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. 0 = Not Present 1 = Mild 2 = Moderate 3 = Severe 4 = Very Severe 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. 121234567891011 : 0030 AMPM time If you are human, leave this field blank. Submit Reference: Hamilton M.The assessment of anxiety states by rating. Br J Med Psychol 1959; 32:50–55.