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

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 Severity^1,2; Populations: Adult^1,2; Administration Method: Clinician-report^1,2; Time to Administer: 16–30 minutes^1,2; Commonly used in: Clinical Trials & Research³