Hamilton Anxiety Rating Scale (HAM-A) Hamilton Anxiety Rating Scale (HAM-A) Hamilton Anxiety Rating Scale (HAM-A) Patient Name Patient Name First First Last Last Date Bellow is a list of phrases that describe certain feeling that people have. Please select one of the five responses for each of the 14 questions. 0 = Not Present 1 = Mild 2 = Moderate 3 = Severe 4 = Very Severe 1. Anxious Mood 0 1 2 3 4 Worries, anticipation, of the words, fearful anticipation, irritability. 2. Tension 0 1 2 3 4 Feeling of tension, fatiguability, startle response, moved to tears easily, trembling, feelings of restlessness, inability to relax. 3. Fears 0 1 2 3 4 Of dark, of strangers, of being alone, of animals, of trafic, of crowds. 4. Insomnia 0 1 2 3 4 Difficulty in falling to asleep, broken sleep, unsatisfying sleep, and fatigue on walking, dreams, nightmares, night terrors. 5. Intellectual 0 1 2 3 4 Difficulty in concentration, poor memory 6. Depressed Mood 0 1 2 3 4 Loss of interest, lack of pleasure in hobbies, depression, early walking, diurnal swing. 7. Somatic(muscular) 0 1 2 3 4 Pains and aches, twitching, stiffness, myoclonic jerks, grinding of teeth, unsteady voice, increased muscular tone. 8. Somatic(sensory) 0 1 2 3 4 Tinnitus, blurring of vision, hot and cold flashes, feeling of weakness, pricking sensation. 9. Cardiovascular Symptoms 0 1 2 3 4 Tachycardia, palpitations pain in chest, throbbing of vessels, fainting feelings, missing beats. 10. Respiratory Symptoms 0 1 2 3 4 Pressure or constriction in chest, choking feeling, sighing, dyspnea. 11. Gastrointestinal Symptoms 0 1 2 3 4 Difficulty in swallowing, wind abdominal pain, burning sensations, abdominal fullness, nausea, vomiting, borborygmi, looseness of bowels, loss of weight, constipation. 12. Genitourinary Symptoms 0 1 2 3 4 Frequency of micturition, urgency of micturition, amenorrhea, menorrhagia, development of frigidity, premature ejaculation, loss of libido, impotence. 13. Autonomic Symptoms 0 1 2 3 4 Dry mouth, flushing, pallor, tendency to sweat, giddiness, tension, headache, raising of hair. 14. Behavior at Interview 0 1 2 3 4 Fidgeting, restlessness or pacing, tremor of hands, furrowed brow, strained face, sighing or rapid respiration, facial pallor, swallowing, etc. Ranking — 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 17 None to Mild Severity — 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 18-24 Mild to Moderate Severity — 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 25-30 Moderate to Severe Severity — 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 31-56 Severe Severity Submit If you are human, leave this field blank. Reference: Hamilton M.The assessment of anxiety states by rating. Br J Med Psychol 1959; 32:50–55.