PRACTICAL - 2

on

Clinical rating scale: Ham-A for patient

suffering from anxiety disorder

Sonal Kumari
MSc. (Clinical Psy) 2nd
Semester 2020-2022

Reg. #201909013
 Practical 1
Title: - Clinical rating scale: Ham-A for patient suffering from anxiety disorder.
Aim: To identify the severity of the symptoms of the patient with anxiety disorder.

Introduction:-
Anxiety is a common and normal occurrence. However, a chronic, high level of anxiety indicates
an anxiety disorder.
Common Anxiety Disorders
Some of the more common anxiety disorders include:
Generalized Anxiety Disorder: A person with generalized anxiety disorder experiences
persistent and excessive anxiety or worry that lasts at least six months.
Specific Phobia: A person who has specific phobia experiences intense anxiety when exposed to
a particular object or situation. The person often avoids the feared object or situation because of
a desire to escape the anxiety associated with it.
Social Phobia: A person who has social phobia experiences intense anxiety when exposed to
certain kinds of social or performance situations. As a result, the person often avoids these types
of situations.
Panic Disorder and Agoraphobia: A person with panic disorder experiences recurrent,
unexpected panic attacks, which cause worry or anxiety. During a panic attack, a person has
symptoms such as heart palpitations, sweating, trembling, dizziness, chest pain, and fear of
losing control, going crazy, or dying. Panic disorder can occur with or without agoraphobia.
Agoraphobia involves anxiety about losing control in public places, being in situations from
which escape would be difficult or embarrassing, or being in places where there might be no one
to help if a panic attack occurred.
Obsessive-compulsive Disorder: A person with obsessive-compulsive disorder experiences
obsessions, compulsions, or both. Obsessions are ideas, thoughts, impulses, or images that are
persistent and cause anxiety or distress. A person usually feels that the obsessions are
inappropriate but uncontrollable. Compulsions are repetitive behaviors that help to prevent or
relieve anxiety.
Post–traumatic Stress Disorder (PTSD): A person with this disorder persistently re-
experiences a highly traumatic event and avoids stimuli associated with the trauma. Symptoms
include increased arousal such as insomnia, irritability, difficulty concentrating, hyper vigilance,
or exaggerated startle response.
Roots of Anxiety Disorders
Many different interactive factors influence the development of anxiety disorders.
Biological Factors
Many biological factors can contribute to the onset of anxiety disorders:

Genetic predisposition: Twin studies suggest that there may be genetic predispositions to
anxiety disorders. Researchers typically use concordance rates to describe the likelihood that a
disorder might be inherited. A concordance rate indicates the percentage of twin pairs who share
a particular disorder. Research has shown that identical twins have a higher concordance rate for
anxiety disorders than fraternal twins.

Differing sensitivity: Some research suggests that people differ in sensitivity to anxiety. People
who are highly sensitive to the physiological symptoms of anxiety react with even more anxiety
to these symptoms, which sets off a worsening spiral of anxiety that can result in an anxiety
disorder.

Neurotransmitters: Researchers believe there is a link between anxiety disorders and

disturbances in neural circuits that use the neurotransmitters GABA and serotonin. GABA limits
nerve cell activity in the part of the brain associated with anxiety. People who do not produce
enough GABA or whose brains do not process it normally may feel increased anxiety. Inefficient
processing of serotonin may also contribute to anxiety.

Brain damage: Some researchers have suggested that damage to the hippocampus can
contribute to PTSD symptoms.

SSRIs and Anxiety Disorders

Selective serotonin reuptake inhibitors (SSRIs) are a class of drug commonly used to treat
anxiety disorders. They raise the level of serotonin in the brain by preventing it from being
reabsorbed back into cells that released it. Serotonin is a neurotransmitter that affects sleep,
alertness, appetite, and other functions. Abnormal levels of serotonin can lead to mood disorders.
Conditioning and Learning
Research shows that conditioning and learning also play a role in anxiety disorders:

Classical conditioning: People can acquire anxiety responses, especially phobias, through
classical conditioning and then maintain them through operant conditioning. A neutral stimulus
becomes associated with anxiety by being paired with an anxiety-producing stimulus. After this
classical conditioning process has occurred, a person may begin to avoid the conditioned
anxiety-producing stimulus. This leads to a decrease in anxiety, which reinforces the avoidance
through an operant conditioning process. For example, a near drowning experience might
produce a phobia of water. Avoiding oceans, pools, and ponds decreases anxiety about water and
reinforces the behavior of avoidance.

Evolutionary predisposition: Researchers such as Martin Seligman have proposed that people
may be more likely to develop conditioned fears to certain objects and situations. According to
this view, evolutionary history biologically prepares people to develop phobias about ancient
dangers, such as snakes and heights.
Observational learning: People also may develop phobias through observational learning. For
example, children may learn to be afraid of certain objects or situations by observing their
parents’ behavior in the face of those objects or Situations.

Cognitive Factors
Some researchers have suggested that people with certain styles of thinking are more susceptible
to anxiety disorders than others. Such people have increased susceptibility for several reasons:
 They tend to see threats in harmless situations.
 They focus too much attention on situations that they perceive to be threatening.
 They tend to recall threatening information better than nonthreatening information.

Personality Traits
The personality trait of neuroticism is associated with a higher likelihood of having an anxiety
disorder.
• The State-Trait Anxiety Inventory (STAI)
• Beck Anxiety Inventory (BAI)
 • Hospital Anxiety And Depression Scale-Anxiety (HADS)
• Zung Self-Rating Anxiety Scale
• Hamilton Anxiety Scale (HAM-A)
• Social Phobia Inventory (SPIN)
• Generalized Anxiety Disorder Scale
• Yale-Brown Obsessive-Compulsive Scale (YBOCS)

HAM-A
The HAM-A was one of the first rating scales developed to measure the severity of anxiety
symptoms, and is still widely used today in both clinical and research settings. 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). Although the HAM-A remains widely used as an outcome measure in clinical trials, it
has been criticized for its sometimes poor ability to discriminate between anxiolytic and
antidepressant effects, and somatic anxiety versus somatic side
effects. The HAM-A does not provide any standardized probe questions. Despite this, the
reported levels of inter-rater reliability for the scale appear to be acceptable.

METHODOLOGY:
AIM: To identify the severity of the symptoms of the patient.

PARTICIPANT DETAILS:
Name - XYZ
Age- 24
Gender- Female
Qualification- Graduate
Place- SGT University

Time- 12:30 P.M.

Material required:
HAM-A SCALE, PEN, NOTEBOOK
PRECAUTIONS:
1. Responses should be marked on basis of recent information.
2. Subjectivity should be avoided.
3. Symptoms should be marked on basis of diagnostic criteria or the significant period.
4. A clear distinction should be made between normal anxiety and anxiety disorder
symptoms w.r.t. individual.

PROCEDURE:
We provided a calm and composed atmosphere to the patient. We build a good rapport. We
started the conversation with patient and during the conversation whatever information we got
according to that, we marked the HAM-A clinician rating scale.

RESULT:
Anxious mood 1
TENSION 1
FEARS 0
INSOMNIA 1
INTELLECTUAL 0
DEPRESSED MOOD 1
SOMATIC (MUSCULAR) 0
SOMATIC ( SENSORY) 0
CARDIOVASCULAR
0
SYMPTOMS
RESPIRATORY SYMPTOMS 0
GASTROINTESTINAL
0
SYMPTOMS
GENITOURINARY
0
SYMPTOMS
AUTONOMIC SYMPTOMS 0
BEHAVIOUR AT INTERVIEW 0

The patient score on HAM-A scale was - 2. Since, it is less than 17, she has mild severity.

DISCUSSION:
She has scored very low in the result. Although the client experiences anxiety sometimes, the
level is not clinically significant to diagnose anxiety disorder.
REFERENCES:

Borkovec T and Costello E. Efficacy of applied relaxation and cognitive behavioral therapy in
the treatment of generalized anxiety disorder. J Clin Consult Psychol 1993; 61(4):611–19

Maier W, Buller R, Philipp M, Heuser I. The Hamilton Anxiety Scale: reliability, validity and
sensitivity to change in anxiety and depressive disorders. J Affect Disord 1988;14(1):61–8.