The Hamilton Depression Scale

The consistency of the Hamilton Depression Scale (HDS) as a measure of the severity of depressive states has been examined when the scale was used weekly during a trial with imipramine. By use of logistic models (Rasch) the consistency of the HDS has been considered across patient-variables as age, sex, plasma levels of imipramine, and diagnosis. The results showed that the original 17-item HDS was without adequate consistency, i.e. the total score of the sample of items was no one-dimensional measure of depressive states. However, a melancholia subscale of the HDS contained items the total of which can be used to compare patients quantitatively, although in some part of the analysis one of these items showed ceiling effect. It was concluded that the melancholia sub-scale (containing the items depressed mood, guilt, work and interests, retardation, psychic anxiety, and general somatic symptoms) can form the basis for further improvements in the field of quantitative rating scales for depressive states.     

Four-dimensional structure underlying scales for depression anxiety and retardation: emergence of trapped anger and scale improvements

Improvement of rating scales for anxiety and depression has insufficiently been based on their underlying multidimensional structure. The aim of this study was to detect the underlying symptom structure of 3 scales for anxiety, depression, and retardation from the Comprehensive Psychopathological Rating Scale (CPRS), to test its validity, and to investigate whether the scales developed from this structure have lower item overlap than the original scales. All items (N = 21) of the 3 subscales (Brief Anxiety Scale [BAS], Montgomery Asberg Depression Rating Scale [MADRS], and Motivational Inhibition) were selected. Principal components analysis was performed on the scores of 334 outpatients. Correlations between factor-regression scores on the CPRS components and scores on the Mood and Anxiety Symptom Questionnaire dimensions were analyzed. New rating scales based on the CPRS components were developed and compared with the original scales. Four CPRS components were found: depression, retardation, anxiety, and trapped anger. Each had a specific correlational pattern with the Mood and Anxiety Symptom Questionnaire dimensions. Overlap between the 4 new scales was lower than that between the original scales. A 4-dimensional symptom structure underlies CPRS scales for anxiety, depression, and retardation. This structure results in the detection of a scale for trapped anger and improvement of the 3 original scales.     

The Parkinson Anxiety Scale (PAS): Development and validation of a new anxiety scale

Existing anxiety rating scales have limited construct validity in patients with Parkinson's disease (PD). This study was undertaken to develop and validate a new anxiety rating scale, the Parkinson Anxiety Scale (PAS), that would overcome the limitations of existing scales. The general structure of the PAS was based on the outcome of a Delphi procedure. Item selection was based on a canonical correlation analysis and a Rasch analysis of items of the Hamilton Anxiety Rating Scale (HARS) and the Beck Anxiety Inventory (BAI) from a previously published study. Validation was done in a cross‐sectional international multicenter study involving 362 patients with idiopathic PD. Patients underwent a single screening session in which the PAS was administered, along with the Hamilton Depression Rating Scale, the HARS, and the BAI. The Mini International Neuropsychiatric Interview was administered to establish Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses of anxiety and depressive disorders. The PAS is a 12‐item observer or patient‐rated scale with three subscales, for persistent, episodic anxiety and avoidance behavior. Properties for acceptability and reliability met predetermined criteria. The convergent and known groups validity was good. The scale has a satisfactory factorial structure. The area under the receiver operating characteristics curve and Youden index of the PAS are higher than that of existing anxiety rating scales. The PAS is a reliable and valid anxiety measure for use in PD patients. It is easy and brief to administer, and has better clinimetric properties than existing anxiety rating scales. The sensitivity to change of the PAS remains to be assessed. © 2014 International Parkinson and Movement Disorder Society     

Sertraline in generalized anxiety disorder: efficacy in treating the psychic and somatic anxiety factors

OBJECTIVE: The objective was to study the efficacy of sertraline on symptoms of psychic and somatic anxiety in patients suffering from moderate-to-severe generalized anxiety disorder (GAD). METHOD: Out-patients with DSM-IV GAD were randomized to 12 weeks of double-blind treatment with placebo. The psychic and somatic anxiety factors of the Hamilton Anxiety Rating Scale (HAM-A) and the Quality of Life, Enjoyment, and Satisfaction Questionnaire were analyzed. RESULTS: Treatment with sertraline resulted in significantly greater last observation carried forward (LOCF)-endpoint improvement than placebo on both the HAM-A psychic and somatic anxiety factors. At LOCF-endpoint, all items on the HAM-A psychic factor were more improved on sertraline than placebo, as were three of seven items on the somatic factor. Reduction of secondary depressive symptoms was more correlated with endpoint improvement in quality of life than either psychic- or somatic anxiety. CONCLUSION: Sertraline treatment demonstrated efficacy for both the psychic and somatic anxiety symptoms of GAD.     

门诊首发抑郁症临床现象学分析

目的　了解首发抑郁症临床特征。方法　采用自制一般情况调查表、自制抑郁及焦虑症状调查有对符合ICD 10抑郁发作诊断标准的 14 4例门诊首发抑郁症患者进行研究。采用汉密顿抑郁量表 (HAMD2 4)、汉密顿焦虑量表 (HAMA)评定疾病的严重程度 ;采用生活满意度量表 (LSR)、社会功能缺陷筛选量表 (SDSS)、生活事件量表 (LES)评定患者的生活质量和社会功能。结果　 14 4例首发抑郁症患者心境低落出现频率高达 10 0 % ,工作兴趣减少为 95 8% ,思维迟缓为 84 7% -能力减退感为 97 2 % ,早醒为 92 4 % ,睡眠不深为 90 3% ,性欲减退和 /或月经紊乱为 82 6 % ,同时伴有昼重夜轻 ,躯体化症状。男性患者的疑病症状出现频率显著高于女性 (P <0 0 5 ) ;男性患者的性欲减退、绝望感症状出现率高于女性 ;女性患者在自杀意念、精神性焦虑、躯体性焦虑、全身疲乏、晨夜夕轻症状出现频率多于男性 ,但无统计差异。 4 0岁以上患者组比 4 0岁以下组更易表现为睡眠不深、早醒、躯体性焦虑 (P <0 0 5 )。 6 1 1%的患者伴有一定程度的焦虑症状 ;6 0 %的患者伴有躯体化症状。重度抑郁的躯体化症状表现频率显著高于中度患者 (P <0 0 5或P <0 0 1) ,两者社会功能缺陷程度有显著性差异 (P <0 0 1)。结论　首发抑郁症临床以心     

Factorial structure of Hamilton Anxiety Rating Scale

Among subjects suffering from anxiety disorders, mixed anxiety-depression and dysthymia (DSM III R), severity of disease has been assessed in six centres, using the Hamilton Anxiety Rating Scale. Results from two centres have been rejected because of major difference in comparison with the other centres, in which there were no statistically relevant difference. Resting on 90 subjects' rates, the analysis of factorial structure and factor reliability has been conducted with the principal components method and varimax rotation. Four factors have been extracted: somatization, psychic anxiety, somatic anxiety and psychic depression. The rotated factors accounted from 13% to 19% of the total variance (all four--60%). Unlike many previous investigators, we found that psychic factors of depression and anxiety are clearly separated, what must be due to heterogeneity of the group. The factorial structure in case of a homogenic group could be reduced to two factors: somatization and psychic anxiety or depression--depending on cases selection. Results explain the ability of Hamilton Anxiety Rating Scale to assess severity of anxiety as well as depressive state, and point out that the scale is not diagnostic.     

Placebo-controlled trial of sertraline in the treatment of children with generalized anxiety disorder.

OBJECTIVE: The study compared the safety and efficacy of sertraline, a selective serotonin reuptake inhibitor, and placebo in the treatment of generalized anxiety disorder in children and adolescents. METHOD: The study subjects were 22 children and adolescents age 5-17 years who met the DSM-IV criteria for generalized anxiety disorder according to the Anxiety Disorders Interview Schedule for Children-Revised and who had a Hamilton Anxiety Rating Scale score > or = 16. The patients underwent a 2-3-week prestudy evaluation period, followed by a 9-week double-blind treatment phase in which they were randomly assigned in blocks of four to receive either sertraline or pill placebo. The maximum dose of sertraline was 50 mg/day. Primary outcome measures were the Hamilton anxiety scale and the Clinical Global Impression scale. RESULTS: The Hamilton anxiety scale total score, psychic factor, and somatic factor and the Clinical Global Impression severity and improvement scales showed significant differences with treatment in favor of sertraline over placebo beginning at week 4. Self-report measures reflected these results at the end of treatment. CONCLUSIONS: The results of this double-blind, placebo-controlled trial suggest that sertraline at the daily dose of 50 mg is safe and efficacious for the treatment of generalized anxiety disorder in children and adolescents.     

Spanish adaptation and validation of the anxiety scale of the French-language AMDP

The Spanish translation of the 17-item Anxiety Scale extracted from the francophone extension of the AMDP scales, the AMDP-AT, has been filled out in 72 anxious, depressed and other psychiatric patients along with numerous other scales measuring global psychopathology (CGI, AMDP-SY), anxiety (VAS, Hamilton, Zung, Spielberger) and depression (VAS, Hamilton). The results point to a higher correlation with psychic anxiety than with somatic anxiety, and with state anxiety than with trait anxiety. The correlations are lower with depression scales than with anxiety scales but the mean scores in depressed vs. anxious patients do not differ significantly, which indicates that the AMDP-AT, like the HAMA, needs a preselection of anxious patients according to other criteria. The authors also report the results of correlations between AMDP-AT items and the total score, of a principal components analysis and of a stepwise regression.     

Performance of the Hamilton Depression Rating Scale in depressed patients in the United Arab Emirates

Cross-cultural variation in the frequencies and modes of expression of depressive symptoms may influence the validity of depression rating scales. The most widely used instrument for this purpose, namely Hamilton's Depression Rating Scale (HDRS), has not been systematically evaluated in Arab countries. This study evaluates the face validity of the HDRS-21 by studying symptom frequencies, factor structure and symptom clusters in 100 UAE depressed patients. Concurrent validity is tested by comparing total HDRS scores with global estimates of severity made by clinicians, admission status, impairment of social and occupational functioning, and the endogenicity score of the Newcastle (NC) Diagnostic Index. Total HDRS scores show highly significant agreement with three independent measures of severity of depression. Rank orders of the most and least frequent symptoms are consistent with studies of similar design. Marked differences lie in more retardation and somatization and fewer cognitive components in the present study. Principal-component analysis confirmed the heterogeneous structure of the scale, separating a group of core depressive symptoms, and endogenous, somatization, anxiety and psychotic symptom components. The internal consistency (reliability) of the whole scale is moderate, and improves in the core symptom factor. The main conclusion is that the HDRS is sensitive to severity of depression in the UAE culture. However, it measures heterogeneous aspects, and its internal consistency suffers as a result. High levels of retardation and somatization contribute significantly to the total score in socially developing communities.     

Preliminary construction and validation of an anxiety scale derived from the French version of the AMDP, the AMDP-AT

The authors have applied to 493 Belgian and French patients the French version of the AMDP Psychopathology and Somatic scales, made of 140 items from the original German version and of 22 items specific to its French adaptation, among others anxiety items. By applying a principal components factor analysis to this sample, a 17-items. Anxiety Scale was extracted from the 162-items complete scales. This new scale is characterized by a predominence of tension/irritability items over somatic items as compared to the Hamilton Anxiety Scale. On 116 cases, the correlation between both scales is .59 (p less than .0001). A cut-off score for anxiety and an inclusion score for drug trials are suggested on the basis of statistical data.     

Use of the Adinfer diagnostic system in a study of somatic disorders in general practice]

Somatic complaints are very common in general medical practice. They are not identified as psychic disorders and are treated symptomatically. We explore two kind of problems: 1. methodological problems such as the instruments to use to examine somatic complaints (it is evident that a checklist does not give the best results with suggestible patients); and 2. the relationships between somatic complaints and psychic disorders such as anxiety, depression and somatoform disorders. Psychiatric nosology is by no means clear and includes many diagnoses from "hysteria" to "hypochondria" or "psychosomatic", "somatization". In this study, we compare the symptoms collected by general practitioners, and their clinical diagnoses to those obtained by an automatic DSM-III diagnostic program. Adinfer was modified so that three DSM decision trees were systematically scanned: depressive, anxiety and somatoform disorders. This allows for an epidemiological study of somatic complaints and their relationship to depression and anxiety. The subjects' score on rating scales for anxiety and depression are compared with the diagnoses made by the expert system. We discuss the significance of somatic symptoms, the DSM classes and the value of expert systems in epidemiological studies.     

Differential effects of alprazolam and imipramine in generalized anxiety disorder: somatic versus psychic symptoms

Some researchers have recently suggested that antidepressants may be superior to benzodiazepines in the alleviation of generalized anxiety. In a 6-week, double-blind, parallel-design study with flexible dosage scheduling, the authors compared the effects of alprazolam with those of imipramine in 60 patients who had generalized anxiety disorder. On rating scales that contained both psychic and somatic symptoms, patients in both treatment groups improved to a similar degree after 2 weeks. However, alprazolam was more effective in attenuating somatic symptoms, and imipramine was more effective in attenuating psychic symptoms such as dysphoria and negative anticipatory thinking. The authors' results suggest that, in generalized anxiety, somatic symptoms and hyperarousal selectively respond to drugs acting on the gamma-aminobutyric acid system, whereas psychic symptoms respond to treatments affecting the noradrenergic or serotonergic systems.     

A new self-rating scale for depression and anxiety states based on the Comprehensive Psychopathological Rating Scale

Self-assessment scales have long been used in psychiatric research even if their validity has often been questioned, one reason being poor the concordance of expert ratings. In clinical practice the use of rating scales is restricted, since they are considered to be time-consuming and perhaps even to disrupt the clinician's rapport with the patient. In the present study, a self-assessment scale, the CPRS Self-rating Scale for Affective Syndromes (CPRS-S-A), was constructed by re-phrasing in a self-rating format 19 items from the original Comprehensive Psychopathological Rating Scale (CPRS) and covering depression, anxiety and obsessional symptoms. In a group of 30 patients with depression syndromes and anxiety syndromes, the CPRS-S-A and the original CPRS were both used on 2 occasions. The patient's Global Assessment of Functioning scores ranged from 30 to 76 (mean 58), which suggests a moderate severity of illness, as does the fact that the majority were outpatients. There was a high degree of concordance between the instruments for most items and for the scores on the subscales for both diagnostic groups (i.e., the Montgomery-Åsberg Depression Rating Scale and the Brief Anxiety Scale, which are both subscales drawn from the CPRS). The time taken to complete the CPRS-S-A varied from 5 to 30 min (mean 19 min for depressive and 16 min for anxiety patients on the first occasion, 13 min for both groups on the second), and the self-rating procedure was readily accepted by both groups of patients. The CPRS-S-A would thus seem to be a promising instrument for quantitative rating of symptoms in ambulatory patients, both in clinical practice and in research.     

Pooled analysis of venlafaxine XR efficacy on somatic and psychic symptoms of anxiety in patients with generalized anxiety disorder

We evaluated the relative efficacy of venlafaxine XR on the psychic versus somatic symptoms of anxiety in patients with generalized anxiety disorder as determined by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Data were pooled and analyzed from 1,841 patients with generalized anxiety disorder who participated in five short-term (8-week) double-blind, multicenter, placebo-controlled studies, two of which had long-term (6-month) extensions. Somatic and psychic anxieties were studied using the Hamilton rating scale for anxiety (HAM-A) factor scores. We examined response rates (> or =50% improvement over baseline severity score) in the overall population and in patients with mainly somatic symptomatology at baseline (somatizers). Venlafaxine XR significantly reduced factor scores for both psychic and somatic HAM-A factors compared with placebo, from the first and second weeks of treatment, respectively. Patients treated with venlafaxine XR had significantly higher rates of response than patients receiving placebo on the psychic (58% vs. 38%, P<.001 at week 8; 66% vs. 35% at week 24, P<.001) and somatic (56% vs. 43%, P<.001 at week 8; 67% vs. 47% at week 24, P<.001) factors of the HAM-A. There was a TreatmentxFactor interaction (P<.027) in response rates: Patients treated with venlafaxine showed similar somatic and psychic anxiety response rates, whereas placebo-treated patients showed higher somatic compared with psychic response rates. Somatizers showed similar rates of response to the total population for the somatic factor of the HAM-A in either treatment group. Patients with generalized anxiety disorder treated with venlafaxine XR showed similar absolute rates of response on somatic and psychic symptoms, but relative to patients treated with placebo, more improvement in psychic than somatic symptoms.     

Validation of the Depression and Somatic Symptoms Scale by comparison with the Short Form 36 scale among psychiatric outpatients with major depressive disorder

Background: The Depression and Somatic Symptoms Scale (DSSS) is a self‐administered scale developed for monitoring both depression and somatic symptoms. The aims of this study were to establish the criterion‐related validity of the DSSS by testing the correlation between the DSSS and the Short Form 36 (SF‐36) scale and to compare the ability of the DSSS and two other scales in predicting the outcome of the SF‐36. Methods: The study enrolled 135 outpatients with a major depressive episode, 95 of whom received treatment for 1 month. Four scales were administered and evaluated: the DSSS, the SF‐36, the Hospital Anxiety and Depression Scale, and the Hamilton Depression Rating Scale. Pearson correlation was used to test correlations among scales. Multiple linear regressions were used to find the scales most effective in predicting the SF‐36. Results: The three scales were significantly correlated with most of the SF‐36 subscales. The depression and somatic subscales of the DSSS significantly correlated with the mental and physical subscales of the SF‐36, respectively. The DSSS and the Hospital Anxiety and Depression Scale were better able to predict physical and mental subscales of the SF‐36, respectively. The Hamilton Depression Rating Scale had a good ability to predict functional impairment. Conclusions: Psychometric scales with appropriate somatic symptoms might be more compatible with both physical and mental dimensions of the SF‐36. DSSS proved to be a valid scale for monitoring both depression and somatic symptoms in patients with depression. Future studies should test whether the DSSS is better at predicting the treatment and prognosis of depression than conventional scales for depression. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc.     

Predictors of somatic symptoms in depressive disorder

We explored the relative contribution of potential psychological predictors of somatic symptoms in outpatients with major depressive disorder, including; 1) severity of depression; 2) general anxiety; 3) hypochondriacal worry; 4) somatosensory amplification; and, 5) alexithymia by sampling 100 consecutive outpatients with DSM-IV diagnoses of major depressive disorder attending the psychiatry clinics of general hospitals in Turkey. The subjects were rated by clinicians on depressive symptomatology (Hamilton Depression Rating Scale), and anxiety (Hamilton Anxiety Scale), and completed self-report measures of Hypochondriacal worry (7-item version of the Whiteley Index), the Somatosensory Amplification Scale, and the Toronto Alexithymia Scale. Multivariate models tested the independent contribution of each of the scales to the level of somatic symptoms as measured by a modified version of the SCL-90 somatization scale. At the bivariate level, somatic symptoms were associated with female gender and lower educational level, as well as the Hamilton Depression and Anxiety scales, the Whitely Index, and the Somatosensory Amplification and Alexithymia scales. In multiple regression models incorporating all variables, female gender and higher scores on the anxiety, somatosensory amplification and alexithymia scales all made independent contributions to the level of somatic symptoms and accounted for 54% of the variance. Therefore, somatic symptoms in depression are related to concomitant anxiety, tendency to amplify somatic distress, and difficulty identifying and communicating emotional distress. However, these factors do not account for the tendency for women to report more somatic symptoms.     

The factor structure of the Social Interaction Anxiety Scale and the Social Phobia Scale

The Social Interaction Anxiety Scale (SIAS) and the Social Phobia Scale (SPS) are two compendium measures that have become some of the most popular self-report scales of social anxiety. Despite their popularity, it remains unclear whether it is necessary to maintain two separate scales of social anxiety. The primary objective of the present study was to examine the factor analytic structure of both measures to determine the factorial validity of each scale. For this purpose, we administered both scales to 577 patients at the beginning of outpatient treatment. Analyzing both scales simultaneously, a CFA with two correlated factors showed a better fit to the data than a single factor model. An additional EFA with an oblique rotation on all 40 items using the WLSMV estimator further supported the two factor solution. These results suggest that the SIAS and SPS measure similar, but not identical facets of social anxiety. Thus, our findings provide support to retain the SIAS and SPS as two separate scales.     

Anxiety rating scales in Parkinson's disease: Critique and recommendations

Anxiety syndromes are common in patients with Parkinson's disease (PD) with up to 30% suffering from panic disorder, and up to 11% from generalized anxiety disorder (GAD). Anxiety is associated with increased subjective motor symptoms, more severe gait problems, dyskinesias, freezing, and on/off fluctuations. Anxiety has a negative impact on health related quality of life and is strongly associated with depressive syndromes. Since a variety of anxiety scales have been used in PD patients, the Movement Disorder Society commissioned a task force to assess the clinimetric properties of these scales in PD. A systematic review was conducted to identify anxiety scales that have either been validated or used in patients with PD. Six anxiety rating scales were identified. These were the Beck anxiety inventory, the hospital anxiety and depression scale, the Zung self‐rating anxiety scale and anxiety status inventory, the Spielberger state trait anxiety inventory, and the Hamilton anxiety rating scale. In addition, Item 5 (anxiety) of the neuropsychiatric inventory was included in the review. No scales met the criteria to be “recommended,” and all scales were classified as “suggested.” Essential clinimetric information is missing for all scales. Because several scales exist and have been used in PD, the task force recommends further studies of these instruments. If these studies show that the clinimetric properties of existing scales are inadequate, development of a new scale to assess anxiety in PD should be considered. © 2008 Movement Disorder Society     

Difference in symptom profile between generalized anxiety disorder and anxiety secondary to hyperthyroidism

OBJECTIVE: The differential diagnosis between subclinical hyperthyroidism and Generalized Anxiety Disorder (GAD) is often a difficult problem to solve without laboratory examination. The aim of this pilot study was to assess whether there are differences in the symptom profile between these two disorders. METHODS: Fifty patients took part in the study: Twenty-five were hyperthyroid patients, and twenty-five were GAD patients. The diagnosis was based on the TSH values and the DSM-IV criteria, respectively. The Hamilton Anxiety Scale (HAS) and the list of fifty-one symptoms produced by the detailed expansion of HAS items were used to quantify the anxiety symptomatology. The differences in the frequencies between the two diagnostic groups were calculated at each categorical response for every item of both scales. Forward Stepwise Discriminant Function Analysis was performed twice using HAS items and the fifty-one-list items. RESULTS: The symptoms of anxiety in subclinical hyperthyroidism were not identical to those of GAD. Four Hyperthyroid/Anxiety Indices (HAI I-IV) were developed. These indices reach optimum classification of patients (3 of them reach 100% sensitivity and specificity). CONCLUSION: The results of the current study suggest that it is possible to differentiate between GAD and subclinical cases of hyperthyroidism by the careful study of clinical symptomatology. This may be of particular help in isolated areas without laboratory support, but replication of the indices in other samples is indicated.