Interactive Interpreter

Young Mania Rating Scale (YMRS): Scoring and Cutoffs

The YMRS (Young Mania Rating Scale) is an 11-item clinician-rated scale that measures the severity of manic symptoms over the preceding 48 hours, mainly in bipolar disorder. Totals run 0–60, with bands linked to CGI-S ratings: ≤11 minimal, 12–19 mild, 20–29 moderate, 30–39 markedly severe and ≥40 extremely severe.

For professional reference, research, and education only. Not for diagnosis or medical advice.

YMRS Score Interpreter

  • Enter a total score to see its range.

  • 11 items; items 5, 6, 8, 9 scored 0–8 (double-weighted); remaining items 0–4. Higher scores indicate greater manic symptom severity. Clinician-administered over the preceding 48 hours.

    Total scoreInterpretation
    40+Extremely severeCorresponds to 'severely to most extremely ill' on the CGI-S. Scores in this range were associated with the most impaired patients across 8 randomized controlled trials.
    30–39Markedly severeCorresponds to 'markedly ill' on the CGI-S. Typical range associated with acute manic episodes requiring intensive treatment.
    20–29ModerateCorresponds to 'moderately ill' on the CGI-S. A score of 20 is the common entry threshold for acute mania trials (Lukasiewicz et al., 2013).
    12–19MildCorresponds to 'mildly ill' on the CGI-S. A score ≤12 is the widely cited remission threshold in clinical trials (Patel et al., 2007).
    0–11Minimal / remission rangeScores below the remission threshold. Persistent low-level symptoms may still warrant clinical monitoring.

    Samara MT, Levine SZ, Leucht S. Pharmacopsychiatry. 2023;56(1):18–24. YMRS–CGI-S equipercentile linkage (N=2,988 across 8 randomized trials). Score anchors correspond to CGI-S severity levels.

The YMRS (Young Mania Rating Scale) is an 11-item clinician-administered scale that rates the severity of manic symptoms, mainly in bipolar disorder [1]. Totals run 0 to 60.

What does the YMRS measure?

The YMRS was introduced in 1978 as an eleven-item clinician-administered mania rating scale [1]. A 2023 linking study describes it as the reference standard for assessing manic symptoms of bipolar disorder [3].

Items cover the core domains of a manic episode: elevated mood, increased motor activity, sexual interest, reduced sleep, irritability, pressured speech, thought disorder, grandiose content, disruptive behaviour, appearance changes, and impaired insight. Seven items are scored 0–4; four items (irritability, speech, content, and disruptive-aggressive behaviour) are weighted and scored 0–8. Total scores range from 0 to 60.

How do you give the YMRS?

The YMRS is designed for clinician administration [1]. Clinical judgment is needed for accurate scoring, particularly for thought disorder, content (delusions/hallucinations) and disruptive-aggressive behaviour.

  • Window. Each item is rated over the past 48 hours (or since the last assessment).
  • Weighting. Items 5, 6, 8 and 9 are weighted double (scored 0–8); the remaining items are scored 0–4.
  • Range. Totals run 0 to 60.

Educational and training purposes only. Not a substitute for trained clinician assessment.

How do you score and interpret the YMRS?

Total score = sum of all 11 items (items 5, 6, 8, 9 scored 0-8; remaining items 0-4). Score range: 0-60. Use the score interpreter above to look up the severity band; the band anchors come from an equipercentile linkage of YMRS scores to CGI-S ratings in 2,988 trial participants [3].

What is a clinically meaningful change on the YMRS?

  • Minimal clinically significant difference. 6.6 points, in a cohort of 3,459 adults with acute manic or mixed states [4].
  • Linked to CGI improvement. "Minimally improved" corresponded to a drop of about 4 to 8 points (21% to 29% of baseline), and "much improved" to 10 to 15 points (42% to 53%) [3].
  • Response and remission. Common definitions are a reduction of 50% or more from baseline for response and a score of 12 or less for remission; in adolescents, 55% was the optimal response cutoff and 12 the optimal remission cutoff [2].

These thresholds vary by study protocol and clinical context.

Psychometric properties

  • Original study [1]: Interrater correlation was 0.93 for the total score and 0.66 to 0.92 for individual items. Scores correlated highly with an independent global rating and with two other mania scales, correlated with subsequent length of hospital stay, and distinguished participants before and after two weeks of treatment.
  • Severity threshold and MCSD [4]: In 3,459 adults with acute manic or mixed states, the optimal threshold for marked severity was 25, and the minimal clinically significant difference was 6.6 points.
  • CGI-S linkage [3]: In 2,988 participants from eight randomized trials, YMRS scores of about 6, 12, 20, 30, 40 and 52 corresponded to borderline, mildly, moderately, markedly, severely and among the most extremely ill on the CGI-S.
  • Adolescents [2]: In 99 adolescents with acute mania, a reduction of 55% or more was the optimal response cutoff and an endpoint score of 12 or less the optimal remission cutoff.

Limitations

  • Not a diagnosis. The YMRS measures current manic symptom severity; it does not diagnose bipolar disorder.
  • Requires clinical judgement. Items such as thought disorder, content and disruptive-aggressive behaviour need a trained rater.
  • Thresholds vary. Remission (often ≤12), response (≥50% or ≥55% reduction) and severity thresholds (20 as a typical trial entry cutoff, 25 for marked severity) differ between studies and populations [2] [4].
  • Short window. Ratings cover the preceding 48 hours, so a single score reflects current state only.
  • Mania only. It does not assess depressive symptoms; pair it with a depression measure such as the MADRS in bipolar disorder.

YMRS item structure

The YMRS covers 11 symptom domains. Four items are weighted double (scored 0–8).

YMRS vs MDQ for bipolar assessment

The YMRS and MDQ serve different purposes in bipolar disorder assessment: one measures current mania severity, the other screens for lifetime bipolar disorder history.

For individuals: This page is a clinical reference, not a diagnostic tool. If you have concerns about your own symptoms, bring this information to a qualified mental health professional.

Related

FAQ

  • Is the YMRS clinician-administered or a self-report measure?

    The YMRS is a clinician-administered rating scale. Accurate scoring of several items, such as thought disorder, grandiose content and disruptive-aggressive behaviour, requires clinical judgment that self-report cannot reliably replace. Self-report adaptations exist in the research literature but are not the standard administration format.

  • What YMRS score indicates remission from mania?

    A total score of ≤12 is the most widely cited threshold for remission, supported by a signal detection analysis in adolescents comparing YMRS scores against clinician global impression ratings. Some protocols use a stricter criterion. These thresholds are outcome conventions used in clinical trials and should be interpreted within the broader clinical picture.

  • How is the YMRS scored?

    Eleven items are rated over the preceding 48 hours. Seven items are scored on a 0–4 scale. Four items (irritability, speech, thought content and disruptive-aggressive behaviour) are weighted and scored 0–8 to reflect their greater clinical significance in distinguishing mania severity. Total scores range from 0 to 60.

  • Can the YMRS be used to diagnose bipolar disorder?

    No. The YMRS measures the current severity of manic symptoms; it does not provide a diagnosis of bipolar disorder or any other condition. Diagnosis requires comprehensive clinical evaluation according to established diagnostic criteria. The YMRS is used to track symptom severity over time and to assess treatment response.

References

    1. 1.Young RC, Biggs JT, Ziegler VE, Meyer DA. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry. 1978;133(5):429-435.
    2. 2.Patel NC, Patrick DM, Youngstrom EA, Strakowski SM, DelBello MP. Response and remission in adolescent mania: signal detection analyses of the Young Mania Rating Scale. J Am Acad Child Adolesc Psychiatry. 2007;46(5):628-635.
    3. 3.Samara MT, Levine SZ, Leucht S. Linkage of Young Mania Rating Scale to Clinical Global Impression Scale to Enhance Utility in Clinical Practice and Research Trials. Pharmacopsychiatry. 2023;56(1):18-24.
    4. 4.Lukasiewicz M, Gerard S, Besnard A, et al. Young Mania Rating Scale: how to interpret the numbers? Determination of a severity threshold and of the minimal clinically significant difference in the EMBLEM cohort. Int J Methods Psychiatr Res. 2013;22(1):46-58.

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