Hamilton Anxiety Rating Scale (HAM-A)

Hamilton Anxiety Rating Scale (HAM-A)
Week 2 Initial Post

           The psychiatric interview is the basis upon which all the other work of the PMHNP is based. It is during this assessment that the key data points are collected that are needed for diagnosis and treatment planning. The purpose of this discussion to briefly explain three components of the psychiatric interview and to look at the psychometric properties of the Hamilton Anxiety Rating Scale.

            The first component, and arguably the most important, is the history of present illness (HPI). This section discusses, chronologically, the events and the symptoms that lead the client to seek treatment. It also covers other changes that may impact these symptoms, such as interpersonal relationships, personal habits, physical health, and behaviors (Sadock, Sadock, and Ruiz, 2017). Because this part of the interview sets the tone for the remainder of the visit, and also allows for the collection of data relating to the client’s primary concerns, it is critical for a proper diagnosis and treatment plan Hamilton Anxiety Rating Scale (HAM-A).

The second component this post will discuss is the past psychiatric history (PH). This piece allows the provider to obtain relevant data related to the client’s psychiatric illnesses, including symptoms and treatment over the course of their lifetime (Sadock, Sadock, and Ruiz, 2017). These elements are important, as they help to create a complete picture of the mental illness that the client is seeking help for.

The third component is the family history. Hamilton Anxiety Rating Scale (HAM-A) This part of the interview covers mental health diagnoses, substance use issues, and suicidal or violent behaviors in biological relatives (American Psychiatric Association, 2016). This information is important, as genetic links have been found to influence the development of psychiatric illness in individuals.

In addition to the psychiatric interview, clinicians often use rating scales to get a clearer picture of the symptoms that clients report, such as severity, triggers, and other variables. For anxiety, the Hamilton Anxiety Rating Scale (HAM-A) is often utilized by practitioners. This scale discusses fourteen symptoms of anxiety, ranging from anxious mood to autonomic symptoms, and asks the client to rate them from 0, or not present, to 4, or very severe (Hamilton, 1959). It would be appropriate to use this scale during the history of present illness portion of the psychiatric interview (American Psychiatric Association, 2016). Utilizing the HAM-A at this point of the interview allows the PMHNP to determine if the described symptoms do support the diagnosis of anxiety and to what severity.

In conclusion, the psychiatric interview is crucial to the assessment, diagnosis, treatment planning, and evaluation of clients with mental health issues. Each section allows the collection of critical data for the PMHNP to utilize. In addition, clinical rating scales add to this information and allow for an objective piece of data to support the subjective data collected during the interview. When taken together, the big picture of a client’s concerns can be formulated and needs addressed. Hamilton Anxiety Rating Scale (HAM-A)


American Psychiatric Association. (2016). Practice guidelines for the psychiatric evaluation of adults (3rd ed.). https://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760

Hamilton, M. (1959). Hamilton anxiety rating scale (HAM-A). Br J Med Psychol 1959; 32:50–55. Retrieved from https://dcf.psychiatry.ufl.edu/files/2011/05/HAMILTON-ANXIETY.pdf

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Psychiatric interview, history, and mental status examination. Kaplan and Sadock’s Concise Textbook of Clinical Psychiatry (4th ed.). pp. 9–15. Wolters Kluwer.


Thank you for an informative and interesting post on the Hamilton Anxiety Scale (HAM-A). This tool is a widely used interview scale that measures the severity of a patient’s anxiety. The scale predates the current definition of generalized anxiety disorder (GAD). However, it covers many of the features of GAD and can be helpful also in assessing its severity (Porter et al., 2017). The major value of the HAM-A is to document results of the psychotherapy, rather than as a diagnostic or screening tool. It takes roughly 15 minutes to complete the interview and scoring. Each item is given a 5 point score, 0 (not present) to 4 (severe). The questionnaire consist of a total of 14 questions (Porter et al., 2017). The scale has demonstrated high levels of accuracy and validity, and the results give important clues to possible mental disorders that warrant follow-up by a health care provider (Porter et al., 2017).

The assessment tool I chose was the CAGE Questionnaire. This test is widely used and measures the possibility of alcohol dependency. The test is composed of a total of 4 yes or no questions. Each question answered yes increases the chances of alcohol dependency. Answering with 2-3 yes responses often indicates alcohol abuse or dependency (Bush et al., 2016). The CAGE questionnaire aims to evaluate the current state of an individual rather than long-term (Bush et al., 2016). The questionnaire is reported to accurately identify people with alcohol dependency 93 percent of the time (Bush et al., 2016). This makes the questionnaire relatively accurate, and a quick way to screen people for alcohol dependency.


Bush, B., Shaw, S., Cleary, P., Delbanco, T. L., & Aronson, M. D. (2016). Screening for alcohol abuse using the cage questionnaire. The

               American Journal of Medicine82(2), 231–235. https://doi.org/10.1016/0002-9343(87)90061-1

Porter, E., Chambless, D. L., McCarthy, K. S., DeRubeis, R. J., Sharpless, B. A., Barrett, M. S., Milrod, B., Hollon, S. D., &

Barber, J. P. (2017). Psychometric properties of the reconstructed hamilton depression and anxiety scales. The

            Journal of Nervous and Mental Disease205(8), 656–664. https://doi.org/10.1097/nmd.0000000000000666



Thank you for your insight on the Hamilton Anxiety Rating Scale (HAM-A) and your overall view of the psychiatric evaluation. The

American Psychiatric Association also states that in the initial exam the interviewer may have to return to elaborate on certain aspects of the exam depending on the presentation of the client (2016).  I think it is important for us to remember as you indicated that we need to focus on the presenting problem and not get to tied up with making sure that every single line item on the intake exam be covered on the first visit.

I am dealing with a patient who has a huge amount of anxiety. His issues are overwhelming to him. He has Congestive Heart Failure, debilitating arthritis and now he is positive with Covid-19.  He is so afraid that it will get in his lungs and kill him. His pain with the arthritis sends him in a tailspin and he feels like his worst problem is Covid-19.  His oxygen saturation is 99% when he says he cannot catch his breath. He has perseverated about having this dreaded virus since he tested positive 3 weeks ago. He is still saying he does not want it to get into his lungs and kill him. However, he is refusing to do anything such as taking medication or supplements or even a breathing treatment when he is feeling short of breath. His breath sounds are clear. He is not suffering from Covid related shortness of breath, but his anxiety is making him feel like he is at deaths door.

I think the clients’ medical history is extremely important to how they are presenting. A head-to-toe exam may help the patient who is suffering from anxiety, feeling like they are surely dying to have some comfort. A physical exam with laboratory testing may help this patient to relax so that he can recover more effectively from the Covid. In case studies done with current heart patients, anxiety can cause clients to manifest the symptoms they fear the most (Giannitsi et al.,2020) (Tully, Cosh, & Baumeister, 2014) Hamilton Anxiety Rating Scale (HAM-A).


The American Psychiatric Association. (2016). Practice Guidelines for the Psychiatric Evaluation of

Adults (3rd ed.). https://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760


Giannitsi, S., Tsinivizov, P., Poulimenos, L. E., Kallistratos, M. S., Varvarousis, D., Manolis, A. J.,

Tsamakis, K., Rizos, E., Spandidos, D. A., Tsiptsios, D., & Triantafyllis, A. S. (2020). [Case Report]

Stress induced (Takotsubo) cardiomyopathy triggered by the COVID-19 pandemic. Experimental &

          Therapeutic Medicine20(3), 2812./watch/schizophrenia-and-other-psychotic-

Tully, P. J., Cosh, S. M., & Baumeister, H. (2014). The anxious heart in whose mind? A systematic review

and meta-regression of factors associated with anxiety disorder diagnosis, treatment and morbidity

risk in coronary heart disease. Journal of Psychosomatic Research77(6), 439–448 https://doi-

org.ezp.waldenulibrary.org/10.1016/j.jpsychores.2014.10.001 Hamilton Anxiety Rating Scale (HAM-A)

Assessment tools have two primary purposes: 1) to measure illness and diagnose clients, and 2) to measure a client’s response to treatment. Often, you will find that multiple assessment tools are designed to measure the same condition or response. Not all tools, however, are appropriate for use in all clinical situations. You must consider the strengths and weaknesses of each tool to select the appropriate assessment tool for your client. For this Discussion, as you examine the assessment tool assigned to you by the Course Instructor, consider its use in psychotherapy.

Photo Credit: [shironosov]/[iStock / Getty Images Plus]/Getty Images

To Prepare:

  • Review this week’s Learning Resources and reflect on the insights they provide regarding psychiatric assessment and diagnosis.
  • Consider the elements of the psychiatric interview, history, and examination.
  • Consider the assessment tool assigned to you by the Course Instructor.
  • Hamilton Anxiety Rating Scale (HAM-A)
By Day 3 of Week 2

Post a brief explanation of three important components of the psychiatric interview and why you consider these elements important. Explain the psychometric properties of the rating scale you were assigned. Explain when it is appropriate to use this rating scale with clients during the psychiatric interview and how the scale is helpful to a nurse practitioner’s psychiatric assessment. Support your approach with evidence-based literature.

 a selection of your colleagues’ responses.

By Day 6 of Week 2

Respond to at least two of your colleagues on 2 different days by comparing your assessment tool to theirs.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! Hamilton Anxiety Rating Scale (HAM-A)

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