Patient- and family-rated scale for bipolar disorder symptoms: Internal State Scale

The monitoring of patients, by themselves and their caregivers, is very important in the prophylaxis of bipolar disorder. This study aimed to develop a Chinese-language version of an instrument for assessment of manic and depressive symptoms by patients and their families. Fifty-eight inpatients and outpatients with a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) diagnosis of bipolar disorder were recruited. All subjects underwent clinical psychopathologic assessment by experienced psychiatrists using the Young Mania Rating Scale (YMRS) and the Hamilton Depression Rating Scale (HDRS). At the same time, each patient and key family members filled out the Chinese-language version of the Internal State Scale (ISS) for monitoring mental symptoms. Patients were examined a second time if they had entered remission or a new episode of the opposite polarity. The ISS was divided into two subscales, of well-being/activation and of irritability. Patients' well-being/activation and irritability subscales were significantly correlated with YMRS scores and the well-being/activation subscale was also significantly correlated with the HDRS score. Family members' irritability subscales were significantly correlated with HDRS scores only. The reliability and constructive validity of the ISS was good in both patients with bipolar disorder and their families.