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Clinician-Administered Rating Scale for Mania
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About Clinician-Administered Rating Scale for Mania
Scale Name
Clinician-Administered Rating Scale for Mania
Author Details
Edward G. Altman, Donald R. Hedeker, Philip G. Janicak, James L. Peterson, and John M. Davis
Translation Availability
English
Background/Description
The Clinician-Administered Rating Scale for Mania (CARS-M), developed by Edward G. Altman, Donald R. Hedeker, Philip G. Janicak, James L. Peterson, and John M. Davis in 1994, is a precise, observer-rated tool designed to assess the severity of manic symptoms in clinical populations, particularly those with bipolar disorder. Published in Biological Psychiatry, the CARS-M was created to address the need for a reliable, clinician-based measure that distinguishes mania from other psychiatric states, offering a structured approach to evaluating symptom intensity. It is widely used in both research and clinical settings to monitor mania during acute episodes and treatment phases.
The CARS-M consists of 15 items, divided into two subscales: a 10-item mania scale (e.g., elevated mood, grandiosity) and a 5-item psychosis scale (e.g., delusions, hallucinations), each scored on a 6-point scale (0 = “absent” to 5 = “severe”). Total scores range from 0 to 75, with higher scores indicating greater mania severity; a cutoff of 15 on the mania subscale often suggests significant symptoms. Administered through a semi-structured interview, it takes about 15-20 minutes to complete, relying on clinician observations and patient responses. Its translations into several languages and focus on observable behaviors enhance its utility across diverse psychiatric contexts, making it a valuable tool for diagnosis and treatment evaluation.
Administration, Scoring and Interpretation
- Obtain the copy: Access the CARS-M from its original publication in Altman et al. (1994) via Biological Psychiatry or authorized psychiatric resources, ensuring clinician training.
- Explain the purpose: Inform the clinician (and indirectly the patient) that the scale assesses mania severity to guide diagnosis, treatment, or research outcomes.
- Provide instructions: Instruct the clinician to rate each of the 15 items based on a semi-structured interview and direct observation, using the 6-point scale and provided descriptors.
- Approximate time: Allow approximately 15-20 minutes for the interview and scoring, depending on the patient’s presentation and clinician experience.
- Administer the scale: Conduct the assessment in a clinical setting, observing the patient’s behavior and responses during the interview, and record scores systematically.
Reliability and Validity
The Clinician-Administered Rating Scale for Mania demonstrates strong psychometric properties, as established in Altman et al. (1994). Inter-rater reliability is high, with intraclass correlation coefficients (ICC) ranging from 0.88 to 0.93 for the mania subscale and 0.85 to 0.90 for the psychosis subscale, indicating excellent agreement among trained clinicians. Test-retest reliability, assessed over a short interval, yields coefficients around 0.85, reflecting stability in consistent manic states.
Validity is robustly supported. Concurrent validity is shown through strong correlations (r = 0.80-0.90) with the Young Mania Rating Scale (YMRS), while its two-factor structure (mania and psychosis) is confirmed via factor analysis. Discriminant validity distinguishes CARS-M scores from depression measures like the Hamilton Depression Rating Scale, ensuring specificity to mania. Its sensitivity to treatment effects, such as reductions in scores post-medication, underscores its utility in clinical trials and practice, making it a reliable and valid measure for mania assessment.
Available Versions
15-Items
Reference
Altman, E. G., Hedeker, D. R., Janicak, P. G., Peterson, J. L., & Davis, J. M. (1994). The clinician-administered rating scale for mania (CARS-M): development, reliability, and validity. Biological psychiatry, 36(2), 124-134.
Important Link
Scale File:
Frequently Asked Questions
What does the CARS-M measure?
It measures the severity of manic and psychotic symptoms in bipolar disorder.
How many items are in the CARS-M?
It includes 15 items across two subscales.
Who developed the CARS-M?
It was developed by Edward Altman and colleagues in 1994.
How long does it take to complete the CARS-M?
It takes about 15-20 minutes via clinical interview.
What is the CARS-M cutoff score?
A score of 15 or higher on the mania subscale suggests significant symptoms.
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