The Bech-Rafaelsen Mania Rating Scale (BRMRS)

motor activity

normal, with adequate facial expression

0

slightly increased, with lively facial expression

1

somewhat excessive, lively gestures

2

outright excessive, on the move most of the time; rises one or more times during the interview

3

constantly active, restless, energetic, cannot sit still

4

verbal activity

normal

0

somewhat talkative

1

very talkative; no spontaneous intervals in the conversation

2

difficult to interrupt

3

impossible to interrupt; dominates the conversation completely

4

flight of thoughts

cohesive speech with no flight of thoughts

0

lively descriptions, explanations and elaborations without losing connection with the topic of conversation; speech is still cohesive

1

now and again it is difficult for the patient to stick to the topic, and the patient is distracted by random associations (often rhymes, clangs, puns, pieces of verse or music)

2

line of thought is regularly disrupted by diversionary associations

3

it is difficult to impossible to follow the patient's line of thought, as patient constantly jumps from one topic subject to another

4

voice and noise level

natural volume of voice

0

speaks loudly without being noisy

1

voice discernible at a distance, and somewhat noisy

2

vociferous, voice discernible at a long distance, is noisy, may be singing

3

shouting, screaming, or using other sources of noise when hoarse

4

hostility or destructiveness

no signs of impatience or hostility

0

somewhat impatient or irritable, but control is maintained

1

markedly impatient or irritable; provocation badly tolerated

2

provocative, makes threats, but can be calmed down

3

over physical violence; physically destructive

4

mood

neutral

0

slightly elevated mood, optimistic, but still adapted to situation

1

moderately elevated mood, joking, laughing

2

markedly elevated mood, exuberant both in manner and speech

3

extremely elevated mood, quite irrelevant to situation

4

self-esteem

normal self-esteem

0

slightly increased, slightly boasting

1

moderately increased, boasting, frequent use of superlatives

2

bragging, unrealistic ideas

3

grandiose ideas which cannot be corrected

4

contact

normal

0

slightly meddling, putting his or her oar in

1

moderately meddling and arguing

2

dominating, arranging, directing, but still in context with the setting

3

extremely dominating and manipulating, without context with the setting

4

sleep

normal sleep pattern

0

duration of sleep reduced by 25%

1

duration of sleep reduced by 50%

2

duration of sleep reduced by 75%

3

unable to sleep

4

sexual interest and activity

normal level

0

slight increase

1

moderate increase

2

marked increase

3

completely and inadequately occupied by sexuality

4

at initial evaluation

normal

0

slightly increased drive, but work quality is reduced, as motivation is changing, and the patient is somewhat distractable

1

increased drive, but motivation clearly fluctuating; the patient has difficulties in judging own work quality and quality is lowered; often quarrels at work

2

work capacity clearly reduced, and from time to time the patient is out of control; has to stop work and be sick-listed; if in the hospital able to participate in ward activities

3

needs to be hospitalized; if in the hospital unable to participate in ward activities

4

at followup

either has or capable of resuming normal activities

0

working but effort is somewhat reduced; may be unable to resume normal activities due to distractibility and changing motivation

1

working but at clearly reduced levels; if hospitalized or on sick leave may be able to do some work if supervised

2

if hospitalized or on sick leave may be able to participate in activities for a few hours

3

fully hospitalized and unable to participate in ward activities

4