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Bech-Rafaelsen Mania Scale
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About Bech-Rafaelsen Mania Scale
Scale Name
Bech-Rafaelsen Mania Scale
Author Details
Per Bech (pebe@fa.dk), Ole J. Rafaelsen, Peter Kramp, & Tom G. Bolwig
Translation Availability
English
Background/Description
The Bech-Rafaelsen Mania Scale (BRMS), developed by Per Bech, Ole J. Rafaelsen, Peter Kramp, and Tom G. Bolwig in 1978, is a widely respected clinical tool designed to assess the severity of manic symptoms in individuals with bipolar disorder or related conditions. Published in Neuropharmacology, the BRMS was created to provide a reliable, observer-rated measure that captures the core features of mania, such as elevated mood, increased activity, and irritability, with a focus on clinical precision. Unlike self-report scales, the BRMS relies on trained clinicians’ observations, making it particularly valuable in psychiatric settings where objective evaluation is critical.
The BRMS consists of 11 items, each scored on a 5-point scale (0 = “not present” to 4 = “severe”), yielding a total score range of 0 to 44. Items cover key manic symptoms, including mood elevation, motor activity, sleep disturbance, and hostility, with clear descriptors to ensure consistency across raters. Typically completed in 15-20 minutes during a structured interview, the BRMS offers a quick yet thorough assessment of mania severity, aiding in diagnosis, treatment planning, and monitoring response to interventions like mood stabilizers. Its translations into multiple languages and enduring use in research and practice highlight its global applicability and relevance in understanding manic states.
Administration, Scoring and Interpretation
- Obtain the copy: Access the BRMS from its original publication in Bech et al. (1978) via Neuropharmacology or authorized psychiatric resources, ensuring proper training for clinical use.
- Explain the purpose: Inform the clinician (and indirectly the patient) that the scale evaluates the presence and intensity of manic symptoms to guide diagnosis and treatment.
- Provide instructions: Instruct the clinician to rate each of the 11 items based on observations and a semi-structured interview with the patient, using the 5-point scale and provided guidelines.
- Approximate time: Allow approximately 15-20 minutes for the interview and scoring, depending on the patient’s presentation and the clinician’s familiarity with the tool.
- Administer the scale: Conduct the assessment in a clinical setting, observing the patient’s behavior and responses during a structured interview, and record scores systematically.
Reliability and Validity
The Bech-Rafaelsen Mania Scale demonstrates strong psychometric properties, as established in its initial development by Bech et al. (1978). Inter-rater reliability is excellent, with correlation coefficients ranging from 0.90 to 0.95 among trained observers, reflecting high agreement across clinicians. Test-retest reliability, though less extensively studied in the original paper, has been supported in later research with coefficients around 0.85 over short intervals, indicating stability in consistent clinical states.
Validity is well-documented through its construction and subsequent studies. Concurrent validity is evidenced by strong correlations (r = 0.70-0.85) with other mania scales, such as the Young Mania Rating Scale (YMRS), while its focus on observable symptoms ensures content validity aligned with clinical mania criteria. Discriminant validity distinguishes BRMS scores from depression measures like the Hamilton Depression Rating Scale, confirming specificity to mania. Its sensitivity to treatment effects, such as reductions in scores post-medication, further supports its practical utility in psychiatric research and practice.
Available Versions
11-Items
Reference
Bech, P., Rafaelsen, O. J., Kramp, P., & Bolwig, T. G. (1978). The mania rating scale: scale construction and inter-observer agreement. Neuropharmacology.
Bech, P. (2002). The Bech-Rafaelsen Mania Scale in clinical trials of therapies for bipolar disorder: a 20-year review of its use as an outcome measure. CNS drugs, 16(1), 47-63.
Higgins, J., Gore, R., Gutkind, D., Mednick, S. A., Parnas, J., Schulsinger, F., & Cannon, T. D. (1997). Effects of child‐rearing by schizophrenic mothers: a 25‐year follow‐up. Acta Psychiatrica Scandinavica, 96(5), 402-404.
Important Link
Scale File:
Frequently Asked Questions
What does the Bech-Rafaelsen Mania Scale measure?
It measures the severity of manic symptoms in bipolar disorder.
How many items are in the BRMS?
It includes 11 items scored from 0 to 4.
Who developed the BRMS?
It was developed by Per Bech, Ole Rafaelsen, Peter Kramp, and Tom Bolwig in 1978.
How long does it take to complete the BRMS?
It takes about 15-20 minutes via clinical interview.
Is the BRMS still used today?
Yes, it remains a reliable tool in bipolar research and practice.
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