The aim of this paper is to provide an overview of the self-report and interview-based instruments to assess mania/hypomania symptoms and related features, with a focus on 7 selected instruments in widespread use to illustrate their psychometric properties, comparative performance and pros and cons.
A systematic search strategy was devised and queried on Medline from 1973 to 2012 using the terms mania, hypomania, instrument, scale, questionnaire, interview, validity, reliability, psychometric properties and adults, elderly, aged. To be included, a study had to be published in a peer-reviewed journal or book in English or Italian.
Of the 17 self-report instruments identified, two (the Mood Disorder Questionnaire (MDQ) and the Hypomania Checklist-32 (HCL-32), received the most research attention. Although the psychometric properties of these instruments are good, their use as screening instruments to detect hypomania in the community or in patients with depression is partially limited by their low positive predictive value, related to the low prevalence of this condition. Nonetheless, they can be efficiently used to rule out the presence of hypomania. The Altman Self-Rating Mania Scale is increasingly being used to monitor mania symptoms over time by phone or email in patients diagnosed with bipolar disorder because it consists of only 5 items. When the aim is early detection of manic/hypomanic symptoms that a patient may have experienced during their lifetime, the 33-item subset of the MOODS-SR seems promising because it includes the key psychopathology dimensions that better discriminate bipolar from unipolar disorder. Of the interview-based instruments, the Young Mania Rating Scale and the Bech-Rafaelsen Mania Scale are the most widely used outcome measures in clinical trials. Although they were developed more than 30 years ago, they continue to be the gold standard for research purposes. The two instruments have a similar coverage, although the YMRS is preferred over the BRMAS because it includes an item on insight.
Although no instrument can replace the need for accurate clinical diagnosis based on patient history, we argue that the increasing use of self-report instruments to screen bipolar disorder in patients presenting with depression or to monitor mania/hypomania symptoms over time may contribute to increasing the use of routine standardized assessment. Measurement-based care as the standard of care has the potential to transform psychiatric practice, move psychiatry into the mainstream of medicine, and ultimately improve the quality of care for patients with psychiatric illness.