7

Rating Scales and

Screening Assessment
of Bipolar Spectrum
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Disorders
James H. Kleiger

sing rating scales in psychological assessment can be a quick and eco-

U nomical way to screen for diagnostic conditions of interest. Why are
screening measures for bipolar disorders important? Research has shown that
incorrect or delayed diagnosis of bipolar spectrum disorders frequently occurs
(Hirschfeld et al., 2003). Even among individuals with a history of major
depression, many clinicians do not routinely screen for bipolarity (Brickman
et al., 2002). The consequences of missed or delayed diagnosis are immense
(Conus et al., 2014; see also the Introduction in this volume) and may result
in poor outcomes, including persistent symptoms, symptom relapse, educa-
tional and occupational impairment, comorbidities, and increased suicidality
(McIntyre et al., 2021).
An increasing number of bipolar screening instruments have appeared in the
literature (Sajatovic et al., 2015), many of which are available as free downloads
(e.g., https://www.sciencedirect.com/topics/psychology/mania-scale).
The scales and instruments selected for this chapter by no means exhaust the
inventory of screening measures that currently exist. Commonly used interview–
clinician rated measures are discussed first, followed by self-report scales. Within
each category, measures that focus solely on manic/hypomanic symptoms,
general depression, bipolar depression, and bipolar II disorder are distinguished

https://doi.org/10.1037/0000356-008
Psychological Assessment of Bipolar Spectrum Disorders, J. H. Kleiger and I. B. Weiner (Editors)
Copyright © 2023 by the American Psychological Association. All rights reserved.

107
 108 James H. Kleiger

from those that focus on both depressive and manic/hypomanic features.

Whether the instruments are used only with adults, children and adolescents,
or all ages is also specified. Finally, limitations and cautions for using screening
assessment instruments are discussed.

INTERVIEW–CLINICIAN RATED MEASURES

Clinician-rated scales include gold standard instruments often used as criterion

measures in clinical and pharmacological investigations. Many are based on
semistructured interviews and some on clinician judgment alone.
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Structured Clinical Interview for DSM-5 Disorders

The Structured Clinical Interview for DSM-5 Disorders (SCID-5) includes a

research version (RV) and a clinical version (CV; First et al., 2016). Module
A in both versions covers current and past mood episodes (major depression,
manic and hypomanic episodes, substance/medication-induced bipolar and
depressive disorders), and persistent depressive disorder. The RV also has ratings
for current cyclothymic disorders. The SCID-CV may be used in diagnostic
consultations to target specific disorders. SCID modules contain probes to target
core symptoms. Interviewers rely on their clinical judgment to gather additional
information to assess target symptoms. The bipolar module in an earlier version,
the SCID-IV for Axis I disorders (First et al., 1996), demonstrated adequate
reliability in large international and multisite trials (Williams et al., 1992). The
SCID appears to be significantly more reliable than other structured interviews,
such as the Diagnostic Interview Schedule (Robins et al., 1981), the Composite
International Diagnostic Interview (Andrews & Peters, 1998), and more stan-
dard clinical interviews (Miller et al., 2009; Ramirez Basco et al., 2000). The SCID
Mood Module is used primarily with adult disorders. Routine use by clinicians is
probably uncommon, due to the time it takes and the training required to
develop proficiency.

Schedule for Affective Disorders and Schizophrenia

The Schedule for Affective Disorders and Schizophrenia (SADS; Endicott &
Spitzer, 1978) was constructed to assist with Axis I diagnostic decision making.
The psychometric properties have been established for both symptoms and
diagnoses (Andreasen et al., 1981; Rogers et al., 2001). Mania symptom ratings
achieved good reliability (interrater and test–retest) from 5 to 10 years with
young adults (Coryell et al., 1995; Rice et al., 1986). The SADS was also shown
to correlate significantly with other measures of mania (Secunda et al., 1985).
The SADS-C (Change Version) mania subscale is a five-item interview that
assesses the severity of current dimensions of mania (Spitzer & Endicott, 1977).
 Rating Scales and Screening Assessment of Bipolar Spectrum Disorders 109

Spitzer and Endicott (1977) developed the SADS-C into an 11-item Mania
Rating Scale (MRS), which was found to have strong psychometric properties.

The Kiddie Schedule for Affective Disorders and Schizophrenia for

School Aged Children, Present and Lifetime Version

The Kiddie Schedule for Affective Disorders and Schizophrenia for School Aged
Children, Present and Lifetime Version (KSADS-PL) was developed (Kaufman
et al., 2000) for the Diagnostic and Statistical Manual of Mental Disorders (5th ed.;
DSM-5; American Psychiatric Association, 2013). Like the SADS, the KSADS-PL
provides a reliable and valid diagnostic assessment of DSM disorders. The MRS
(Axelson et al., 2003) is based on items from the WASH-U-KSADS (Geller et al.,
2001). The interviewer rates the presence of 15 symptoms of mania or hypo-
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mania over the past 2 months. Some symptoms, such as a need for sleep, racing
thoughts, hyperactivity, grandiosity, and increased energy are also rated if they
fluctuate with an expansive or irritable mood. It is important that raters can
clearly demarcate the beginning and end of manic and hypomanic episodes. The
rater also needs to establish whether multiple symptoms occurred at the same
time. If any items are judged to be present, the interviewer inquires into how the
child was behaving at the time.
Like the SCID and SADS, the KSADS-PL can be time-consuming to learn and
administer. Psychologists in general outpatient settings may not have the time to
conduct gold standard interview scales, not to mention the excessive demands
that lengthy interviews may place on children with limited tolerance for sitting
and focusing.
KSADS-PL materials are available for clinical use with permission from the
authors at the website of the University of Pittsburgh Center for Childhood
Bipolar Spectrum Services. The KSADS-PL is available online from the Kennedy
Krieger Institute (https://www.kennedykrieger.org/sites/default/files/library/
documents/faculty/ksads-dsm-5-screener.pdf). Focal assessment with the Manic
or Depression Rating Scales of the KSADS may also be downloaded from the
University of Pittsburgh website (https://www.pediatricbipolar.pitt.edu/resources/
instruments).

Bipolar Depression Rating Scale

The Bipolar Depression Rating Scale (BDRS) was developed as an interview-

based scale to identify symptom severity in bipolar depression (Berk et al., 2007).
Raters complete a 20-item scale following a clinical interview to rate the severity
of depression, as well as mixed symptoms over the past several days. The BDRS
has been shown to be sensitive to symptoms characteristic of bipolar depression,
such as hyperphagia and hypersomnia, which may be overlooked by standard
depression rating scales. The measure was also shown to differentiate bipolar
from unipolar depression (Galvão et al., 2013), which is a frequent differential
diagnostic question. The scale developers demonstrated that the BDRS had
 110 James H. Kleiger

good psychometric properties with acceptable levels of reliability and validity.

Exploratory factor analysis revealed three factors corresponding to psychological
depression, somatic depression, and mixed symptom clusters (e.g., increased motor
drive, sleep disturbance, agitation). The scale and scoring manual can be down-
loaded for free from https://www.barwonhealth.org.au/health-professionals/
bipolar-depression-rating-scale-bdrs.

Young Mania Rating Scale

One of the oldest and most frequently used MRSs is the Young Mania Rating
Scale (YMRS), an 11-item clinician-rated instrument (Young et al., 1978).
Modeled on the Hamilton Depression Scale (Hamilton, 1960), the YMRS is
based on a 15- to 30-minute interview conducted by a trained clinician. The
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YMRS integrates clinician observations with patient self-report of manic symp-

toms over the previous 2 days. The 11 items cover core symptoms of a manic
episode pertaining to mood, activity level, sexual interest, sleep, irritability,
speech, grandiosity, flight of ideas, aggressive behavior, appearance, and
insight. One of the items combines symptoms of grandiosity with psychotic
symptoms, such as paranoia, ideas of reference, hyper-religiosity, delusions, and
hallucinations. The items have five defined grades of severity. Four items are
double-weighted (irritability, speech, thought content, and disruptive/aggressive
behavior). Factor analytic studies showed factors of thought disturbance,
overactive/aggressive behavior, elevated mood, and psychomotor symptoms
(Double, 1990). Psychometric properties were shown to be excellent (Young
et al., 1978). Young et al. (1978) found adequate interrater reliability ranging
from .93 for the total score and .67 to .95 for individual items. The time required
to complete YMRS is about 15 minutes. It also contains a parent-rating version.
The scale is available as a free download at https://dcf.psychiatry.ufl.edu/files/
2011/05/Young-Mania-Rating-Scale-Measure-with-background.pdf.

Mania Scale

Like the YMRS, the Mania Scale (MAS; Bech et al., 1979) is used in both clinical
and research settings. Also known as the Bech–Rafaelsen Scale, the MAS covers
the same dimensions of mania as the YMRS and has been shown to have
excellent psychometric properties. The MAS consists of 11 items assessing motor
activity, verbal activity, flight of thoughts, voice/noise level, hostility/destruc-
tiveness, mood (feelings of well-being), self-esteem, contact with others, sleep
changes, sexual interest, and work activities. Each item is rated on a 5-point scale
with 0 indicating normal mood and behavior and 4 indicating severe
impairment. The total score can be used to reflect the severity of mania as
mild (15–20), moderate (21–28), marked (29–32), severe (33–43), or extreme
(≥44). Behavioral anchors are provided for each rating. Ratings are made for
symptoms that occur over the past 3 days, based on a clinical interview with the
client which takes 15 to 30 minutes to complete.
 Rating Scales and Screening Assessment of Bipolar Spectrum Disorders 111

Bipolarity Index

The Bipolarity Index (Phelps, 2016; Sachs, 2004) is a clinician-rated measure

that is not based on a semistructured interview. The Index rates key aspects of
bipolarity, including nonmanic markers across five domains, which include (a)
signs and symptoms, (b) family history, (c) age of onset, (d) course of illness and
associated features, and (e) response to treatment. There are a total of 24 features
that are weighted within each domain from 2 to 20 points. A cutoff of 50
has good sensitivity and specificity for identifying bipolar spectrum disorders
(Aiken et al., 2015). The Bipolarity Index is an excellent diagnostic aid and
can be downloaded from https://www.moodtreatmentcenter.com/wp-content/
uploads/2021/01/bipolarityindex.pdf.
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Pediatric Behavior Rating Scale

The Pediatric Behavior Rating Scale (PBRS; Marshall & Wilkerson, 2008) is a
commercially published parent- and teacher-rated scale for identifying early-
onset bipolar disorders in children aged 3 to 18. Norm-referenced scores are
computed for Symptom Scales and a Total Bipolar Index. A Validity Scale
(inconsistent responses) and Critical Items are also reported. Symptom scales
include Atypicality (psychotic symptoms), Grandiosity, Aggression, Irritability,
Hyperactivity, Inattention, Affective Disturbance, and Social Interactions. The
parent scale contains 102 items and the teacher scale has 95 items. T scores
above 70 reflect emotional dysregulation, and scores above 80 suggest the
presence of early-onset bipolar disorder. The manual contains information
on psychometric features. Validity studies mostly consist of correlations
with other screening measures like the Child Mania Rating Scale (CMRS),
Behavioral Assessment System for Children, and Clinical Assessment of
Behavior.

Bipolar Prodrome Symptom Interview and Scale

The Bipolar Prodrome Symptom Interview and Scale (BPSS) is a retrospec-

tive measure developed to assess subthreshold symptoms of mania, depres-
sion, and psychosis (Correll et al., 2014). Correll et al. (2014) found that in
the 52 subjects with either child- or adolescent-onset mania, all had experi-
enced at least one manic symptom before demonstrating a full-blown manic
episode. Roughly half of the subjects experienced an insidious progression at
least a year prior to the onset of their more severe symptoms. The remainder
demonstrated a subacute onset of symptoms from 1 month to a year prior to
displaying a full range of manic symptomatology. Among the subthreshold
symptoms, racing thoughts, depressed mood, irritability, and increased
energy level marked the most frequent subthreshold symptoms. As part
of their study, Correll et al. developed a prospective version of the BPSS
(BPSS-P). The scale discriminated between individuals with bipolar dis-
orders, nonclinical controls, and subjects with other disorders. Although the
 112 James H. Kleiger

BPSS-P correlated with other scales measuring depressive and manic symp-
toms, its use in prospective studies has not been demonstrated.

SELF-REPORT SCALES

Whereas gold standard measures like the SCID, SADS, and KSADS-PL are
diagnostic in scope, self-report scales are screening instruments that, if positive,
suggest the need for a more comprehensive evaluation. Self-report scales
are appealing for clinicians or researchers looking for diagnostic support from
user-friendly, evidence-based instruments. Scales are grouped in terms of (a)
symptom-specific measures (mania, depression, and bipolar II disorder), (b)
biphasic symptoms of bipolar spectrum disorders, and (c) prodromal symptoms
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of bipolar disorders.

Mania-Specific Scales

Altman Self-Rating Mania Scale

The Altman Self-Rating Mania Scale (ASRM; Altman et al., 1997) was developed
initially as a brief, five-item scale in which subjects were asked to identify 11
characteristics of mania over a 7-day time frame. Items addressed elevated
mood, increased self-esteem, decreased need for sleep, pressured speech, and
psychomotor retardation. Items are rated on a 5-point scale. Scores of 6 or above
indicate a higher greater chance of manic or hypomanic symptoms. The scale
was expanded to 11- and 14-item versions, with added items to assess psychotic
features (Altman & Østergaard, 2019). Psychometric properties and major
studies involving the ASRM are described by Meyer et al. (2020).

Hypomania Checklist
The Hypomania Checklist (HCL-32) is a questionnaire consisting of 32 items
developed for identifying hypomanic features in patients presenting with a
depressive episode (Meyer et al., 2007). Angst et al. (2005) described HCL-32 as
a sensitive but less specific measure for distinguishing major depression from
bipolar disorders.

Self-Report Mania Inventory

The Self-Report Mania Inventory (SRMI) is a 47-item true-or-false instrument
focusing on hypomanic symptoms (Shugar et al., 1992). A total score of 14 or
more provided optimal sensitivity and specificity for identifying acutely manic
inpatients (see Meyer et al., 2020). The SRMI successfully distinguished mania
from other diagnoses. It takes roughly 15 minutes to complete.

Mood Disorder Questionnaire

Developed as a screening tool for manic symptoms based on DSM-IV criteria, the
Mood Disorder Questionnaire (MDQ) has become a popular screening tool.
It consists of 13 items relating to manic symptoms, plus additional items asking if
 Rating Scales and Screening Assessment of Bipolar Spectrum Disorders 113

symptoms co-occurred and whether the endorsed symptoms caused at least a

moderate level of impairment (Hirschfeld et al., 2000). A score of 7 indicates a
positive screen. Studies have demonstrated varying levels of sensitivity and
specificity, with some research showing relatively low coefficients (see Meyer
et al., 2020). The MDQ also has a parent-rated version.

Child Mania Rating Scale–Parent Rating

The Child Mania Rating Scale–Parent Rating (CMRS-P) is frequently used in
clinical assessment and research. It was developed to address the need for a brief,
easily administered parent-reporting measure for pediatric mania (Pavuluri
et al., 2006). The 21-item version demonstrated excellent psychometric proper-
ties and accuracy in distinguishing pediatric mania from attention-deficit/
hyperactivity disorder (ADHD). A briefer 10-item version showed comparable
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accuracy in differentiating youth with bipolar disorders from children with other
psychiatric disorders, including ADHD (Henry et al., 2008). The CMRS-P is in the
public domain and can be downloaded from https://brainandwellness.com/
accordian/upload_file/CMRS-P_followup.pdf.

Depression Rating Scales

Hamilton Depression Rating Scale

Developed initially as a 17-item rating scale for depression, the Hamilton
Depression Rating Scale (HAM-D; Hamilton, 1960) was expanded to 21 items
to assess symptom severity and change over time. The HAM-D is frequently used
in clinical and research settings as a measure of depression. Three clusters
include energy and activity, mood, and other symptoms.

Beck Depression Inventory

Along with the HAM-D, the Beck Depression Inventory (BDI) is considered a
gold standard self-report measure to screen for depression (Beck et al., 1961).
With its wide age range, the BDI has utility as both a clinical screening
instrument and a criterion measure in empirical studies. The inventory contains
21 multiple-choice items and can be completed in roughly 10 minutes. The
validity and reliability have been demonstrated in studies in multiple countries
over more than 50 years.

PHQ-9 Depression Scale

The Patient Health Questionnaire–9 (PHQ-9) was developed as a nine-item scale
based on DSM-IV (American Psychiatric Association, 1994) criteria for major
depression in a primary-care setting (Kroenke et al., 2001). The PHQ-9 can be
used in both clinical and research settings for a quick and valid measure of the
severity of depression.
The most commonly used depression screening measures are in the public
domain: https://www.apa.org/depression-guideline/assessment.
 114 James H. Kleiger

Bipolar-II–Specific Scales

Bipolar-II Diagnostic Questionnaire

The Bipolar-II Diagnostic Questionnaire (BPIIDQ) was constructed to fill a
diagnostic void: distinguishing unipolar from bipolar depression (Leung et al.,
2016). Based on a study with 298 subjects, the questionnaire was developed
from multiple factors, including (a) positive family history, (b) age of onset,
(c) presence of postpartum depression, (d) episodic course, (e) panicky feelings,
(f) social phobia, (g) hypersomnia, and (h) agoraphobia. The questionnaire
differentiated unipolar depression from bipolar II disorder with a sensitivity/
specificity of .75/.63 and a slightly high rate for females who had given birth.

Biphasic Hypomania/Depression and Mixed Symptom Scales

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General Behavior Inventory

The General Behavior Inventory (GBI) was developed to assess core symp-
toms of bipolarity, including both depressive and manic symptoms (Depue
et al., 1981). It has become one of the most popular self-report measures for
identifying broad symptoms of bipolarity. There are self- and parent-report
scales with versions ranging from the original 72 items down to 14
(Youngstrom et al., 2013). The GBI not only has value in identifying man-
ic/hypomanic, depressive, and mixed symptoms but can also be used as a
screener for prodromal bipolar features. Both the original and brief versions
have excellent psychometric properties and have become valuable screening
tools in clinical assessments. The full version of the GBI is a free download
from https://cls.unc.edu/wp-content/uploads/sites/3019/2014/06/GBI_self_
English_v1a.pdf. A 10-item parent-report version (Youngstrom et al.,
2001) can be downloaded from https://moodcenter.org/wp-content/uploads/
2015/08/PGBI-Clinical-Version-.pdf.

Bipolar Spectrum Diagnostic Scale

The Bipolar Spectrum Diagnostic Scale (BSDS; Nassir Ghaemi et al., 2005) was
designed to identify patients falling along a broader bipolar spectrum. It is a
widely used and well-validated measure that performs as well as other more
established scales (Phelps, 2016). Part A is presented as a paragraph about mood-
related experiences. The respondent reads through the paragraph and then
checks statements referring to hypomanic/manic symptoms and depressive
experiences that apply to them. Part B has questions pertaining to how well
the statements in Part A describe the individual. One point is given for each
sentence checked, and additional points are given for how well the story fits with
the respondent’s experience. The BSDS has shown good sensitivity for bipolar I,
bipolar II, and not otherwise specified bipolar disorders, and identified a large
percentage of unipolar patients (85%) as not having a bipolar spectrum disorder.
The BSDS is available at https://www.healthline.com/health/bipolar-disorder/
bipolar-spectrum.
 Rating Scales and Screening Assessment of Bipolar Spectrum Disorders 115

MoodCheck
MoodCheck is a self-report scale that combines questions from the BSDS with
the Bipolarity Index described previously (Phelps, 2014). Parts A and B are the
original items in the BSDS. Part C screens for a family of possible bipolar
spectrum conditions. Part D consists of 13 questions that form the basis of
the Bipolarity Index. MoodCheck is a quick and cost-effective way to screen for
bipolarity, including nonmanic and mixed features, in patients presenting with
depression. The instrument is simple to score and interpret. The MoodCheck
can be downloaded for free from https://psycheducation.org/blog/moodcheck-
bipolar-screening.

Rapid Mood Screener

The Rapid Mood Screener (RMS) consists of questions developed to decrease the
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likelihood of misdiagnosing adult patients with bipolar I features as having major

depressive disorder (McIntyre et al., 2021). Three questions pertain to hypo-
manic/manic symptoms and three to bipolar risk factors like activation and
irritability after taking an antidepressant, early onset depression, and multiple
depressive episodes. The RMS is a simple and effective screener with easily
understood questions, which can be completed in less than 2 minutes. The RMS,
scoring guide, and psychometric properties are in the public domain and may
be downloaded from https://howdenmedicalclinic.com/wp-content/uploads/
2021/03/RMS-scale.pdf.

Scales for Predicting Bipolar Disorders

Bipolar Prodrome Symptom Scale, Abbreviated Screen for Patients

A self-report version of the BPSS was developed to identify patients who should
be further evaluated with the full BPSS interview scale (Van Meter et al., 2019).
The initial validation showed that the Bipolar Prodrome Symptom Scale,
Abbreviated Screen for Patients (BPSS-A-SP) correlated well with the interview-
based BPSS and other measures of mania and depression. However, as promis-
ing as developing a predictive measure might be, the predictive validity of
BPSS-A-SP has yet to be established.

Hypomanic Personality Scale

The Hypomanic Personality Scale (HPS; Eckblad & Chapman, 1986) measures
an extroversive style of social interaction. Originally designed to assess predis-
position to bipolar disorders, questions surfaced on whether the scale measured
personality style or bipolarity. Of most interest was whether the HPS could be
used to predict the risk of developing bipolar disorders. Early studies found that
high scores on the HPS were associated with elevated lifetime rates of mood,
disruptive behavior, and substance use problems but was not predictive of future
development of bipolar disorders (Klein et al., 1996). Nonetheless, this research
found that subjects with a past history of major depression and hypomanic traits
had increased levels of depression at the time of assessment, along with higher
 116 James H. Kleiger

rates of attempted suicide, concurrent disruptive behavior disorders, and recur-

rent major depressive episodes. However, Kwapil et al. (2000) found high scores
on the HPS predicted bipolar disorders at 13-year follow-up, but only 25% of
high-scoring subjects actually developed bipolar disorders. More recent research
showed that the HPS was highly confounded by correlations with other mea-
sures of bipolar disorders, casting further doubt on using the HPS as a measure
of bipolar risk or prodrome (Parker et al., 2014).

Child Behavior Checklist Subscales

The Child Behavior Checklist (CBCL; Achenbach & Rescorla, 2000) is a com-
monly used, broadband parent-reporting measure for children and adolescents.
Longitudinal research found that high scores on the sum of subscales of
attention, aggression, and anxiety/depression predicted new-onset bipolar dis-
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order in youth with ADHD (Biederman et al., 2009). As a result, they termed this
profile “the pediatric bipolar disorder phenotype” or CBCL-PBD. However, Diler
et al. (2009) found that the profile also predicted conduct disorders and
depression. Thus, the CBCL-PBD became regarded as an indicator of general
psychopathology, predicting the severity of the disorder and poor functioning.
A 19-item mania scale developed from CBCL (CBCL-MS; Papachristou et al.,
2013) was found to have acceptable psychometric properties. Internal consis-
tency was high, and the scale effectively differentiated young people with Type I
bipolar disorder (BD-I) from nonclinical controls. Young subjects with BD-I were
also found to score higher on the CBCL-MS than those subjects diagnosed with
anxiety (p .004) and major depression (p .002). However, high scores on the
CBCL-MS did not discriminate between BD-I and ADHD or oppositional defiant
disorder. Finally, a longitudinal study of youth in the Netherlands found that 11-
year-olds who had mild to higher levels of symptoms on the CBCL-MS were 2–5
times more prone to be diagnosed with bipolar disorders by the age of 19
(Papachristou et al., 2017).

CAVEATS AND LIMITATIONS

Providing that they have good psychometric properties and are sensitive and
specific to the groups being studied, rating scales are easy-to-administer tools
that can save clinicians time. Scales with acceptable psychometric properties can
add evidence-based support for clinical inferences and also indicate the need to
delve more deeply into the nature and severity of symptoms.
Screening scales are helpful for clinicians in general practice for treatment
decision making, primarily as it relates to prescribing medication and tracking
symptoms to gauge change or response to treatment. Screening measures can
also be used productively in psychological assessment, provided that psycho-
diagnosticians remember that most such measures are what the name implies:
screening tools that help determine whether more in-depth assessment instru-
ments are indicated.
 Rating Scales and Screening Assessment of Bipolar Spectrum Disorders 117

Despite their utility in mental-health and primary-care settings, evaluators

need to be aware of the limited scope of screening measures and rating scales
(Kleiger & Khadivi, 2015). Rating scales are principally symptom- or diagnosis-
focused, whereas multimethod psychological assessment has a broader focus in
identifying, describing, and organizing a narrative regarding dimensions of
psychological functioning and implications for treatment.
From this review, it is clear that not all screening measures are of equal value.
Gold standard interview-based scales like the SCID, SADS, and KSADS-PL may
be diagnostic themselves, but they tend to be time-consuming and require
significant time and training to learn. The SADS and SCID have also been less
useful in assessing bipolar II disorder (Miller et al., 2009). Some that focus
narrowly on the presence and severity of discrete symptoms of mania, like the
YMRS, ASRM, MDQ, and CMRS-P, are simple screening tools that are easy to
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administer and can be useful diagnostic aids to include in one’s assessment

battery. However, the usefulness of scales also depends on the prevalence of the
disorder in the population of interest (Phelps & Ghaemi, 2006; Youngstrom &
Van Meter, 2016).
Busy clinicians will find three simple self-report scales of great value. The
GBI and P-GBI are easily obtainable as free downloads. They are well-
constructed, with solid research supporting their use as assessment screening
measures. The GBI is also useful in assessing depressive, hypomanic/manic, and
mixed features.
The Bipolarity Index includes assessments of episodic symptoms, family
history, age of onset, course, and response to treatment in a single scale.
Clinicians can also use both the BSDS and MoodCheck, which have all the
information to compute the Bipolarity Index to help gauge the presence of
nonmanic features and the ultimate likelihood of a bipolar spectrum disorder.
Given the high number of patients with underlying bipolarity who initially
present with depression, accurate diagnosis is of critical importance for treatment
planning.
A final note regarding the use of rating scales is important. Although
screening measures with sound psychometric properties have a role in assessing
psychopathology, restricting assessment practice to self-report and structured-
interview scales may lead clinicians to focus too much on manifest symptoms
and move away from traditional methods designed to assess psychological
functioning and personality structure and dynamics. Rating scales may provide
information about symptoms but tell us little about the person with the
symptoms, which is often what referral sources are seeking to understand about
those whom they refer for psychological assessment.

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