The CARS-M is a 15-item, clinician-rated scale used to assess symptoms of mania and psychosis experienced by a patient in the last 7 days.1 The scale assesses mania and psychosis independently,1 with items 1–10 comprising the mania subscale and items 11–15 comprising the psychosis subscale.1 All items are scored on a 0–5 scale according to severity, with the exception of item 15, which assesses insight on a 0–4 scale.1 Behavioral anchors (ie, descriptive examples of symptoms or behaviors that would qualify a patient for a given rating score) and sample questions are provided for each item to facilitate clinician ratings.2,4 Items are then summed to generate a mania subscore (range: 0–50) and a psychosis subscore (range: 0–24).2 Severity thresholds used to classify patients are shown in the table below.1,2
None or questionable mania
Psychometric properties of the CARS-M were assessed in a study with 14 adult inpatients with schizophrenia, major depressive disorder, or bipolar disorder.1 Inter-rater reliability across 5 trained raters was good, ranging from 0.66 to 0.94 for the 15 individual items (average = 0.83).1 A second study of 44 adult inpatients with bipolar disorder also demonstrated that sensitivity and specificity of the CARS-M is high.5 Using a cutoff value of 15 to distinguish patients with mild symptoms or no symptoms from patients with moderate symptoms, the CARS-M mania subscale had a sensitivity of 0.97 and specificity of 0.95.5
No alternative versions have been identified in the literature.
No studies have examined if the CARS-M can distinguish between mania due to schizophrenia and mania due to bipolar disorder.1 Similarly, the CARS-M cannot be used to assess mixed states unless it is paired with another scale assessing depressive symptoms, such as the Hamilton Depression Rating Scale.1,2,6
Supporting references for the filters are as follows:
Disease States: Bipolar disorder1 ; Validated Uses: Treatment Monitoring & Evaluation1, Symptom Severity1,2; Populations: Adult1,2; Administration Method: Clinician-report1,2; Time to Administer: 16–30 minutes1,2; Commonly used in: Clinical Trials & Research3
Altman, EG et al. Biol Psychiatry. 1994;36(2):124-134.
Lam, R et al. Assessment Scales in Depression, Mania and Anxiety. (Taylor & Francis Group, 2005).
Tohen, M et al. Clinical trial design challenges in mood disorders. (Elsevier Inc., 2015).
Goldstein, G et al. Handbook of Psychological Assessment. 4th edn (Elsevier, 2020).
Altman, E et al. Biol Psychiatry. 2001;50(6):468-471. . 2017;7(3).
Shansis, FM et al. J Affect Disord. 2016;197:1-7.
Welcome To NP Psych Navigator
This website is intended for healthcare professionals inside the United States. Please confirm that you are a healthcare professional inside the US.