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. Issue 1 (21st March 2013)

• Record Type: Journal Article
• Authors: Lukasiewicz, Michael; Gerard, Stephanie; Besnard, Adeline; Falissard, Bruno; Perrin, Elena; Sapin, Helene; Tohen, Mauricio; Reed, Catherine; Azorin, Jean‐Michel
• Is Part Of: International journal of methods in psychiatric research. Volume 22:Issue 1(2013:Mar.)
• Page Start: 46
• Page End: 58
• Publication Date: 2013-03-21
• Subjects: bipolar disorder -- severity threshold -- Young Mania Rating Scale -- receiver‐operating characteristic analysis -- minimal clinically significant difference; Psychiatry -- Research -- Methodology -- Periodicals; Psychiatry -- Periodicals; 616.890072
• DOI: 10.1002/mpr.1379
• Languages: English
• ISSNs: 1049-8931

Abstract

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.