Is the Hamilton Rating Scale for Anxiety (HAM-A) a standardized rating scale for establishing and monitoring a patient's diagnosis of anxiety over time?

Answer: False

The Hamilton Rating Scale for Anxiety (HAM-A) is a clinician-rated assessment tool for measuring anxiety symptom severity, but it is not a standardized diagnostic instrument for establishing anxiety disorder diagnoses. The HAM-A measures symptom severity and can monitor treatment response over time, but diagnosis requires structured diagnostic interviews that assess DSM criteria 1.

Key Distinctions

What HAM-A Actually Measures

• The HAM-A is a severity rating scale that quantifies anxiety symptoms across somatic and psychic domains 1
• It functions similarly to other clinician-rated scales that assess symptom intensity rather than diagnostic criteria 1
• The scale can detect treatment-related changes in anxiety severity and is sensitive to therapeutic interventions 1

What Is Required for Diagnosis

• Structured diagnostic interviews (such as the ADIS or K-SADS) are the gold standard for establishing anxiety disorder diagnoses, as they systematically assess DSM criteria 1
• Diagnoses require assessment of specific symptom clusters, duration criteria (typically 6 months for GAD), and functional impairment 2
• Clinician Severity Ratings (CSRs) derived from diagnostic interviews provide both diagnostic determination and severity assessment 1

Appropriate Screening and Monitoring Tools

• The GAD-7 is the validated screening instrument for anxiety disorders in primary care, with sensitivity of 57.6%-93.9% and specificity of 61%-97% 3, 4
• The GAD-7 stratifies severity: 0-4 (minimal), 5-9 (mild), 10-14 (moderate), 15-21 (severe) 5, 2
• Multidimensional anxiety measures that cover multiple anxiety disorder domains are recommended for treatment trials, providing both total anxiety scores and disorder-specific subscales 1

Clinical Implications

For establishing diagnoses: Use structured diagnostic interviews that assess DSM criteria, not symptom severity scales alone 1

For monitoring treatment: The HAM-A can be used alongside other measures to track symptom changes, but should not be the sole outcome measure 1

For screening in primary care: The GAD-7 (or even the 2-item GAD-2) provides efficient, validated screening with good operating characteristics across anxiety disorder subtypes 4