Name
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First Name
Last Name
HAM-A Score:
HAM-A
Below is a list of statements that describe feelings and physical symptoms people may experience. For each item, please select the option that best describes how much you have experienced each symptom over the past week, including today. Choose one response for each item.
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Rows
Mild
Moderate
Severe
Very Severe
1. Anxious Mood – Worries, anticipation of the worst, fearful anticipation, irritability.
2. Tension – Feelings of tension, fatigability, startle response, moved to tears easily, trembling, feelings of restlessness, inability to relax.
3. Fears – Of dark, of strangers, of being left alone, of animals, of traffic, of crowds.
4. Insomnia – Difficulty in falling asleep, broken sleep, unsatisfying sleep and fatigue on waking, dreams, nightmares, night terrors.
5. Intellectual (Cognitive) – Difficulty in concentration, poor memory.
6. Depressed Mood – Loss of interest, lack of pleasure in hobbies, depression, early waking, diurnal variation.
7. Somatic (Muscular) – Pains and aches, twitching, stiffness, myoclonic jerks, grinding of teeth, unsteady voice, increased muscular tone.
8. Somatic (Sensory) – Tinnitus, blurring of vision, hot and cold flushes, feelings of weakness, pricking sensation.
9. Cardiovascular Symptoms – Tachycardia, palpitations, pain in chest, throbbing of vessels, fainting feelings, missing beat.
10. Respiratory Symptoms – Pressure or constriction in chest, choking feelings, sighing, dyspnea.
11. Gastrointestinal Symptoms – Difficulty in swallowing, wind abdominal pain, burning sensations, abdominal fullness, nausea, vomiting, borborygmi, looseness of bowels, loss of weight, constipation.
12. Genitourinary Symptoms – Frequency of micturition, urgency of micturition, amenorrhea, menorrhagia, development of frigidity, premature ejaculation, loss of libido, impotence.
13. Autonomic Symptoms – Dry mouth, flushing, pallor, tendency to sweat, giddiness, tension headache, raising of hair.
14. Behavior at Interview – Fidgeting, restlessness or pacing, tremor of hands, furrowed brow, strained face, sighing or rapid respiration, facial pallor, swallowing, etc.
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