps and telehealth platforms.
Integration with wearable devices for real‑time monitoring of mood and activity.
Use in global mental health initiatives to standardize measurement.
Expansion to cross‑cultural validation studies.
13. Conclusion
The ASRM is a valuable tool for assessing and monitoring manic symptoms in adults.
Its brevity, validity, and adaptability make it indispensable in clinical practice and research.
When combined with disorder‑specific severity measures, value‑based care, and IOM aims, it enhances the quality and equity of mental health services globally.
15‑Question Quiz: Altman Self‑Rating Mania Scale (ASRM)
What does the ASRM primarily assess?
a) General anxiety symptoms
b) Mania severity
c) Depression severity
d) PTSD severity
Answer: b
How many items are included in the ASRM?
a) 5
b) 8
c) 10
d) 20
Answer: a
What is the raw score range of the ASRM?
a) 0–10
b) 0–20
c) 0–40
d) 0–50
Answer: b
Which score range indicates severe mania?
a) 0–5
b) 6–9
c) 10–13
d) ≥ 14
Answer: d
Which domain is NOT assessed by the ASRM?
a) Mood elevation
b) Appetite changes
c) Sleep patterns
d) Speech patterns
Answer: b
Which IOM aim does the measure support by identifying severe mania early?
a) Efficient
b) Safe
c) Timely
d) Equitable
Answer: b
Which advantage makes the ASRM widely used?
a) Long administration time
b) Requires specialist only
c) Brief and validated
d) Expensive licensing
Answer: c
Which limitation is most significant?
a) Too short
b) Self‑report bias
c) Requires lab tests
d) Not validated
Answer: b
Which country has integrated mania severity measures into electronic health records?
a) Kenya
b) United States
c) India
d) Brazil
Answer: b
Which country uses ASRM in community health programs despite resource constraints?
a) United States
b) Kenya
c) Germany
d) Japan
Answer: b