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Hamilton Anxiety Rating Scale
The Hamilton Anxiety Rating Scale (HAM-A) is a psychological questionnaire used by clinicians to rate the severity of a patient's anxiety. Anxiety can refer to things such as “a mental state…a drive…a response to a particular situation…a personality trait…and a psychiatric disorder.” 〔McDowell, I., Newell, C., & McDowell, I. (2006). Measuring health: a guide to rating scales and questionnaires (Vol. 268). New York: Oxford University Press.〕 Though it was one of the first anxiety rating scales to be published, the HAM-A remains widely used by clinicians.〔Maier W, Buller R, Philipp M, Heuser I. The Hamilton Anxiety Scale: reliability, validity and sensitivity to change in anxiety and depressive disorders. J Affect Disord 1988;14(1):61–8.〕 It was originally published by Max Hamilton in 1959. For clinical purposes, and the purpose of this scale, only severe or improper anxiety is attended to. This scale is considered a “clinical rating” of the extensiveness of anxiety, and is intended for individuals that are “already diagnosed with anxiety neurosis.”〔Hamilton M.The assessment of anxiety states by rating. Br J Med Psychol 1959; 32:50–55.〕 The scale consists of 14 items designed to assess the severity of a patient’s anxiety. Each of the 14 items contains a number of symptoms, and each group of symptoms is rated on a scale of zero to four, with four being the most severe. All of these scores are used to compute an overarching score that indicates a person’s anxiety severity.〔Vaccarino, A. L., Evans, K. R., Sills, T. L., & Kalali, A. H. (2008). Symptoms of anxiety in depression: assessment of item performance of the Hamilton Anxiety Rating Scale in patients with depression. Depression & Anxiety (1091-4269), 25(12), 1006-1013. doi:10.1002/da.20435〕 The Hamilton Anxiety Rating scale has been considered a valuable scale for many years, but the ever-changing definition of anxiety, new technology, and new research has had an effect on the scale’s perceived usefulness. 〔Kobak, K. A., Reynolds, W. M., & Greist, J. H. (1993). Development and validation of a computer-administered version of the Hamilton Rating Scale. Psychological Assessment, 5(4), 487-492. doi: 10.1037/1040-3590.5.4.487〕 As a result, there have been changes, and challenges, to the original version of the scale over time. 〔Koerner, N., Antony, M. M., & Dugas, M. J. (2010). Limitations of the Hamilton Anxiety Rating Scale as a primary outcome measure in randomized, controlled trials of treatments for generalized anxiety disorder. The American Journal Of Psychiatry, 167(1), 103-104. doi:10.1176/appi.ajp.2009.09091264〕
== History ==
In 1959, Max R Hamilton developed the first version of the Hamilton Anxiety Rating Scale. He included a distinction “between anxiety as a normal reaction to danger, anxiety as a pathological condition not related to stress, and anxiety as a state or broad syndrome that he termed “anxiety neurosis.’” Hamilton developed the scale to be used with patients already known to suffer from anxiety neurosis, not to be used as a means of diagnosing anxiety in patients with other disorders. Although Hamilton developed the scale as a rating of severity, he used his scale to differentiate “anxiety as a pathological mood” from a “state (or neurosis).” 〔 He used common methods for designing the rating scale. A variety of relevant symptoms were collected and divided into groups. The scale started with twelve groups of symptoms, which came to form thirteen scale variables. All of the thirteen variables were described by succinct statements and included on a sheet that was used by an interviewer for assessing a patient. The original version used a “five-point scale” for rating the groups of symptoms. The first version of the scale was only a start, and as Hamilton stated, “Some of the variables are obviously a rag-bag of oddments and need further investigation.” He conducted tests on the original scale that initiated improvement and, over time, evolved the structure and scoring of the scale to its present state. 〔
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