Altman Self-Rating Mania Scale

The Altman Self-Rating Mania Scale (ASRM) is a brief, five-item self-report questionnaire that screens for the presence and severity of manic and hypomanic symptoms. Patients rate recent experiences across five statements, and clinicians use the total score to gauge symptom burden, support bipolar spectrum screening, and track how mania-related symptoms change over time.

Why healthcare providers use the ASRM

Fast screening. Five items take most patients about a minute, so screening fits easily into intake.
Patient perspective. Self-report captures how the patient experiences mood, energy, and sleep in their own words.
Symptom tracking. Because it is brief, you can repeat it to see whether manic symptoms rise or ease.
Bipolar workups. It complements depression screening when you are assessing the bipolar spectrum.
Low burden. The short, plain-language format suits a wide range of reading levels and clinic settings.

Which settings use the ASRM?

Psychiatry clinics. Used during evaluation and ongoing management of mood disorders.
Primary care. Helps flag possible manic or hypomanic symptoms that warrant referral.
Behavioral health. Therapists and counselors use it to monitor mood between sessions.
Inpatient and crisis units. Supports rapid symptom checks during acute presentations.

What does the ASRM measure?

The ASRM asks patients to rate recent experiences across five statements that map to the core features of mania and hypomania. It focuses on observable changes from a person's usual baseline rather than on any single diagnostic criterion. The five items cover the following domains.

Elevated mood. Feeling happier or more cheerful than usual.
Self-confidence. Increased self-assurance or sense of importance.
Reduced need for sleep. Sleeping less while still feeling rested.
Increased speech. Talking more or faster than normal.
Heightened activity. More energy or physical activity than is typical.

Scoring the ASRM

Number of items: 5.
Per-item scale: 0 to 4, where 0 is no change from baseline and 4 is the most severe presentation.
Total score range: 0 to 20.
Score direction: higher totals indicate more prominent manic or hypomanic symptoms.

The ASRM is a screening and monitoring tool, not a diagnostic test. It has a single recognized cutoff rather than graded severity bands, so a total should be read as a probability signal and interpreted alongside clinical history and observation. A score of 6 or higher is the most commonly cited threshold for possible mania or hypomania, and it guides clinical decision-making rather than confirming a diagnosis.

Score	Interpretation	Suggested next step
0 to 5	Lower probability of mania or hypomania	Monitor
6 to 20	Elevated probability of mania or hypomania	Consider further assessment

Best practices for administration

Set the time frame. Ask patients to reflect on the past week so ratings stay consistent.
Explain baseline. Clarify that each rating compares the current state to their usual self.
Administer before the visit. Completing it ahead of time frees the appointment for discussion.
Pair with other measures. Combine it with depression and risk screening for a fuller picture.
Repeat consistently. Use the same schedule so score trends stay comparable over time.

How Zentake helps with the ASRM

Automatic scoring. Totals are calculated the moment a patient submits, with no hand-tallying.
Longitudinal tracking. Re-send the scale on a schedule and view how scores change over time.
Before the visit. Patients complete it from home on any device, so mental health practices start the appointment already informed.
HIPAA compliant. Data is encrypted, with a signed BAA on every plan.

References

The ASRM was developed and validated by Altman, Hedeker, Peterson, and Davis and published in Biological Psychiatry in 1997 as a five-item self-report companion to clinician-rated mania scales. See Altman EG, et al. The Altman Self-Rating Mania Scale. Biol Psychiatry. 1997;42(10):948-955.

A screening cutoff of 6 or higher, based on a threshold of 5.5, has been reported to yield sensitivity and specificity of roughly 85 to 86 percent for identifying mania or hypomania. The scale is included among the DSM-5 emerging measures and is freely available for clinical and research use. Clinicians should treat the total as a screening signal and confirm findings through full clinical assessment.

Last updated: August 2026.

Altman Self-Rating Mania Scale questions, answered.

What is the ASRM used for?

The ASRM screens for manic and hypomanic symptoms and gauges their severity. Clinicians use it to support bipolar spectrum assessment, to decide whether a fuller evaluation is warranted, and to track how symptoms change across visits. It is a self-report tool that guides clinical decision-making rather than confirming a diagnosis on its own.

How many items does the ASRM have?

The ASRM contains five items, each covering a different area of manic symptoms: elevated mood, self-confidence, sleep, speech, and activity level. Each item offers five statements scored from 0 to 4, so the questionnaire is short enough for most patients to finish in about a minute before their appointment.

How is the ASRM scored?

You add the five item scores to produce a total ranging from 0 to 20. Higher totals reflect more prominent manic or hypomanic symptoms. Each item is rated from 0, meaning no change from baseline, to 4, meaning the most severe presentation. Zentake calculates the total automatically when the patient submits the form.

What ASRM score suggests mania?

In the original validation, a total score of 6 or higher provided the best balance of sensitivity and specificity for detecting mania or hypomania. A score at or above this threshold prompts follow-up and consideration of further assessment. Scores below 6 suggest a lower probability but never rule out a mood episode entirely.

Is the ASRM a diagnostic test?

No. The ASRM is a screening and monitoring instrument, not a diagnostic test. A raised score signals that manic or hypomanic symptoms may be present and that further evaluation is worthwhile. A clinician interprets the result alongside history, observation, and other measures before reaching any diagnosis or treatment decision.

How often can the ASRM be repeated?

Because it is brief and self-administered, the ASRM can be repeated at each visit or on a set schedule. Repeating it lets clinicians see whether manic symptoms are rising or easing over time. In Zentake you can re-send it automatically and view score changes across a patient's history.