Hamilton scale

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The Hamilton scale (HAMD or HAM-D) (abbreviation for Hamilton rating scale for depression , HRSD, HDRS, HDS for short) is a diagnostic tool for determining the severity of a depressive disorder .

The Hamilton scale, a so-called clinical external assessment scale, was introduced by Max Hamilton in 1960 and originally consisted of 17 questions (HDRS 17 ). Other versions contain 21 (HDRS 21 ) or 24 questions (HDRS 24 ). Since there may be ambiguities due to different versions, the respective version used should be specified.

The examiner (not the patient himself, therefore “external assessment”) should assess how severe a particular symptom is on a scale of 0 to 4 or 0 to 2. Examples are guilt, different types of sleep disorders , hypochondria, or suicidal ideation .

Severity classification based on the values

The classification of the degree of severity on the basis of the values ​​varies, of course, depending on which version of the Hamilton scale is used. Due to the different number of questions, different values ​​can be achieved.

As a result, for example, with the HDRS 21 with 21 questions a numerical value between 0 and 66 is obtained, with the more frequently used HDRS 17 with 17 questions a numerical value between 0 and 51. There is no standardized cut-off value; Different thresholds for mild, moderate and severe depression were set in different studies.

The S3 guideline / NVL "Unipolar Depression" gives the following cut-off values for the HDRS 17 scale with 17 items :

  •  0 - 8 points: no depression or clinically normal or remitted;
  •  9 - 16 points: mild depression;
  • 17 - 24 points: Moderate depression;
  •       ≥ 25 points: severe depression.

However, making a diagnosis of depression based on the cut-off value is not recommended because the HDRS is primarily designed to be change-sensitive and is therefore more suitable for measuring changes over the course of the disease. In clinical trials of depression, the HDRS is the most widely used scale.

Processing time

The duration of the examination, including the evaluation, is less than 15 minutes.

criticism

It is criticized that three questions relate to sleep behavior and the test therefore shows an improvement in sleep disorders compared to other areas. Therefore, the impression arises that sedating drugs lead to a greater improvement than activating drugs. Cognitive and psychomotor symptoms are also comparatively underrepresented. Because of the different weighting of different symptom areas, very different symptoms can be present despite the same value.

The Hamilton scale is an uneconomical scale because it can be reduced to 5 to 6 questions without any noticeable loss of test quality criteria (reliability and validity).

See also

Web links

Individual evidence

  1. ↑ a b c Behavioral Health Disability: Innovations in Prevention and Management . Springer Science & Business Media, 2010, ISBN 978-0-387-09814-2 , pp. 133 ( limited preview in Google Book search).
  2. ↑ a b c d e f g h i Handbook of Bipolar Disorders: Basics - Diagnostics - Therapy . W. Kohlhammer Verlag, 2006, ISBN 978-3-17-018450-3 , pp. 78 ( limited preview in Google Book search).
  3. ↑ Current Psychiatric Diagnostics: A Guide for Daily Work with ICD and DSM . Thieme, 2015, ISBN 978-3-13-200531-0 , pp. 32 ( limited preview in Google Book search).
  4. ^ Diagnosis and classification in psychiatry . W. Kohlhammer Verlag, 2008, ISBN 978-3-17-018944-7 , pp. 71 ( limited preview in Google Book search).
  5. ^ M. Hamilton: A rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23: 56-62
  6. ↑ S3 Guideline / National Care Guideline - Unipolar Depression - Long Version; 04/2011. Archive link ( memento of the original from October 9, 2015 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.awmf.org
  7. ↑ Reliability and validity of subtyping and measurement of the severity of depressive syndromes . Springer-Verlag, 2013, ISBN 978-3-642-84651-9 , Sp. 169 ( limited preview in Google Book search).