Appendix 5a Hamilton Anxiety Scale

HAM-A14

The time frame (window) is the past three days.

Scoring sheet

Nr. Symptom Score

1 Anxious mood 0-4

2 Tension 0-4
3 Fears 0-4
4 Insomnia 0-4
5 Difficulties in concentration and memory 0-4
6 Depressed mood 0-4

7 General somatic symptoms (Muscular symptoms) 0-4

8 Generelle somatiske klager (Sensory) 0-4
9 Cardiovascular symptoms 0-4
10 Respiratory symptoms 0-4
11 Gastrointestinal symptoms 0-4
12 Genito-urinary symptoms 0-4
13 Other autonomic symptoms 0-4
14 Behaviour during interview 0-4
Total score 0-56

Symptoms scored from 0 to 4 Sum

0 = not present 6 to 14 = mild anxiety

1 = mild degree 15 to 28 = moderate anxiety
2 = moderate degree 29 to 52 = severe anxiety
3 = marked degree
4 = maximum degree

Clinical Psychometrics, First Edition. Per Bech.

© 2012 John Wiley & Sons, Ltd. Published 2012 by John Wiley & Sons, Ltd.

154
 Hamilton anxiety scale HAM-A14 155

Hamilton Anxiety Scale (HAM-A14)

Manual

1. Anxiety
This item covers the emotional condition of uncertainty about the future,
ranging from worry, insecurity, irritability, apprehension to overpowering
dread. The patient’s report of worrying, insecurity, uncertainty, fear and
panic, i.e, the psychic, or mental (‘central’) anxiety experience is weighed.
0: The patient is neither more nor less insecure or irritable than usual.
1: The patient reports more tension, irritability or feeling more insecure
than usual.
2: The patient expresses more clearly to be in a state of anxiety,
apprehension or irritability, which he may find difficult to control. It is
thus without influence on the patient’s daily life, because the worrying
still is about minor matters
3: The anxiety or insecurity is at times more difficult to control because
the worrying is about major injuries or harms which might occur in the
future. E.g., the anxiety may be experienced as panic, i.e., overpowering
dread: has occasionally interfered with the patient’s daily life.
4: The feeling of dread is present so often that it markedly interferes with
the patient’s daily life.
2. Tension
This item includes inability to relax, nervousness, bodily tensions, trembling
and restless fatigue.
0: The patient is neither more nor less tense than usual.
1: The patient indicates to be somewhat more nervous and tense than usual.
2: The patient expresses clearly to be unable to relax, full of inner unrest
which he finds difficult to control, but still without influence on the
patient’s daily life.
3: The inner unrest and nervousness is so intense or so frequent that it
occasionally has interfered with the patient’s daily work.
4: Tensions and unrest interfere with the patient’s life and work at all times.
3. Fears
A type of anxiety which arises when the patient finds himself in special situ-
ations. Such situations may be open or closed rooms, to queue, to ride a bus
or a train. The patient shall experience relief by avoiding such situations. It is
important to notice at this evaluation, whether there has been more phobic
anxiety during the present episode than usual.
156 Clinical Psychometrics

0: Not present.
1: Doubtful if present.
2: The patient has experienced phobic anxiety, but was able to fight it.
3: It has been difficult for the patient to fight or overcome his phobic
anxiety which has thus to a certain extent interfered with the patient’s
daily life and work.
4: The phobic anxiety has clearly interfered with the patient’s daily life
and work.
4. Insomnia
This item covers only the patient’s subjective experience of sleep length (hours
of sleep per 24-hour-period) and sleep depth (superficial and interrupted
sleep versus deep and steady sleep). The rating is based on the three preceding
nights. Note: Administration of hypnotics or sedatives shall be disregarded.
0: Usual sleep length and sleep depth.
1: Sleep length is doubtfully or slightly reduced (e.g., due to difficulties
failing asleep), but no change in sleep depth.
2: Sleep depth is now also reduced, sleep being more superficial. Sleep as a
whole somewhat disturbed.
3: Sleep duration as well as sleep depth is markedly changed. The broken
sleep periods total only a few hours per 24-hour-period.
4: It is difficult here to ascertain sleep duration as sleep depth is so shallow that
the patient speaks of short periods of slumber or dosing, but no real sleep.
5. Difficulties in concentration and memory
This item covers difficulties in concentration, making decisions about
everyday matters, and memory.
0: The patient has neither more nor less difficulties in concentration and/
or memory than usual.
1: It is doubtful whether the patient has difficulties in concentration and/
or memory.
2: Even with a major effort it is difficult for the patient to concentrate on
his daily routine work.
3: More pronounced difficulties with concentration, memory, or decision
making. E.g., has difficulties reading an article in a newspaper or watching
a television programme right through. Scores 3 as long as the loss of
concentration or poor memory has not clearly influenced the interview.
4: When the patient during the interview has shown difficulty in concentration
and/or memory, and/or when decisions are reached with considerable delay.
6. Depressed mood
This item covers both the verbal and the non-verbal communication of
sadness, depression, despondency, and hopelessness.
 Hamilton anxiety scale HAM-A14 157

0: Natural mood.
1: When it is doubtful whether the patient is more despondent or sad than
usual. E.g., the patient indicates vaguely to be more depressed than usual.
2: When the patient more clearly is concerned with unpleasant
experiences, although he still is without hopelessness.
3: The patient shows clear non-verbal signs of depression and/or
hopelessness.
4: The patient’s remarks on despondency and the non-verbal ones dominate
the interview in which the patient cannot be distracted.

7. General somatic symptoms (muscular symptoms)

This item includes weakness, stiffness, soreness merging into real pain,
which is more or less diffusely localised in the muscles. E.g., jaw ache or
neck ache.
0: The patient is neither more nor less sore or stiff in his muscles than usual.
1: The patient indicates to be somewhat more sore or stiff in his muscles
than usual.
2: The symptoms have gained the character of pain.
3: The muscle pains interfere to some extent which the patient’s daily life
and work.
4: The muscle pains are present most of the time and interfere clearly with
the patient’s daily life and work.

8. General somatic symptoms (sensory symptoms)

This item includes increased fatigability and weakness merging into real
functional disturbances of the senses. Including: tinnitus, blurring of vision,
hot and cold flushes and prickling sensations.
0: Not present
1: It is doubtful whether the patient’s indications of pressing or prickling
sensations (e.g., in ears, eyes or skin) are more pronounced than usual.
2: The pressing sensations in the ear reach the character of buzzing in the
ears, in the eye as visual disturbances, and in the skin as prickling or
itching sensations (paraesthesias).
3: The generalised sensory symptoms interfere to some extent with the
patient’s daily life and work.
4: The generalised sensory symptoms are present most of the time and
interfere clearly with the patient’s daily life and work.

9. Cardiovascular symptoms
This item includes tachycardia, palpitations, oppression, chest pain, throbbing
in the blood vessels, and feelings of fainting.
158 Clinical Psychometrics

0: Not present.
1: Doubtful if present.
2: Cardiovascular symptoms are present, but the patient can still control the
symptoms.
3: The patient has now and again difficulties in controlling the
cardiovascular symptoms which thus to some extent interfere with the
patient’s daily life and work.
4: The cardiovascular symptoms are present most of the time and interfere
clearly with the patient’s daily life and work.

10. Respiratory symptoms

This item includes feelings of constriction or contraction in throat or chest,
dyspnoea merging into choking sensations and sighing respiration.

0: Not present.
1: Doubtful if present.
2: Respiratory symptoms are present, but the patient can still control the
symptoms.
3: The patient has now and again difficulties in controlling the respiratory
symptoms which thus to some extent interfere with the patient’s daily
life and work.
4: The respiratory symptoms are present most of the time and interfere
clearly with the patient’s daily life and work.

11. Gastro-intestinal symptoms

The item includes difficulties in swallowing, ‘sinking’ sensation of the stom-
ach, dyspepsia (heartburn or burning sensations in the stomach, abdominal
pains related to meals, fullness, nausea and vomiting), abdominal rumbling
and diarrhoea.
0: Not present.
1: Doubtful if present (or doubtful if different from the patient’s ordinary
gastrointestinal sensations).
2: One or more of the above-mentioned gastro-intestinal symptoms are
present, but the patient can still control the symptoms.
3: The patient has now and again difficulties in controlling the gastrointestinal
symptoms which thus to some extent interfere with the patient’s daily life
and work. E.g., tendency of losing control over the bowels.
4: The gastrointestinal symptoms are present most of the time and
interfere clearly with the patient’s daily life and work. E.g., losing control
over the bowels.
 Hamilton anxiety scale HAM-A14 159

12. Genito-urinary symptoms

This item includes non-organic or psychic symptoms such as frequent
or  more pressing passing of urine, menstrual irregularities, anorgasmia,
dyspareunia, premature ejaculation, loss of erection.
0: Not present.
1: Doubtful if present (or doubtful if different from the ordinary genito-
urinary sensations).
2: One or more of the above-mentioned genito-urinary symptoms are
present, but they do not interfere with the patient’s daily life and work.
3: The patient has now and again one or more of the above mentioned
genito-urinary symptoms to such a degree that they to some extent
interfere with the patient’s daily life and work. E.g., tendency of losing
control over micturation.
4: The genito-urinary symptoms are present most of the time and interfere
clearly with the patient’s daily life and work. E.g., losing control over
micturation.

13. Autonomic symptoms

This item includes dryness of mouth, blushing or pallor, sweating and dizziness.
0: Not present.
1: Doubtful if present.
2: One or more of the above-mentioned autonomic symptoms are present,
but they do not interfere with the patient’s daily life and work.
3: The patient has now and again one or more of the above-mentioned
autonomic symptoms to such a degree that they to some extent interfere
with the patient’s daily life and work.
4: The autonomic symptoms are present most of the time and interfere
clearly with the patient’s daily life and work.

14. Behaviour at interview

This item is based on patient behaviour during the interview. Did the patient
appear tense, nervous, agitated, restless, fidgeting, tremulous, pale, hyper-
ventilating, or sweating?
On the basis of such observations a global estimate is made:
0: The patient does not appear anxious.
1: It is doubtful whether the patient is anxious.
2: The patient is moderately anxious.
3: The patient is clearly anxious.
4: The patient is overwhelmed by anxiety. E.g., shaking and trembling all over.