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Clinician-Administered Rating Scale for Mania (CARS-M)

The CARS-M is a 15-item, clinician-rated scale used to assess symptoms of mania and psychosis experienced by a patient over the last 7 days.
Description: The CARS-M is a 15-item, clinician-rated scale used to assess symptoms of mania and psychosis experienced by a patient over the last 7 days.
Disease States: Bipolar disorder
Validated Uses: Treatment Monitoring & Evaluation, Symptom Severity
Populations: Adult
Administration Method: Clinician-report
Time to administer: 16–30 minutes
Commonly used in: Clinical Trials & Research
Detailed Description: 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
 
Score Clinical Indication
≤ 7 None or questionable mania
8–16 Mild mania
17–23 Moderate mania
≥ 24 Severe mania
Scale Validity: 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
Alternative Versions: No alternative versions have been identified in the literature.
Cited Limitations: 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

Footnotes:

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

References:

  1. Altman, EG et al. Biol Psychiatry. 1994;36(2):124-134.
  2. Lam, R et al. Assessment Scales in Depression, Mania and Anxiety. (Taylor & Francis Group, 2005).
  3. Tohen, M et al. Clinical trial design challenges in mood disorders. (Elsevier Inc., 2015).
  4. Goldstein, G et al. Handbook of Psychological Assessment. 4th edn (Elsevier, 2020).
  5. Altman, E et al. Biol Psychiatry. 2001;50(6):468-471. . 2017;7(3).
  6. Shansis, FM et al. J Affect Disord. 2016;197:1-7.

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