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K-SADS MANIA…
Tags: barbara geller, bipolar, birthdays, christmas gifts, circumstances, depressed subjects, different times, difficult patients, elation, feelings, hypomania, joaquim, manic periods, optimistic attitude, period of time, proportion, puig antich, sads, section 1, time period,Pages: 10
Language: english
Created: Wed Nov 14 12:37:19 2007
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K-SADS MANIA RATING SCALE
BIPOLAR DISORDERS
This rating scale is based on the items from the WASH-U-KSADS (Barbara Geller, M.D.) and the 4th Revision of the KSADS-P (Joaquim Puig-Antich,
M.D. and Neal Ryan, M.D.). The following items are to determine the presence of mania or hypomania during a period of time prescribed by the rater/
study. At the end of the scale, the rater should note the onset and offset of the time period being rated. If any of the items are judged present, inquire in
a general way to determine how s/he was behaving at the time with such questions as, "When you were this way, what kind of things were you doing?
How did you spend your time?" If there have been manic periods it is exceedingly important that they are clearly delineated. Whenever two or more
items are scored positively, it is important to determine if they occurred at the same time.
If the subject has only described dysphoric mood, the following questions regarding the manic syndrome should be introduced with a statement such as,
"I know you have been feeling (___), however, many people have other feelings mixed in or at different times too." The most difficult patients to assess
are those in whom manic and depressed symptoms simultaneously coexist, superimposed on each other during the same times (Mixed States). The
rater should keep this possibility in mind as s/he goes through this section.
1. ELATION, EXPANSIVE MOOD S
P C
Elevated mood and/or optimistic attitude toward the future which lasted at least 0 No Information
4 hours and was out of proportion to the circumstances. Differentiate from
normal mood in chronically depressed subjects. Do not rate positive if mild
elation is reported in situations like Christmas gifts, birthdays, amusement 1 Not at all, normal, or depressed
parks, which normally overstimulate and make children very excited.
Have (there been times when) you felt very good or too cheerful or high or 2 Slight: Good spirits, more cheerful than most people
terrific or great, or just not your normal self? in his/her circumstances, but of only possible clinical
If unclear: significance.
When you felt on top of the world or as if there was nothing you couldn't do?
...That this is the best of all possible worlds? 3 Mild: Definitely elevated mood and optimistic outlook
Have you felt that everything would work out just the way you wanted? that is somewhat out of proportion to his/her
If people saw you, would they think you were just in a good mood or something circumstances.
more than that?
Did you get as if you were drunk? Did you laugh a lot, get silly? Did you feel 4 Moderate: Mood and outlook are clearly out of
super happy? When did this happen? proportion to circumstances. Noticeable to others.
(example)
P C S 5 Severe: Quality of euphoric mood way out of
Related to a mood d/o proportion to circumstances.
Current and Past Past:
No 6 Extreme: Clearly elated, almost constantly exalted
Current Past expression, overexpansive.
2. IRRITABILITY AND ANGER
P C S
Subjective feeling of irritability, anger, crankiness, bad temper, short tempered, No Information
resentment, or annoyance, externally directed, whether expressed overtly or not.
0
Rate the intensity and duration of such feelings.
Do not rate here if irritability is due to depression or disruptive disorders. 1 Not at all, clearly of no clinical significance
Do you get annoyed and irritated or cranky at little things?
What kinds of things? 2 Slight and doubtful clinical significance.
Have you been feeling mad or angry also (even if you don't show it)? How angry?
More than before? Mild: Often (at least 3X/3 hrs. ea. week) feels definitely more
What kinds of things make you feel angry? 3 angry, irritable than called for by the situation, relatively frequent
Do you sometimes feel angry and/or irritable, and/or cranky and don't know why? but never very intense. Or often argumentative, quick to express
Does this happen often? annoyance. No homicidal thoughts;.
Do you lose you temper?
With your family? Your friends? Who else? At school? What do you do? 4 Moderate: Most days irritable/angry or over 50% of
Has anybody said anything about it? awake time. Often shouts, loses temper. Occasional
How much of the time do you feel angry, irritable, and/or cranky: All of the time? homicidal thoughts.
Lots of the time? Just now and then? None of the time?
Severe: At least most of the time child is aware of feeling very
5 irritable or quite angry or has frequent homicidal thoughts (no
When you get mad, what do you think about?
Do you think about killing others? Or about hurting them or torturing them? plan) or thoughts of hurting others. Or throws and breaks
Whom: Do you have a plan? How? things around the house.
Related to a mood d/o P C S 6 Extreme: Most of the time feels extremely angry or
irritable, to the point s/he "can't stand it." Or frequent
Current and Past Past: uncontrollable tantrums.
No
Current Past
2477659 YEAR ID: Date:
/ /
2
*3. MOOD LABILITY P C S
0 No information
Changability of mood; rapid mood variation with several mood states
(angry, elated, depressed, anxious, relaxed) within a brief period of time;
appears internally driven without regard to circumstances or not related to Not at all
anything external to the patient. Could be an exaggerated mood change in 1
regard to minor slights, frustrations or positive events.
Slight: Some moodiness or mood variation possibly
2
out of proportion to circumstances, but of doubtful
significance
P C S
Related to a mood d/o
Past: 3 Mild: Definite mood changes, internally driven or
Current and Past somewhat out of proportion to circumstances,
No occurring several times per day. Noticeable by others,
Current Past
but does not cause impairment in function or
relationships.
Moderate: Many mood changes throughout the
4
day, can vary from elevated mood to anger to
sadness within couple of hours; changes in mood
clearly out of proportion to circumstances and
cause impairment in functioning
5 Severe: Rapid mood swings nearly all of the time,
with mood intensity way out of proportion to
circumstances
6 Extreme: Constant, explosive variability in mood,
several mood changes occurring within minutes,
difficult to identiry a particular mood, changes in mood
radically out of proportion to circumstances.
* Pilot item, not in original K-SADS-MRS
4. DECREASED NEED FOR SLEEP
P C S
Less need for sleep than usual in order to feel rested (average for several days
when needed less sleep). (Refer to norms on insomnia) 0 No information
Have you needed less sleep than usual to feel rested? How much sleep do 1 No change or more sleep needed
you ordinarily need?
How much do you sleep when you are feeling so good? Up to 1 hour less than usual
When you wake up do you feel good and rested? 2
When you cannot fall asleep or when you get up through the night, what types 3 Up to 2 hours less than usual
of things do you do?
Watch TV? Read? or do you do active things? (e.g., rearrange furniture? Up to 3 hours less than usual
4
clean house? exercise?)
Do you have a lot of thoughts go through your mind when awake? What kinds
of thoughts? 5 Up to 4 hours less than usual
Do you worry? About what types of things?
How long are you awake? How often during the night? During the week?
6 4 or more hours less than usual
P C S
Related to a mood d/o
Past:
Current and Past
No
Current Past
2477659
ID:
3
5. RACING THOUGHTS
P C S
Subjective experience that thinking was markedly accelerated. 0 No information
When you were (___), were there times when your thoughts raced through
your mind? 1 Not at all
Did you have more ideas than usual or more than you could handle?
2 Doubtful
3 Mild: Occasional racing thoughts at least 3 times
per week
P C S 4 Moderate: Racing thoughts at least 50% of awake
Related to a mood d/o time
Current and Past Past:
No 5 Severe: Racing thoughts most of the time
Current Past
6 Extreme: Almost constant racing thoughts
6. UNUSUALLY ENERGETIC
P C S
More active than his/her usual level without expected fatigue. 0 No information
Have you had more energy than usual to do things? No difference than usual or less energetic
Did people tell you that you were (are) non-stop? 1
Did you agree with them? Did it seem like too much energy? Do you know
why? Were you doing too many things? Did you feel tired? 2 Slightly more energetic but of questionable
When did this happen? (example) significance
3 Little change in activity level but less fatigued than
usual
4 Somewhat more active than usual with little or no
fatigue
P C S 5 Much more active than usual with little or no fatigue
Related to a mood d/o
Current and Past Past:
No 6 Unusually active all day long with little or no fatigue
Current Past
7. INCREASE IN GOAL-DIRECTED ACTIVITY
P C S
As compared with usual level. Consider changes in scholastic, social, sexual,
or leisure involvement or activity level associated with work, family, friends, 0 No information
new projects, interests, or activities (e.g., telephone calls, letter writing)
1 No change or decrease
Is there any time when you were more active or involved in things compared to
the way you usually are? What about in school, at your club, scouts, church,
at home, friends, hobbies, new projects or interests? 2 Slightly more interest or activity but of questionable
Were you doing a lot of things? significance
How much of your day has been spent in this?
Were you trying to do so many different things that you couldn't keep up? 3 Mild but definite increase in general activity level
involving several areas
When did this happen? (example)
4 Moderate generalized increase in activity level
involving several areas
P C S 5 Marked increase and almost constantly involved in
Related to a mood d/o numerous activities in many areas
Current and Past Past:
No 6 Extreme, e.g., constantly active in a variety of
Current Past activities from awakening until going to sleep
2477659
ID:
4
8. MOTOR HYPERACTIVITY
P C S
Visible manifestations of generalized motor hyperactivity which occurred 0 No information
during a period of abnormally elevated, expansive, or irritable mood. Make
certain that the hyperactivity actually occurred and was not merely a
subjective feeling of restlessness. Make sure it is not chronic but episodic 1 Not at all or retarded
hyperactivity.
2 Slight increases which is of doubtful clinical
When you were (___), were there times when you were (high, feeling so good, significance
so angry) that you were always moving, could not stay put, were unable to sit
still or you always had to be moving, pacing up and down? 3 Mild: Unable to sit quietly in a chair
Or are you always like that?
4 Moderate: Paces about a great deal
Related to a mood d/o P C S
5 Marked: Almost constantly moving and pacing
Current and Past Past: about
No Extreme: so hyperactive that s/he would exhaust
Current Past 6
her/himself if not restrained
9. GRANDIOSITY
P C S
Increased self-esteem and appraisal of his/her worth, power, or knowledge 0 No information
(up to grandiose delusions) as compared with usual level. Persecutory
delusions should not be considered evidence of grandiosity unless that subject
feels the persecution is due to some special attributes of his/her 1 Not at all or decreased self esteem
(e.g., power, knowledge).
2 Slight: somewhat more confident about himself but
Have you felt more self-confident than usual? of doubtful clinical significance
Have you felt much better than others? ...smarter? ...stronger?
Why? 3 Mild: Definitely overestimates or axaggerates at
Have you felt that you are a particularly important person or that you had least two of his talents, prospects or plans
special talents or abilities?
What about special plans? 4 Moderate: Disproportionately inflated self-esteem
When did this happen? (example) involving several areas of functioning
P C S 5 Severe: Marked, global, overevaluation of
her/himself and her/his abilities, but falls short of true
Related to a mood d/o Past: delusions
Current and Past 6 Extreme: Clear grandiose delusions
No
Current Past
10. ACCELERATED, PRESSURED OR INCREASED AMOUNT OF
SPEECH P C S
0 No information
When you were (___), were there times that you talked very rapidly or talked
on and on and couldn't be stopped?
Did people say you were talking too much? 1 Not at all of retarded speech
Could people understand you?
2 Slight increase which is doubtful clinical significance
3 Mild: Noticeably more verbose than normal but
conversation is not strained
4 Moderate: So verbose that conversation is strained
P C S 5 Marked: So rapid that conversation is difficult to
Related to a mood d/o maintain
Past:
Current and Past 6 Extreme: Talks rapidly or continuously and cannot
No be interrupted. Conversation extremely difficult or
Current Past impossible
2477659
ID:
5
11. FLIGHT OF IDEAS (Observed or reported by informant)
P C S
Accelerated speech with abrupt changes from topic to topic, usually based on 0 No information
understandable associations, distracting stimuli or play on words. In rating
severity consider speed of associations, inability to complete ideas and
1 Not at all or some other form of
sustain attention in a goal-directed manner. When severe, complete or partial
sentences may be galloping on each other so fast that apparent sentence to
sentence derailment and/or sentence incoherence may also be present. An Slight: Occasional instances, which are of doubtful
extreme example of this symptom is "You have to be quiet to be sad.
2 clinical significance
Everything having to do with 's' is quiet-on the q.t, -sit, sob, sigh, sin, sorrow, Mild: Occasional instances of abrupt change in topic
surcease, sought, sand, sweet mother's love and salvation." 3 swith some impairment in understandability.
>5% of sentence to sentence transitions are abrupt
Have there been times when people could not understand you?
When they said you did not make sense? 4 Moderate: Frequent instances with moderate
Could you give me an example? impairment in understandability. >10%
5 Severe: Very frequent instances with definite
Related to a mood d/o P C S impairment in understandability. >25%
Current and Past Past:
No 6 Extreme: Most of speech consists of such rapid
Current Past changes of topic that is impossible to follow.
>50%
12. POOR JUDGEMENT
P C S
Excessive involvement in dangerous activities without recognizing the high
potential for painful consequences. 0 No information
When you were (___), did you do anything that caused trouble for you or your 1 Not at all
family...or friends?
What about anything that could have?
Did you do things you normally wouldn't do (like giving away a whole lot of 2 Slight: Of doubtful clinical significance
things or taking a whole lot of chances)?
Did you think of what would happen before you did it?
Was there anything that you did that you now think you sould not have done? 3 Mild: e.g., Calls friends at odd hours
4 Moderate: e.g., Purchases many things she/he
doesn't need and can't afford or gives money away
P C S 5 Severe: e.g., On impulse, goes to places without
Related to a mood d/o plans or money and takes too many chances
Current and Past Past:
No 6 Very Severe: Attempts activities with potentially
Current Past very dangerous consequences
13. Inappropriate laughing, joking or grinning.
Do you sometimes laugh or act silly? Does this happen for no reason? P C S
Do other people notice? Do you laugh out loud in class? No information
Are the other students quietly doing their work?
0
Do you sometimes act or talk like a much younger child?
Do you use babytalk? Do you ever crawl like a baby? Not at all- laughter appropriate to situation
1
Slight- occasional inappropriate laughter of doubtful
2
significance
Mild- (e.g., child receives verbal reprimands from
3
teacher for laughing in class 3 times in one week)
P C S
Related to a mood d/o Past: 4 Moderate to severe- (e.g., child sent to principal's
Current and Past office or given detention 3 times or more in one
No week)
Current Past
2477659
ID:
6
14. Uninhibited people seeking, gregariousness.
Do you like meeting new people?
Are you friendly with people you just met? P C S
Do your parents ever complain that you are always bringing new people 0 No information
home? How often does this happen?
Do you find yourself bringing home "friends" that your parents have never 1 Not at all or shy
seen before? How often does this happen?
Do people comment that you are "the most popular" person at the party?
Do you begin conversations with people you have never met? (e.g., at the 2 Doubtful- occasionally more talkative or social
mall, do you go up and talk to just anyone)? Are you the type of person who
never met a "stranger"?
Are you the "class clown"? 3 Mild- definitely present (e.g., parent reprimands child
3 times in one week for talking to strangers)
Related to a mood d/o P C S 4 Moderate to severe- (e.g., child puts self in danger,
cannot be left unsupervised for fear that the child will
Current and Past Past: leave with strangers; adolescent brings home new
No acquaintances once a week).
Current Past
15. Increased productivity.
Are there times when you atart many more projects than you could possibly P C S
complete in an hour's time (e.g., go to music lesson, rearrange your bedroom,
0 No information
play two different sports, start and art project)?
Are there times when you feel that you have to produce more than anyone
else (e.g., sell 100 times more Girl Scout cookies than anyone else)? 1 Not at all- or decreased
2 Doubtful- may start two projects at one time
Mild- definitely more productive or initiates several
3 projects at the same time
P C S
Related to a mood d/o
Past: 4 Moderate to severe- initiates many projects at the
Current and Past same time with unrealistic or unobtainable goals
No within the time allotted. Won't stop projects to eat or
Current Past sleep
16. Sharpened and unusually creative thinking.
P C S
Do you like to write stories, do art projects, draw, paly music, or write songs?
0 No information
Do you feel that you are "outstanding" at these activities when you are feeling
high?
Are there times when you feel that you are "super" creative? 1 Not at all- average creativity
Doubtful- occasionally shows more creativity than
2 usual, but of doubtful significance
Mild- definitely present. Spends moretime on creative
3 activities (e.g., writing, drawing, etc.)
Related to a mood d/o P C S
Current and Past Past: 4 Moderate to severe- able to produce imaginative
No stories, songs, plays or art work better than
Current Past individual's usual quality in a short time span
2477659
ID:
7
17. Hypersexuality.
P C S
Parent of child 6-12:
0 No information
Are there times when your child makes inappropriate sexual remarks to a
teacher or adult? Does your child like to " talk dirty" (e.g., talk about private
1 Not at all
parts of the body inappropriately)? Do adults complain that your child touches
breasts or other private areas? When at the store does your child have to look
at "Playboy" magazines? Does your child search out books or magazines with 2 Doubtful- occasional sexual comment or gesture
nude or suggestive pictures? Does your child draw naked people?
3 Mild- makes inappropriate explicit sexual comments,
drawings or gestures one time a week
4 Moderate to severe- overt sexual behaviors or
language occurs multiple times each week or at
inappropriate times. Major episode one time a week,
e.g., adolescent sleeps with 3 partners at the same
Child 6-12: time
What magazines do you like at the store? What types of movies do you like to
watch? What kind of pictures do you draw?
Observe child for sexually explicit language or behavior during the interview, e.g., trying to touch the interviewer's body; propositioning
the interviewer; talking about seeing sex.
P C S
Adolescents: Related to a mood d/o
Past:
Current and Past
Are there times when you have to have sex no matter what time of day it is? No
Are there times when there are not enough sexual partners to meet your Current Past
needs? Are there times when there are not enough hours in the day to have
as much sex as you want and need? Do you talk non-stop about your many
sexual conquests? Do you call the sex hotline and run up high phone phone
bills?
Be sure to distinguish this behavior from provocation to sexual activity in the environment (e.g., see the Sexual Abuse Section of the Psychosocial
Schedule for School-Age Children).
18. DISTRACTIBILITY (Observed or reported by informant) P C S
0 No information
Child presents evidence of difficulty focusing his/her attention on the
questions of the interviewer, jumps from one thing to another, cannot keep
track of his/her answers, and is drawn by irrelevant stimuli he cannot shut off. 1 Not at all
Not to be confused with avoidance of uncomfortable themes.
Have you ever been told that you have trouble sticking to what you are 2 Slight: Of doubtful clinical significance
supposed to do? did you?
Can you give me an example?
Has a teacher told you that you "always" get distracted?
3 Mild: Present but responds to structuring and
repetition
4 Moderate: Difficult to complete interview because
Related to a mood d/o P C S
of child's inattentiveness which doesn't respond to
Past: structure
Current and Past
No 5 Severe: Impossible to complete interview because
Current Past
of child's inattentiveness
2477659
ID:
8
19. HALLUCINATIONS
P C S
Sometimes children, when they are alone, hear voices or see things, or smell
things and they don't quite know where they come from. 0 No information or N/A
Has this happened to you?
Do you ever hear voices when you are alone? 1 Not at all - Absent
Have you ever seen things that were not there?
When did you?
What did you see? 2 Suspected / Possible
What did you hear?
Has there been anything unusual about the way things sounded?
3 Mild: Definitely present but subject is generally aware
How often have you heard these voices (noises)? (smell, feeling, visions) Is it it is his imagination and usually able to ignore it.
some of the time, only now and then, most of the time, or all of the time? Occurs no more than once per week.
4 Moderate: Generally believes in the reality of the
What do you think it is? hallucinations, but it has little influence on his
Do you think it is your imagination or real? behavior. (Or) Occurs at least once per week.
Diid you think it was real when you (heard, saw, etc.) it?
Do you think it's real or your imagination now? 5 Severe: Convinced his hallucination is real and
What did you do when you (heard, saw, etc.) it? significantly effects his actions. i.e.: locks door to
keep pursuers away. (or) Occurs frequently.
Related to a mood d/o P C S 6 Extreme: Actions based on hallucinations have major
impact on him or others: Unable to do school work
Current and Past Past: because of constant "conversations." (or) Occurs
No most of the time.
Current Past
P C S
20. DELUSIONS
0 No information
Do you know what imaginations is? Tell me.
Sometimes does your imagination play tricks on you? What kind of tricks?
Tell me more about them. Definitely not delusional
Do you have any ideas about things that you don't tell anyone because they 1
might not understand? What are they?
Do you have any secret thoughts? Tell me about them. 2 Suspected
Do you believe in other things that other people don't believe in? Like what?
Is anybody out to hurt you?
Does anybody control your mind or body (like a robot)? 3 Mild: Delusion definitely present but at times subject
Is anything happening to your body? questions his false belief.
Do you ever feel the world is coming to an end?
Do you ever think you are an important or great person? Who? 4 Moderate: Generally has conviction in his false
belief.
Are you sure that this (...?) is this way?
Could there be any other reason for it? 5 Severe: Delusion has a significant effect on his
Who do you know that it happens as you say? actions, e.g., often asks family to forgive his sins,
Any other possible explanation? preoccupied with belief that he is a new Messiah.
Do you enjoy making up stories like this?
Or is it different from making up stories? 6 Extreme: Actions based on delusions have major
(you might suggest other possible explanations and see how the subject impact on him or others, e.g., stops eating because
reacts to them) believes food is poisoned.
Did you ever think that this was your imagination?
Do you think it could be your imagination?
What did you do about...?
Related to a mood d/o P C S
Current and Past Past:
No
Current Past
2477659
ID:
9
21. DISORGANIZED THINKING: Take highest score of (a) or (b). P C S
0 No information
21a. SENTENCE INCOHERENCE
1 Not at all - may be difficult to understand due to
Impaired understandability of speech due to distorted grammar, or unnecessary details, little education, rambling or other
incompleteness within the sentence or clause, not in the connections between nonpathological impediments to clear communication,
sentences (derailment). Portions of coherent sentences may be observed within or simple flight of ideas which is completely
a sentence that is incoherent as a whole. Words may be substituted, or understandable.
connective words (e.g., and, although, the, a) may be deleted so the meaning is
distorted or destroyed. 2 Slight: Occasional instances which are doubtful
clinical significance.
3 Mild: Occasional instances of distorted or idiosyncratic
speech but little impairment of understandability.
(>5%)
4 Moderate: Frequent instances with some
impairment in understandability. (>10%)
P C S 5 Severe: Very frequent instances with definite
Related to a mood d/o impairment in understandability. (>25%)
Past:
Current and Past
No 6 Extreme: Most of speech is distorted so that it is
Current Past almost incomprehensible. (>50%)
21b. DERAILMENT: LOOSENING OF SENTENCE-SENTENCE
P C S
ASSOCIATIONS
0 No information
Repeatedly saying sentences in juxtaposition which lack a readily understandable
relationship, or shifting idiosyncratically from one frame of reference to another.
Example: "I'm tired. All people have eyes." 1 Not at all - may be difficult to understand due to
unnecessary details, little education, rambling or other
nonpathological impediments to clear communication
There is a vague or disjointed connection of ideas. The slippage is usually slow or simple flight of ideas which is completely
and steady; the speaker gets further and further off the track so that his reply no understandable.
longer has any connection to the question asked.
2 Slight: Occasional instances which are doubtful
Distinguish from flight of ideas in the context of acclerated speech with abrupt clinical significance.
changes of topic based on understandable associations.
3 Mild: Occasional instances of distorted or idiosyncratic
speech but little impairment in understandability (>5%).
4 Moderate: Frequent instances with some
impairment in understandability. (>10%)
5 Severe: Very frequent instances with definite
P C S impairment in understandability. (>25%)
Related to a mood d/o
Current and Past Past:
No 6 Extreme: Most of speech is distorted so that it is
Current Past
almost incomprehensible. (>50%)
2477659
ID:
10
Current time period rated:
Onset: / / Offset:
/ /
Number of days during rating period with = 4 hours of manic syptoms: days
Percentage of rated time period that subject had manic symptoms: %
Most severe past time period rated:
Onset: / / Offset:
/ /
Number of days during rating period with = 4 hours of manic syptoms: days
Percentage of rated time period that subject had manic symptoms: %
2477659
ID: