Young Mania Rating Scale: how to interpret the numbers? Determination of a severity threshold and of the minimal clinically significant difference in the EMBLEM cohort. Academic Article uri icon

start page

  • 46

end page

  • 58

abstract

  • The aim of this analysis was to identify Young Mania Rating Scale (YMRS) meaningful benchmarks for clinicians (severity threshold, minimal clinically significant difference [MCSD]) using the Clinical Global Impressions Bipolar (CGI-BP) mania scale, to provide a clinical perspective to randomized clinical trials (RCTs) results. We used the cohort of patients with acute manic/mixed state of bipolar disorders (N = 3459) included in the European Mania in Bipolar Longitudinal Evaluation of Medication (EMBLEM) study. A receiver-operating characteristic analysis was performed on randomly selected patients to determine the YMRS optimal severity threshold with CGI-BP mania score ≥ "Markedly ill" defining severity. The MCSD (clinically meaningful change in score relative to one point difference in CGI-BP mania for outcome measures) of YMRS, was assessed with a linear regression on baseline data. At baseline, YMRS mean score was 26.4 (±9.9), CGI-BP mania mean score was 4.8 (±1.0) and 61.7% of patients had a score ≥ 5. The optimal YMRS severity threshold of 25 (positive predictive value [PPV] = 83.0%; negative predictive value [NPV] = 66.0%) was determined. In this cohort, a YMRS score of 20 (typical cutoff for RCTs inclusion criteria) corresponds to a PPV of 74.6% and to a NPV of 77.6%, meaning that the majority of patients included would be classified as severely ill. The YMRS minimal clinically significant difference was 6.6 points.Copyright © 2013 John Wiley & Sons, Ltd.

date/time value

  • March 2013

Digital Object Identifier (DOI)

  • 10.1002/mpr.1379

PubMed Identifier

  • 23526724

volume

  • 22

number

  • 1

keywords

  • Adult
  • Bipolar Disorder
  • Cohort Studies
  • Europe
  • Female
  • Humans
  • Linear Models
  • Male
  • Middle Aged
  • Observation
  • Psychiatric Status Rating Scales
  • ROC Curve
  • Randomized Controlled Trials as Topic
  • Retrospective Studies
  • Severity of Illness Index
  • Time Factors