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HAM-A: Hamilton Anxiety Rating Scale
The Hamilton Anxiety Rating Scale, also called HAM-A, is a clinician-administered scale used to assess the severity of anxiety symptoms. It includes both psychological anxiety symptoms and physical symptoms of autonomic arousal.
✅ What It Measures
- Anxious mood and excessive worry
- Tension and inability to relax
- Fears and panic-like symptoms
- Insomnia
- Concentration and cognitive symptoms
- Muscular tension and aches
- Cardiovascular, respiratory, gastrointestinal and genitourinary symptoms
- Observed behaviour during the interview
🔢 Scoring
- HAM-A has 14 clinician-rated items.
- Each item is usually scored from 0–4.
- 0 = not present
- 4 = severe
- Total score range is 0–56.
- Higher scores suggest more severe anxiety symptoms.
📊 Common Severity Interpretation
- 0–7: no or minimal anxiety
- 8–14: mild anxiety
- 15–23: moderate anxiety
- 24 or more: severe anxiety
⚠️ Important: HAM-A can be influenced by physical illness because it includes somatic symptoms. Palpitations, tremor, breathlessness or gastrointestinal symptoms may be due to anxiety, but may also reflect medical disease.
🩺 Consider Medical Mimics
- Hyperthyroidism
- Arrhythmia
- Asthma or COPD
- Hypoglycaemia
- Anaemia
- Medication adverse effects
- Caffeine, alcohol or recreational drug use
- Withdrawal states
🚩 Safety Points
- Assess suicide and self-harm risk, especially if anxiety is severe or mixed with depression.
- Ask about panic attacks, trauma symptoms, obsessive-compulsive symptoms and substance use.
- Consider bipolar disorder before starting antidepressants if there is a history of mania or hypomania.
- Escalate urgently if there is severe agitation, psychosis, active suicidal intent or inability to maintain safety.
🧠 Clinical Pearl
HAM-A is useful for measuring anxiety severity and treatment response, but it does not tell you the cause of anxiety. A high score should prompt a careful assessment of mental health, physical illness, medication effects and social stressors.
📚 Exam Pearl
🧠 HAM-D measures depression severity. 😰 HAM-A measures anxiety severity. Both are clinician-rated tools, not standalone diagnostic tests.
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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