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Hamilton Anxiety Rating Scale (HAM-A)
INTRODUCTION:
Anxiety refers to a sense of agitation or nervousness, which is often focused on an upcoming potential danger. The American Psychological Association (APA) defines anxiety as “an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.” It might cause one to sweat, feel restless and tense, and have a rapid heartbeat. It can be considered as a normal reaction to stress. For example, one might feel anxious when faced with a difficult problem at work, before taking a test or before making an important decision. The anxiety may give a person a boost of energy or help them focus. But for people with anxiety disorders, the fear is not temporary and can be overwhelming. An anxiety disorder, on the other hand, involves extreme anxiety, intense arousal, and extreme attempts to avoid stimuli that lead to fear and anxiety. The APA describes a person with anxiety disorder as “having recurrent intrusive thoughts or concerns”. These emotions like fear and anxiety, or the efforts to avoid experiencing them, can create a high level of distress, which can interfere with normal functioning. They differ from transient fear or anxiety, often stress-induced, by being persistent (e.g., typically lasting 6 months or more). Many of the anxiety disorders develop in childhood and tend to persist if not treated.
Clinical Features:
Physical Symptoms A. Motoric Symptoms: Tremors; Restlessness; Muscle twitches; Fearful facial expression B. Autonomic and Visceral Symptoms: Palpitations; Tachycardia; Sweating; Flushes; Dyspnoea; Hyperventilation; Constriction in the chest; Dry mouth; Frequency and hesitancy of micturition; Dizziness; Diarrhoea; Mydriasis Psychological Symptoms A. Cognitive Symptoms: Poor concentration; Distractibility; Hyperarousal; Vigilance or scanning; Negative automatic thoughts B. Perceptual Symptoms: Derealisation; Depersonalisation C. Affective Symptoms: Diffuse, unpleasant, and vague sense of apprehension; Fearfulness; Inability to relax; Irritability; Feeling of impending doom (when severe) D. Other Symptoms: Insomnia (initial); Increased sensitivity to noise; Exaggerated startle response.
Types of Anxiety Disorders:
According to the DSM-5, these are the various types of anxiety disorders:
1. Separation Anxiety Disorder (309.21): Separation anxiety disorder is characterized by a persistent fear of being away from home or without an attachment figure. This usually causes the person significant distress, and they may have difficulty going to school or work due to the separation.
2. Selective Mutism (313.23): Selective mutism is generally seen in children. The
disorder refers to the inability to speak in specific social situations. When encountering other individuals in social interactions, children with selective mutism do not initiate speech or reciprocally respond when spoken to by others.
3. Specific Phobia (300.29): It is common for individuals to have multiple specific phobias. A key feature of this disorder is that the fear or anxiety is circumscribed to the presence of a particular situation or object, which may be termed the phobic stimulus. There are generally five categories of specific phobias: animal type (spiders, snakes, dogs), natural environment type (tornadoes, heights, water, fire), blood injection type (Needles, medical procedures), situational type (flying on an airplane, enclosed spaces), other type (phobias that do not fit into the previous four categories). 4. Social Anxiety Disorder (300.23 ): The essential feature of social anxiety disorder is a marked, or intense, fear or anxiety of social situations in which the individual may be scrutinized by others. When exposed to such social situations, the individual fears that he or she will be negatively evaluated. The individual fears that he or she will act or appear in a certain way or show anxiety symptoms, such as blushing, trembling, sweating, stumbling over one’s words, or staring. 5. Panic Disorder (300.01): Panic disorder is a common mental health condition in which a person experiences recurrent panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four or more of a list of 13 physical and cognitive symptoms occur. Some of the physical symptoms that may signal the presence of a panic attack include : dizziness, nausea, racing heart, trembling, sweating, chills, shortness of breath, the sensation of choking, chest pain, etc., 6. Agoraphobia (300.22): The essential feature of agoraphobia is marked, or intense, fear or anxiety triggered by the real or anticipated exposure to a wide range of situations like, using public transportation, such as automobiles, buses, trains, ships, or planes; 2) being in open spaces, such as parking lots, marketplaces, or bridges; 3) being in enclosed spaces, such as shops, theatres, or cinemas; 4) standing in line or being in a crowd; or 5) being outside of the home alone. When experiencing fear and
substance use. Withdrawal from alcohol, anti-anxiety medications (benzodiazepines) or other medications, may also tend to increase anxiety.
- Chemical imbalance: Severe or long-lasting stress can change the chemical balance that controls your mood. Experiencing a lot of stress over a long period can lead to an anxiety disorder.
- Environmental factors: This refers to stressful events you have seen or lived through. Life events often linked to anxiety disorders include childhood abuse and neglect, a death of a loved one, or being attacked or seeing violence.
- Heredity: Anxiety disorders tend to run in families. One may inherit them from one or both parents, like eye colour.
Management:
Management will usually involve a combined approach (pharmacological and psychological).
Medication: Medications can’t cure an anxiety disorder. But they can improve symptoms
and help one function better. Medications for anxiety disorders often include:
- Anti-anxiety medications, such as benzodiazepines, may decrease your anxiety, panic and worry. They work quickly, but you can build up a tolerance to them.
- Antidepressants can also help with anxiety disorders. They tweak how your brain uses certain chemicals to improve mood and reduce stress.
- Beta-blockers, usually used for high blood pressure, can help reduce some of the physical symptoms of anxiety disorders. They can relieve rapid heartbeat, shaking and trembling.
Psychotherapy: Psychotherapy, or counselling, helps a person deal with their emotional
response to the illness. A mental health professional talks through strategies to help them better understand and manage the disorder. Approaches include:
- Cognitive behavioural therapy (CBT) is the most common type of psychotherapy used with anxiety disorders. CBT for anxiety teaches one to recognize thought patterns and behaviours that lead to troublesome feelings. Then they work on changing them.
- Exposure therapy focuses on dealing with the fears behind the anxiety disorder. It helps the client engage with activities or situations they may have been avoiding. It also includes relaxation exercises and imagery.
- Mindfulness: When feeling anxious, a person can spend a significant amount of time caught up in anxiety-provoking thoughts. Mindfulness guides us to bring our attention back to the present moment and unhook from thoughts that may be unhelpful.
- Relaxation techniques: A person who feels anxious most of the time has trouble relaxing, but knowing how to release muscle tension can be a helpful strategy.
Relaxation techniques include: progressive muscle relaxation , abdominal breathing, isometric relaxation exercises.
- Exercise: The physical symptoms of anxiety are caused by the ‘flight-or-fight’ response, which floods the body with adrenaline and other stress chemicals. Exercise burns up stress chemicals and promotes relaxation. Physical activity is another helpful way to manage anxiety.
- Support groups and education: Support groups allow people with anxiety to meet in comfort and safety, and give and receive support. They also provide the opportunity to learn more about anxiety and to develop social networks. PROBLEM: To assess the severity of symptoms of anxiety of the client. METHOD: Demographic details: Name: Ms. S.T Gender: Female Age: 23 years Education: Graduate Materials Required: Paper, Pen, HAM-A questionnaire and answer Sheet Description of the Test: Hamilton Anxiety Rating Scale (HAM-A) was one of the first rating scales developed to measure or rate the severity of anxiety symptoms or severity of patient’s anxiety. HAM-A was originally published by Max Hamilton in 1959. It is widely used in both clinical and research settings. This scale is considered a “clinical rating” of the range of anxiety, and is proposed for individuals that are “already diagnosed with anxiety neurosis". The scale consists of 14 items, each defined by a series of symptoms, and measures both psychic anxiety (mental agitation and psychological distress) and somatic anxiety (physical complaints related to anxiety). Each item is scored on a scale of 0 (not present) to 4 (severe), with a total score range of 0- 56, where <17 indicates mild severity, 18-24 mild to moderate severity and 25-30 moderate to severe. Procedure: The participant was asked to sit comfortably. Rapport was established with the participant. Eye contact was maintained properly and she was cooperative and active. HAM- A questionnaire was given to the participant. She was instructed properly and asked to read each item carefully and respond to all the 14 phrases of the scale by putting a pick against the most suitable option given from 0 to 4. There was no time limit given however, they were
Lindsey Konkel, Anxiety disorders: what is anxiety? Symptoms, causes, diagnosis, treatment and prevention , https://www.everydayhealth.com/anxiety/guide Anxiety disorders , https://www.psychiatry.org/patients-families/anxiety-disorders/what-are- anxiety-disorders Anxiety disorders , https://my.clevelandclinic.org/health/diseases/9536-anxiety-disorders
