Feasibility of Self-Assessment of Acute Mania: Comparison of Self-Rated and Observer-Rated Scales of Mania in Naturalistic Setting.

Mania is one of the commonest psychiatric disorders causing severe social and functional disturbances and thus requiring immediate intervention. Rating scales of mania are limited, especially the self-rating scales. Aim: To study correlation between the self-rated and observer rated scales of mania over 4 weeks period; To study the resolution and persistence of symptoms of mania with respect to clinical characteristics and treatment in the naturalistic ward setting over 4 weeks period. Methods: 40 consecutive hospitalized patients of either sex between 15-55 years with diagnosis of Mania (ICD-10 – Diagnostic criteria for research) were recruited for the study. The subjects were assessed using semistructured Performa covering socio-demographic and clinical characteristics of patient and his/her illness and by using following rating scales: Clinician Administered Rating Scale for Mania (CARS-M) [Altman et al, 1994]; Altman Self-Rating Mania scale (ARSM) [Altman et al 1997]; Hamilton Rating Scale for Depression (HAM-D) [M Hamilton 1960]; Clinical Global Impression Scale (CGI) (modified by Brandit et al, 1996). Results: The scores of the CARSM, ARSM, HAM-D, CGIS-S AND CGIS-1 showed the decreasing trends in the subsequent weekly assessments. This indicated improvement in the illness in the due course of treatment, which is an expected phenomenon. The reliability analysis scale (alpha) among the respective ARSM and CARSM scores showed the value as 0.8846 indicating that each self-rating is significantly reliable enough with the respective objective ratings. There are similar correlation patterns among CGI-S scores vs. the ASRM scores. However the correlation between the scores of CGI-I vs. ARSM in the first week does not seem to correlate significantly (p=.568), but the subsequent scores from 2nd through 4th week do correlate significantly. The HAM-D scores do not seem to correlate with the ARSM scale at any point except on the third week of the symptoms that resolved first were the hallucinations and disorientations. Insomnia and disordered thinking (incoherence/ extreme pressure of speech) disappeared nearly at the end of 2 weeks, followed subsequently by distractibility, excess energy and the delusions. Lack of insight and judgment, and euphoric/irritable mood were among the last to disappear.