Measuring mania and critical appraisal of rating scales

In clinical trials of acute mania, a number of measures have been used to assess the severity of illness and its response to treatment. Rating instruments need to be validated in order for a clinical study to provide reliable and meaningful estimates of treatment effects.

To critically assess rating scales used in measuring mania.

A systematic search of the literature, retrieval of reports of clinical trials of drugs used in mania and the rating scales and a critical and systematic appraisal of their quality.

Eight symptom-rating scales were identified. The Mania Rating Scale (MRS) was the most commonly used for assessing treatment response. Two more recently developed scales are the Manchester Nurse Rating Scale for Mania (MNRS-M) and the Clinician-Administered Rating Scale for Mania (CARS-M). The latter appears well validated but its in-use reliability needs to be explored further. The translation of observed changes in instrumental ratings into clinically meaningful change has to be established further. In particular, the relative weighting to be attached to the individual items needs further study. The advantage of the MRS is that there is a relatively extensive database of studies based on it and this will no doubt ensure that it remains a gold standard for the foreseeable future.

Useful rating scales are available for measuring mania but further cross-validation and validation against clinically meaningful global changes are required.