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

The Clinician-Administered Rating Scale for Mania  (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 Clinician-Administered Rating Scale for Mania  (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
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 to 10 comprising the mania subscale and items 11 to 15 comprising the psychosis subscale.1 All items are scored from 0 to 5 according to severity, with the exception of item 15, which assesses insight on a 0 to 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 to 50) and a psychosis subscore (range: 0 to 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
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Footnotes:

Supporting references for the filters are as follows:
Disease States: Bipolar disorder1; Validated Uses: Treatment Monitoring & Evaluation,1 Symptom Severity1,2; Administration Method: Clinician-report1,2; Time to Administer: 16–30 minutes1,2; Commonly used in: Clinical Trials & Research3
 

This resource is intended for educational purposes only and is intended for US healthcare professionals. Healthcare professionals should use independent medical judgment. All decisions regarding patient care must be handled by a healthcare professional and be made based on the unique needs of each patient. 
 

ABBV-US-01585-MC, Version 1.0 
Approved 04/2024 
AbbVie Medical Affairs 

References:

  1. Altman EG, Hedeker DR, Janicak PG, Peterson JL, Davis JM. The Clinician-Administered Rating Scale for Mania (CARS-M): development, reliability, and validity. Biol Psychiatry. 1994;36(2):124-134. doi:10.1016/0006-3223(94)91193-2 
  2. Lam RW, Michalaak EE, Swinson RP. Assessment Scales in Depression, Mania and Anxiety. Taylor & Francis Group; 2005. doi:10.4324/9780203308356 
  3. Tohen M, Bowden CL, Nierenberg AA, Geddes JR. Clinical Trial Design Challenges in Mood Disorders. Elsevier; 2015. doi:10.1016/C2012-0-00773-9 
  4. Goldstein G, Allen DN, Deluca J. Handbook of Psychological Assessment. 4th ed. Elsevier; 2020. doi:10.1016/C2014-0-01970-3  
  5. Altman E, Hedeker D, Peterson JL, Davis JM. A comparative evaluation of three self-rating scales for acute mania. Biol Psychiatry. 2001;50(6):468-471. doi:10.1016/s0006-3223(01)01065-4 
  6. Shansis FM, Reche M, Capp E. Evaluating response to mood stabilizers in patients with mixed depression: a study of agreement between three different mania rating scales and a depression rating scale. J Affect Disord. 2016;197:1-7. doi:10.1016/j.jad.2016.02.064 

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