Hamilton Anxiety Scales

What is the Hamilton Anxiety Rating Scale?

The Hamilton Anxiety Rating Scale (HAM-A/HARS) is a self-survey that measures the severity of the patient’s anxiety symptoms. Initially, Dr. Max Hamilton, the developer of this scale, created HARS in 1959 as an evaluation tool for anxiety symptoms in those with “anxiety neurosis.” The scale is used to assess and understand the nature and intensity of anxiety disorders.

The Hamilton Anxiety Rating Scale helps objectify the severity of the patient’s anxiety. It is composed of 14 indicators that are based on clinical questions. Several anxiety symptoms define each indicator.

Here are the 14 indicators:

• Anxious mood
• Tension
• Fears
• Insomnia
• Intellectual
• Depressed mood
• Somatic (muscular)
• Somatic (sensory)
• Cardiovascular symptoms
• Respiratory symptoms
• Gastrointestinal symptoms
• Genitourinary symptoms
• Autonomic symptoms
• Behavior at the interview

The indicators are further expounded in the evaluation. Each item briefly stated specific examples or descriptions of the feeling or observation.

The HAM-A is typically administered at the beginning of therapy to assess the patient’s status before receiving assistance. The test is then administered again to see if the treatment has made a difference following a course of therapy.

How do you use this Hamilton Anxiety Rating Scale?

Step 1: Download the PDF

This template may be administered through printed material or digital software. To get a copy of the anxiety scale, click the "Download PDF Template" button or access it through Carepatron's template library.

Step 2: Brief the client/patient

Explain the process to administration to the patient or client and set proper expectations. Ensure that they pledge honesty and are truthful about their behavior. Ensure that they truly understand the point of the assessment. 

Step 3: Go through each statement

Administer the evaluation with thorough observation. Match the client's pacing and be diligent in specifying how they feel. 

Step 4: Record the observations

Be active in noticing the apparent behaviors of the client/patient. As a mental health practitioner, being able to determine traits and recognize non-verbal symptoms should be a basic expectation. 

Step 5: Properly store the documentation

If you are using Carepatron, you don't have to worry about storage. The health compliance software is a cloud-based company where your documents are securely stored and properly organized. If you decide to document it through print, it is best to collate it in a folder. This survey may be helpful in comparative analysis or for future evaluation to measure progress. 

Scoring

The Hamilton Anxiety Rating Scale (HAM-A) is a widely used instrument for assessing anxiety severity by evaluating psychological and somatic symptoms. It comprises 14 items, each rated on a scale from 0 to 4, where 0 indicates the absence of anxiety and 4 denotes severe anxiety. The cumulative score, ranging from 0 to 56, quantitatively measures anxiety intensity.

Scores are interpreted as follows:

• >17: Suggests mild anxiety
• Between 18-24: Indicates moderate anxiety
• Between 25-30: Reflects severe anxiety

Next steps

After administering the Hamilton Anxiety Rating Scale (HAM-A) and obtaining the scores, the subsequent steps involve a comprehensive approach to treatment and management. Initially, the total score is interpreted to ascertain the severity of anxiety, from mild to moderate and severe. Do note, though, that the scale may not effectively distinguish between various subtypes of anxiety disorders, such as generalized anxiety disorder.

Following the interpretation, a detailed clinical assessment is essential. This involves considering additional information, including the patient’s medical history, physical health conditions, specific symptoms, the overall context of their condition, and how anxiety affects their patient's daily functioning and quality of life.

A tailored treatment plan should be developed based on the severity and individual needs. Interventions may be psychoeducational, lifestyle modifications, strategies, psychotherapy, and/or pharmacotherapy.

Regular monitoring of the patient’s progress is crucial. This includes periodic reassessment of symptoms using the HAM-A or other relevant scales. The treatment plan should be adjusted based on the patient’s response and progress, ensuring optimal anxiety management over time.

When to use this Hamilton Anxiety Rating Scale

There are a lot of assessments that have been developed over time to evaluate anxiety disorder, with the Hamilton Anxiety Rating Scale being the benchmark of these emerging assessments. Knowing when to use this assessment is vital because it will help draw good observations and monitor the patient’s improvement. Here are the instances when you would need to use HARS:

Initial screening 

A regular clinic visitation for initial screening would be a typical time to use HARS. It is used when a patient confides in feeling some anxiety traits or somatic symptoms like tension headache, trouble sleeping, muscle tension, faster breathing, fatigue, wind abdominal pain, and hot and cold flushes.

During active consultations

Patients assessed with HARS should be called in for regular monitoring and evaluation. The test can be administered again to measure their improvement. This is crucial, as the result may call for better prescriptions or more effective treatment plans.

Final diagnosis ‍

Mental health professionals sometimes have to conduct multiple HARS administrations to better understand the patient's improvement trend. Administering the assessment for the last time can indicate the patient's actual or consistent result. There will be more concrete observations at this point, and you can develop a more substantial treatment plan. 

Consider our anxiety assessment template for comprehensive strategies and tools to handle client issues effectively.