Appendix 6 The Bech-Rafaelsen
Mania Scale (MAS)
The time frame (window) is the past three days.
Scoring sheet
No. Symptom Score
1 Elevated mood 0–4
2 Increased verbal activity 0–4
3 Increased social contact 0–4
(intrusiveness)
4 Increased motor activity 0–4
5 Sleep disturbances 0–4
6 Work activities (distractibility) 0–4
7 Irritable mood, hostility 0–4
8 Increased sexual activity 0–4
9 Increased self-esteem 0–4
10 Flight of thoughts 0–4
11 Noise level 0–4
Total score 0–44
No mania: 0–6
Doubtful mania: 7–10
Hypomania: 11–14
Moderate mania: 15–24
Marked/severe mania: 25–44
Clinical Psychometrics, First Edition. Per Bech.
© 2012 John Wiley & Sons, Ltd. Published 2012 by John Wiley & Sons, Ltd.
161
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162 Clinical Psychometrics
The Bech-Rafaelsen Mania Scale (MAS) Manual
Item 1 Elevated mood
0: Not present
1: Slightly elevated mood, optimistic, but still adapted to situation
2: Moderately elevated mood, joking, laughing, however, somewhat irrele-
vant to situation
3: Markedly elevated mood, exuberant both in manner and speech, clearly
irrelevant to situation
4: Extremely elevated mood, quite irrelevant to situation
Item 2 Increased verbal activity
0: Not present
1: Somewhat talkative
2: Clearly talkative, few spontaneous intervals in the conversation, but still
not difficult to interrupt
3: Almost no spontaneous intervals in the conversation, difficult to
interrupt
4: Impossible to interrupt, dominates the conversation completely
Item 3 Increased social contact (intrusiveness)
0: Not present
1: Slightly meddling (putting his/her oar in), slightly intrusive
2: Moderately meddling and arguing or intrusive
3: Dominating, arranging, directing, but still in context with the setting
4: Extremely dominating and manipulating, not in context with the
setting
Item 4 Increased motor activity
0: Not present
1: Slightly increased motor activity (e.g., some tendency to lively facial
expression)
2: Clearly increased motor activity (e.g., lively facial expression, not able to
sit quietly in chair)
3: Excessive motor activity, on the move most of the time, but the patient
can sit still if urged to (rises only once during interview)
4: Constantly active, restlessly energetic. Even if urged to, the patient
cannot sit still
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The Bech-Rafaelsen mania scale (MAS) 163
Item 5 Sleep disturbances
This item covers the patient’s subjective experience of the duration of sleep
(hours of sleep per 24-h periods). The rating should be based on the three
preceding nights, irrespective of the administration of hypnotics or sedatives.
The score is the average of the past three nights.
0: Not present (habitual duration of sleep)
1: Duration of sleep reduced by 25%
2: Duration of sleep reduced by 50%
3: Duration of sleep reduced by 75%
4: No sleep
Item 6 Work activities (distractibility)
Work activity should be measured in terms of the degree of disability or
distractibility in social, occupational or other important areas of
functioning.
0: No difficulties
1: Slightly increased drive, but work quality is slightly reduced as motiva-
tion is changing; the patient is somewhat distractible (attention drawn to
irrelevant stimuli)
2: Work activity clearly affected by distractibility, but still to a moderate degree
3: The patient occasionally loses control of routine tasks because of marked
distractibility
4: Unable to perform any task without help
Item 7 Irritable mood, hostility
0: Not present
1: Somewhat impatient or irritable, but control is maintained
2: Moderately impatient or irritable. Does not tolerate provocations
3: Provocative, makes threats, but can be calmed down
4: Overt physical violence; physically destructive
Item 8 Increased sexual activity
0: Not present
1: Slight increase in sexual interest and activity, for example, slightly flirta-
tious
2: Moderately increase in sexual interest and activity, for example, clearly
flirtatious
3: Marked increase in sexual interest and activity, excessively flirtatious
4: Completely preoccupied by sexual interests
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164 Clinical Psychometrics
Item 9 Increased self-esteem
0: Not present
1: Slightly increased self-esteem, for example, overestimates slightly own
habitual capabilities
2: Moderate increased self-esteem, for example, overestimates more clearly
own habitual capabilities or hints at unusual abilities
3: Markedly unrealistic ideas, for example, believes he/she possesses
extraordinary abilities, powers or knowledge (scientific, religious etc),
but can quickly be corrected
4: Grandiose ideas which cannot be corrected
Item 10 Flight of thoughts
0: Not present
1: Somewhat lively in descriptions, explanations and elaborations without
losing the connection with the topic of the conversation. The thoughts
are thus still coherent
2: The patient’s thoughts are occasionally distracted by random associa-
tions (often rhymes, slangs, puns, pieces of verse or music)
3: The line of thoughts is more regularly disrupted by diversionary
associations.
4: It is very difficult or impossible to follow the patient because of the flight
of thoughts; he or she constantly jumps from one topic to another
Item 11 Noise level
0: Not present
1: Speaks somewhat loudly without being noisy
2: Voice discernible at a distance, and somewhat noisy
3: Vociferous, voice discernible at a long distance, is markedly noisy or singing
4: Shouting, screaming; or using other sources of noise due to hoarseness
